系统评价温针灸防治绝经后骨质疏松的临床疗效及对骨代谢的影响

Systematic Review for Clinical Effect and Bone Metabolic of Warm Needle Moxibustion in Treatment of Postmenopausal Osteoporosis

目的：系统评价和Meta分析温针灸对比钙片防治绝经后骨质疏松患者的总有效率及骨代谢水平。方法：收集2016年6月以前CNKI、CBM、维普、万方、Pubmed等数据库中温针灸对比钙片治疗绝经后骨质疏松的临床试验资料,用Cochrane系统评价的方法对文章的各种偏倚进行评估,利用Rev Man 5.3软件对多个研究结果的总体效应进行Meta分析。结果：共纳入4篇RCTs文献,Meta分析结果示：温针灸相对于口服钙片而言,总有效率高2.65倍：OR=3.65,95%Cl[1.39,9.54]（P〈0.01）;骨密度水平[WMD=0.07,95%Cl（0.04,0.10）]和雌激素水平[WMD=7.82,95%Cl（2.09,13.54）]较高（P〈0.01）;同时,骨钙素水平[WMD=-4.58,95%Cl（-7.11,-2.05）]和Ca/Cr水平[WMD=-0.23,95%Cl（-0.33,-0.12）]较低（P〈0.01）。结论：温针灸可提高绝经后骨质疏松患者的骨密度及临床总有效率,可能与提高雌激素水平,抑制Ca/Cr水平,减缓骨钙素增幅有关。

Objective： To evaluate the total effective rate and bone metabolic results of warm needle moxibustion in treating patients with postmenopausal osteoporosis： a systematic review and Meta-analysis. Methods： A systematic search of all trials related to the effects of warm needle moxibustion for postmenopausal osteoporosis in the CNKI,CBM,VIP,Wanfang and Pub Med（ June2016 ago）. The quality of trials were assessed using cochrane systematic review. Multiple overall effect of the results of the study used Neta analysis with the Rev Man 5. 3 software. Results： A total of 4 articles were included. Compared with calcium tablet,warm needle moxibustion in treatment of postmenopausal osteoporosis had significant higher total effective rate[OR = 3. 65,95% Cl（ 1.39,9. 54）,P〈0. 01],higher bone density [WMD = 0. 07,95% Cl（ 0. 04,0. 10）,P〈0. 01] and estrogen level [WMD = 7. 82,95% Cl（ 2. 09,13. 54）,P〈0. 01]. At the same time,its had significantly lower oseocalcin（ Ca/Cr） [WMD =-4. 58,95% Cl（-7. 11,-2. 05）,P〈0. 01] and urine calcium/creatinine[WMD =-0. 23,95% Cl（-0. 33,-0. 12）,P〈0. 01]. Conclusion： Warm needle moxibustion could improve the bone density and total effective rate of patients with postmenopausal osteoporosis. The potential mechanism is that warm needle moxibustion could improve estrogen level,inhibit the Ca/Cr and lower osteocalcin.