H_2受体拮抗剂对髋部骨折风险影响的Meta分析

Histamine H_2-receptor Antagonists Therapy and Risk of Hip Fracture:A Meta-analysis

目的采用Meta分析方法评价H_2受体拮抗剂(histamine H_2-receptor antagonists,H_2RA)对髋部骨折风险的影响。方法计算机检索CNKI、Pub Med和EMbase数据库,搜集H_2RA使用与髋部骨折风险的观察性研究,检索时限均从1997年至2016年9月19日。由2位评价员独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用Stata 13软件进行Meta分析。结果共纳入11个研究,包括206 276例患者。Meta分析结果显示,H_2RA使用组发生髋部骨折的风险是非使用组的1.12倍[OR=1.12,95%CI(1.02,1.24),P=0.022]。亚组分析结果显示,H_2RA连续服药组发生髋部骨折的风险高于非使用组[OR=1.11,95%CI(1.01,1.24),P=0.039],而H_2RA不连续服药组髋部骨折风险与非使用组相比无显著性差异。结论 H_2RA的应用可能会增加髋部骨折风险,对于不连续服药患者,停药30天以上可能逆转该效应,但本研究未发现时间-效应关系和剂量-效应关系,鉴于此次研究的局限性,未来需要设计更加严谨的临床试验进一步证实。

Objective To evaluate the association between H2RA and the risk of hip fracture by performing a meta- analysis. Methods We searched CNKI, PubMed and EMbase from inception to September 19th 2016, to collect case- control studies or cohort studies reporting the risk of hip fracture with H2RA. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then meta-analysis was performed using Stata 13 software. Results Eleven studies involving 206 276 hip fracture cases were included. The result ofmeta-analysis showed that patients receiving H2RA therapy had approximately 1.12 times the risk of developing hip fracture compared with nonusers （OR=1.12 95%CI 1.02 to 1.24, P=0.022）. Subgroup analyses by interval time indicated that the risk appeared greater with the continuous users （OR=1.11, 95%CI 1.01 to 1.24, P=0.039） whereas the discontinuous users was not significantly associated with hip fracture risk. Conclusion H：RA therapy may be associated with an increased risk of hip fracture. For patients with intermittent medication, the side effect may disappear by discontinuation of PPI use for at least 30 days, but the study did not find time-effect relationship or dose-effect relationship. Considering the limitations of this study, more rigorous clinical trials evaluating the potential side-effect of H2RA are needed.