强化牛奶对缓解亚洲女性绝经后骨质疏松作用的Meta分析

Calcium and vitamin D-enriched milk has limited impact on osteoporosis in Asian postmenopausal women: a meta-analysis

目的探究强化牛奶(向普通牛奶中增加钙及维生素D的含量)对亚洲妇女绝经后骨质疏松的作用。方法随机对照研究的Meta分析。按纳入和排除标准系统检索自建库至2019年6月PubMed、Embase、Web of Science和Cochrane Central database强化牛奶对亚洲妇女绝经后骨密度、骨代谢的文献。采用Cochrane推荐风险偏倚评估工具评价量表评价文献质量。采用Revman 5.3软件进行Meta分析。结果共纳入5项随机对照研究,包含594例研究对象。与对照组相比,强化奶可明显降低绝经后亚洲妇女的血CTX(carboxy-terminal collagen cross-links)、P1NP(procollagen amino-terminal propeptide type 1)、PTH(parathyroid hormone)的浓度(CTX:MD=-0.13,95%CI=-0.22^-0.04,P=0.006;P1NP:MD=-6.84,95%CI=-11.66^-2.01,P=0.005;PTH:MD=-0.67,95%CI=-1.14^-0.19,P=0.006),提升血维生素D的浓度(MD=12.23,95%CI=7.95~16.52,P<0.00001),而两组在血OC(osteocalcin)、钙、镁、磷浓度、快速血糖及血总胆固醇方面差异并无统计学意义(OC:MD=-3.82,95%CI=-12.99~5.34,P=0.41;钙:MD=-0.02,95%CI=-0.06~0.02,P=0.31;镁:MD=0.03,95%CI=-0.01~0.07,P=0.16;磷:MD=-0.02,95%CI=-0.06~0.02,P=0.23;快速血糖:MD=-0.01,95%CI=-0.14~0.13,P=0.92;血总胆固醇:MD=-0.20,95%CI=-0.42~0.02,P=0.07)。结论强化奶可以在微观上抑制绝经后亚洲妇女骨质疏松的进展,降低骨转化标志物及PTH的浓度,提升血维生素D的浓度,然而,相较于普通牛奶来说,强化牛奶在微观上的优势不甚明显,两者对骨质疏松的进展影响差异不大。

Objective To explore the impact of Calcium and vitamin D-enriched milk on osteoporosis in Asian postmenopausal women.Methods This was a meta-analysis of randomized controlled trials.Databases of PubMed,Embase,Web of Science,and Cochrane Central database were searched systematically according to the inclusion and exclusion criteria.The literatures about the effect of calcium and vitamin D-enriched milk on osteoporosis in postmenopausal women before June,2019 were identified.The quality of the literature was evaluated by the risk assessment tool recommended by the Cochrane.Meta-analysis was conducted by RevMan 5.3 software.Results Totally 5 randomized controlled trials including 594 subjects were entered in meta-analysis.Compared with the control group,calcium and vitamin D-enriched milk could significantly reduce the serum carboxy-terminal collagen cross-links(CTX),procollagen amino-terminal propeptide type 1(P1NP),and parathyroid hormone(PTH)levels(CTX:MD=-0.13,95%CI=-0.22 to-0.04,P=0.006;P1NP:MD=-6.84,95%CI=-11.66 to-2.01,P=0.005;PTH:MD=-0.67,95%CI=-1.14 to-0.19,P=0.006),and increase serum vitamin D levels(MD=12.23,95%CI=7.95 to 16.52,P<0.00001)in Asian postmenopausal women.There was no significant difference in serum osteocalcin(OC),calcium,magnesium,phosphorus levels,rapid blood glucose and total cholesterol between the two groups(OC:MD=-3.82,95%CI=-12.99 to 5.34,P=0.41;calcium:MD=-0.02,95%CI=-0.06 to 0.02,P=0.31;magnesium:MD=0.03,95%CI=-0.01 to 0.07,P=0.16;phosphorus:MD=-0.02,95%CI=-0.06 to 0.02,P=0.23;rapid blood glucose:MD=-0.01,95%CI=-0.14 to 0.13,P=0.92;total cholesterol:MD=-0.20,95%CI=-0.42 to 0.02,P=0.07).Conclusion Calcium and vitamin D-enriched milk can microscopically inhibit the progress of osteoporosis in Asian postmenopausal women,decrease serum bone turnover markers and PTH levels,and increase serum vitamin D levels.In addition,compared with ordinary milk,the microcosmic advantage of calcium and vitamin D-enriched milk is not obvious,and there is little difference in the effect of calcium and vitamin D-enriched milk on the progress of osteoporosis.