补肾健脾活血法治疗中老年原发性骨质疏松症Meta分析

Meta-analysis of invigorating kidney,invigorating spleen and promoting blood circulation principle in the treatment of middle-aged and elderly primary osteoporosis

目的系统评估补肾健脾活血法治疗中老年原发性骨质疏松症(primary osteoporosis,POP)的有效性,进一步为临床提供循证参考。方法检索中国知网、万方数据库、维普中文科技期刊数据库、Medline、PubMed、Springer、PHMC、Cochrane Library,收集运用具有补肾健脾活血功效的中药制剂或联合西药治疗骨质疏松症的临床随机对照试验(RCT)。提取资料并应用改良Jadad评分量表进行质量评估,最后运用国际Cochrane协作网提供的Rev Man5.3统计软件进行Meta分析评估。结果共纳入9项随机对照试验,合计809例患者。分析结果显示,运用补肾健脾活血法治疗中老年原发性骨质疏松症,与对照组相比,可显著提高临床疗效[OR=17.44,95%CI(6.75~45.09),P<0.01]和骨密度T值[MD=-0.24,95%CI(-0.33~-0.14),P<0.01],改善中医证候[MD=-4.07,95%CI(-5.99~-2.15),P<0.01]及疼痛[MD=-0.92,95%CI(-1.05~-0.78),P<0.01]。结论补肾健脾活血符合中老年骨质疏松症的证治规律,且效果较为理想,但仍需高质量大样本试验进行分析评估。

Objective To systematically evaluate the effectiveness of invigorating kidney and spleen as well as promoting blood circulation principle in the treatment of middle-aged and elderly primary osteoporosis(POP),provide more accurate evidence-based reference for clinical practice.Methods CNKI,Wan-fang Database,VIP,Medline,PubMed,Springer,PHMC and Cochrane Library were searched.Clinical randomized controlled trials(RCT)were collected for the treatment of osteoporosis with with TCM preparation of invigorating kidney and spleen as well as promoting blood circulation principle or combined with western medicine(experimental group).Meta-analysis was performed by using Rev Man 5.3 software provided by Cochrane after data extraction and quality evaluation modified by Jadad scale.Results Totally 9 RCTs were enrolled,involving 809 patients.Meta-analysis showed that the treatment of primary osteoporosis in middle-aged and elderly patients with the method of tonifying kidney and spleen and activating blood circulation could significantly improve the clinical efficacy compared with the control group[OR=17.44,95%CI(6.75,45.09),P<0.01]and increased T-score of bone mineral density[MD=-0.24,95%CI(-0.33,-0.14),P<0.01].Meanwhile,it could improve TCM syndromes[MD=-4.07,95%CI(-5.99,-2.15),P<0.01],obviously relieved pain[MD=-0.92,95%CI(-1.05,-0.78),P<0.01].Conclusion Invigorating kidney and spleen as well as promoting blood circulation principle according to the rule of syndrome differentiation and treatment of middle-aged and elderly primary osteoporosis and the effect is ideal.However,high quality large sample tests are still needed for analysis and evaluation.