补肾中药治疗绝经后骨质疏松症有效性和安全性:系统评价和Meta分析

Efficacy and safety of Chinese medicine for Tonifying kidney in the treatment of postmenopausal osteoporosis: a systematic review and meta-analysis

目的系统评价补肾中药治疗绝经后骨质疏松症有效性和安全性。方法通过电子检索中、英文6个数据库(包括Medline、Embase、PubMed、CNKI、万方、VIP),检索范围自建库至2019年5月。按照统一纳入和排除标准,进行文献筛选、质量评价,并运用RevMan 5.3软件对所纳入随机对照试验(randomized controlled trial,RCT)进行Meta分析。结果检索到的2038篇文献经筛选后,最终纳入28个RCT,包含患者2687例。Meta分析结果显示:在改善疼痛评分方面,单用补肾中药较常规治疗效果更明显[MD=-1.71,95%CI:-2.24^-1.18,P<0.001];补肾中药联合常规治疗在改善疼痛评分时,同样优于单一常规治疗[MD=-1.15,95%CI:-1.79^-0.52,P<0.001];在提高腰椎及髋部骨密度方面,单用补肾中药治疗效果显著较常规治疗更好[MD=0.04,95%CI:0.02~0.05,P<0.001];补肾中药联合常规治疗在提高腰椎及髋部骨密度上,治疗效果可能较常规治疗更好[MD=0.10,95%CI:0.07~0.14,P<0.001]。结论运用补肾中药治疗绝经后骨质疏松症,无论单用或与常规治疗合用,在改善疼痛、提高骨密度方面治疗效果均优于单一常规治疗,效果较明显,适用于临床治疗采纳运用。然而本研究所纳入文献质量较低,治疗效果证据有限,亟需更多大样本、多中心、高质量临床随机对照研究以佐证补肾中药治疗绝经后骨质疏松症的安全性和有效性。

Objective To systematically evaluate the efficacy and safety of Chinese medicine for Tonifying kidney in the treatment of postmenopausal osteoporosis.Methods Six databases(including Medline,Embase,PubMed,CNKI,Wanfang,VIP)were searched by electronic retrieval,and the retrieval scope was self-established until May 2019.According to the unified inclusion and exclusion criteria,we preliminary conduded screening the collected and quality evaluation,and the random control trial(RCT)was analyzed by RevMan 5.3 software.Results After screening 2038 articles,28 RCTs were included,including 2687 patients.Meta-analysis showed that in improving pain score,the effects of kidney-tonifying traditional Chinese medicine alone was more obvious than those of routine treatment(MD=-1.71,95%CI:-2.24-1.18,P<0.001);the effect of kidney-tonifying traditional Chinese medicine combined with routine treatment was also better than that of single routine treatment(MD=-1.15,95%CI:-1.79--0.52,P<0.001).In terms of improving bone mineral density at lumbar spine and hip,the effects of kidney-tonifying Chinese herbs alone were significantly better than those of conventional therapy(MD=0.04,95%CI:0.02-0.05,P<0.001);the effects of kidney-tonifying Chinese herbs combined with conventional therapy on improving bone mineral density at lumbar spine and hip might be better than those of conventional therapy(MD=0.10,95%CI:0.07~0.14,P<0.001).Conclusions Chinese medicine for Tonifying kidney is superior to improve pain and bone mineral density in the treatment of postmenopausal osteoporosis,whether it is used alone or in combination with conventional therapy,and the effect is obvious.It is suitable for clinical treatment.However,the quality of the included literature is low and the evidence of curative effect is limited.Therefore,larger samples,multi-centers and high-quality randomized controlled trials to confirm the safety and effectiveness of Chinese medicine for Tonifying kidney in the treatment of postmenopausal osteoporosis are urgently needed.