补肾活血法治疗绝经后骨质疏松症的Meta分析

Meta-analysis of the treatment of tonifying liver-kidney decoction in postmenopausal osteoporosis

目的系统评估补益肝肾方治疗绝经后骨质疏松症(postmenopausal osteoporosis,PMOP)的有效性和安全性,为临床治疗提供参考依据。方法计算机检索中国知网、万方数据库、维普中文科技期刊数据库、Medline、PubMed、Web of Science、Ovid,检索时限截至2018年5月。纳入补益肝肾方(试验组)对比其他方式(西药及非补益肝肾方,对照组)治疗PMOP的临床随机对照试验,使用Jadad评定量表提取数据并对相关数据进行评分,采用国际Cochrane协作网提供的Rev Man5. 3统计软件进行Meta分析。结果共纳入19项随机对照试验,合计1 480例患者。Meta分析显示,试验组在改善腰椎骨密度水平[MD=0. 20,95%CI(-0. 16,0. 56),P=0. 28]、雌二醇水平[MD=9. 53,95%CI (-2. 71,21. 78),P=0. 13]以及血清钙水平[MD=0. 07,95%CI(-0. 05,0. 19),P=0. 23]与对照组相比无明显差异;试验组在改善疼痛[MD=-0. 92,95%CI(-1. 03,-0. 82),P<0. 01]、骨钙素水平[MD=3. 49,95%CI(2. 04,4. 93),P<0. 01]以及临床疗效[OR=2. 47,95%CI(1. 35,4. 50),P=0. 003]方面优于对照组。补益肝肾方配合西药在改善临床疗效[OR=4. 47,95%CI(3. 09,6. 44),P<0. 01]、腰椎骨密度[MD=0. 10,95%CI(0. 06,0. 15),P<0. 01]、骨钙素[MD=1. 51,95%CI(0. 77,2. 24),P<0. 01]以及E2水平[MD=6. 57,95%CI(1. 97,11. 23),P=0. 006]等方面疗效优于西药组或非补益肝肾方组。结论补益肝肾方能有效治疗PMOP,并可与西药协同增效,促进机体骨质生成,降低骨质吸收,从而缓解临床症状,但因纳入文献质与量的限制,更深入的研究有待进行。

Objective To systematically evaluate the efficacy and safety of tonifying liver-kidney decoction in the treatment of postmenopausal osteoporosis(PMOP),providing a reference for clinical practice. Methods CNKI,Wanfang Database,VIP,Medline,PubMed,Web of Science,and Ovid were searched. The search deadline was May 2018. The clinical randomized controlled trial of treatment of postmenopausal osteoporosis with tonifying liver-kidney decoction(experimental group) was compared with other method(Western medicine and non-tonifying liver-kidney decoction group,as control group). Data were extracted and scored with the modified Jadad rating scale for quality assessment. Meta-analysis was performed using the Rev Man 5. 3 statistical software provided by International Cochrane Collaboration Network. Results A total of 19 RCTs were included,including 1 480 patients. Meta-analysis showed that there was no significant difference in bone mineral density [MD = 0. 20,95% CI(-0. 16,0. 56),P = 0. 28],estradiol level [MD = 9. 53,95% CI(-2. 71,21. 78),P = 0. 13],and serum calcium [MD = 0. 07,95% CI(-0. 05,0. 19),P = 0. 23]levels between the experimental group and the control group. The pain was relieved [MD =-0. 92,95% CI(-1. 03,-0. 82),P <0. 01],and osteocalcin level [MD = 3. 49,95% CI(2. 04,4. 93),P<0. 01]and the clinical efficacy [OR = 2. 47,95% CI(1. 35,4. 50),P = 0. 003]in the experimental group were better than those in the control group. The effect of tonifying liver-kidney decoction combined with Western medicine was better than Western medicine or non-tonifying liver-kidney decoction alone in improving clinical efficacy [OR = 4. 47,95% CI(3. 09,6. 44),P<0. 01],BMD of the lumbar spine [MD = 0. 10,95% CI(0. 06,0. 15),P<0. 01],BGP [MD = 1. 51,95% CI(0. 77,2. 24),P < 0. 01 ],and E2 levels [MD = 6. 57,95% CI(1. 97,11. 23),P = 0. 006].Conclusion Tonifying liver-kidney decoction effectively treats postmenopausal osteoporosis,synergizes with Western medicine,promotes bone formation,inhibits bone resorption,and relieves clinical symptoms. However,due to the limit of the quality and quantity of the literatures,further study is needed.