骨质疏松症与中医体质类型关系的 Meta分析

The relationship between osteoporosis and TCM constitutional types:a meta-analysis

目的:探讨骨质疏松症与中医体质类型的关系。方法:应用计算机检索Cochrane Library、PubMed、Embase、中国知网、万方数据库、维普网、中国生物医学文献数据库中有关骨质疏松症与中医体质类型关系的观察性研究文献,检索时限均设定为建库至2021年7月。经文献筛选、数据提取及偏倚风险评价后,采用RevMan5.3软件和R软件(version3.5.2)对各中医体质类型在骨质疏松症患者中的分布情况、骨质疏松症患者中医体质类型和健康人群中医体质类型的对比情况、绝经后骨质疏松症患者中医体质类型和健康人群中医体质类型的对比情况进行Meta分析。结果:共检索到208篇文献,经过逐层筛选最终纳入23篇文献,其中横断面研究4项、病例对照研究19项。Meta分析结果显示,骨质疏松症患者中阴虚质[27%,95%CI(21%,33%)]、阳虚质[26%,95%CI(14%,40%)]、气虚质[17%,95%CI(10%,25%)]和血瘀质[17%,95%CI(12%,24%)]所占比例较高;阳虚质、气虚质、血瘀质、阴虚质在骨质疏松症患者中的比例高于健康人群[OR=2.51,95%CI(1.94,3.25),P=0.000;OR=2.20,95%CI(1.64,2.96),P=0.000;OR=1.93,95%CI(1.34,2.78),P=0.000;OR=1.47,95%CI(1.06,2.05),P=0.020],湿热质、平和质在骨质疏松症患者中的比例低于健康人群[OR=0.59,95%CI(0.39,0.90),P=0.010;OR=0.23,95%CI(0.14,0.38),P=0.000],气郁质、特禀质、痰湿质在骨质疏松症患者和健康人群中的比例相当[OR=1.31,95%CI(0.81,2.11),P=0.260;OR=1.13,95%CI(0.68,1.90),P=0.630;OR=0.68,95%CI(0.45,1.02),P=0.060];阳虚质、气虚质、血瘀质、阴虚质在绝经后骨质疏松症患者中的比例高于健康人群[OR=2.52,95%CI(1.47,4.34),P=0.001;OR=2.22,95%CI(1.32,3.73),P=0.003;OR=2.18,95%CI(1.06,4.52),P=0.040;OR=1.70,95%CI(1.30,2.22),P=0.000],湿热质、痰湿质、平和质在绝经后骨质疏松症患者中的比例低于健康人群[OR=0.69,95%CI(0.48,0.99),P=0.040;OR=0.48,95%CI(0.25,0.93),P=0.030;OR=0.21,95%CI(0.09,0.50),P=0.000],特禀质、气郁质在绝经后骨质疏松症患者和健康人群中的比例相当[OR=0.89,95%CI(0.56,1.39),P=0.600;OR=0.75,95%CI(0.55,1.02),P=0.070]。结论:现有的证据表明,阳虚质、气虚质、血瘀质和阴虚质是骨质疏松症患者的主要中医体质类型。

Objective:To explore the relationship between osteoporosis and TCM constitutional types.Methods:All observational research articles about the relationship between osteoporosis and TCM constitutional types included from database establishing to July 2021 were retrieved from Cochrane Library, PubMed, Embase, China National Knowledge Internet, Wanfang Database, Vip Database and Chinese Biomedical Literature Database through computer.The articles were screened and the information was extracted according to the inclusion and exclusion criteria.The bias risk of the research in the articles was evaluated by using the Newcastle-Ottawa scale(NOS)and the evaluation criterions recommended by agency for health care research and quality(AHRQ),and then a Meta-analysis on the distribution of TCM constitutional types in osteoporosis patients and the comparison of TCM constitutional types between osteoporosis patients and healthy people as well as between postmenopausal osteoporosis(PMOP)patients and healthy people was conducted by using RevMan5.3 software and R software(version3.5.2).Results:Two hundred and eight articles were searched out.After screening, 23 articles were included in the final analysis, including 4 cross-sectional articles and 19 case-control articles.The results of Meta-analysis revealed that the Yin-deficiency constitution( 27%,95% CI( 21%,33%)),Yang-deficiency constitution( 26%,95% CI( 14%,40%)),Qi-deficiency constitution( 17%,95% CI( 10%,25%)) and Stagnant-blood constitution( 17%,95% CI( 12%,24%)) accounted for a high proportion in osteoporosis patients. The Yang-deficiency constitution,Qi-deficiency constitution,Stagnant-blood constitution and Yin-deficiency constitution accounted for a higher proportion in osteoporosis patients compared with healthy people( OR = 2. 51,95% CI( 1. 94,3. 25),P = 0. 000;OR = 2. 20,95% CI( 1. 64,2. 96),P = 0. 000;OR = 1. 93,95% CI( 1. 34,2. 78),P = 0. 000;OR = 1. 47,95% CI( 1. 06,2. 05),P =0. 020),while the Damp-heat constitution and Balanced constitution( TCM) accounted for a lower proportion in osteoporosis patients compared with healthy people( OR = 0. 59,95% CI( 0. 39,0. 90),P = 0. 010;OR = 0. 23,95% CI( 0. 14,0. 38),P = 0. 000). Moreover,the Stagnant-qi constitution( TCM),Inherited-special constitution and Phlegm-dampness constitution accounted for a similar proportion in osteoporosis patients compared with healthy people( OR = 1. 31,95% CI( 0. 81,2. 11),P = 0. 260;OR = 1. 13,95% CI( 0. 68,1. 90),P =0. 630;OR = 0. 68,95% % CI( 0. 45,1. 02),P = 0. 060). The Yang-deficiency constitution,Qi-deficiency constitution,Stagnant-blood constitution and Yin-deficiency constitution accounted for a higher proportion in PMOP patients compared with healthy people( OR =2. 52,95% CI( 1. 47,4. 34),P = 0. 001;OR = 2. 22,95% CI( 1. 32,3. 73),P = 0. 003;OR = 2. 18,95% CI( 1. 06,4. 52),P = 0. 040;OR =1. 70,95% CI( 1. 30,2. 22),P = 0. 000),while the Damp-heat constitution,Phlegm-dampness constitution and Balanced constitution( TCM) accounted for a lower proportion in PMOP patients compared with healthy people( OR = 0. 69,95% CI( 0. 48,0. 99),P = 0. 040;OR = 0. 48,95% CI( 0. 25,0. 93),P = 0. 030;OR = 0. 21,95% CI( 0. 09,0. 50),P = 0. 000). Moreover,the Inherited-special constitution and Stagnant-qi constitution( TCM) accounted for a similar proportion in PMOP patients compared with healthy people( OR = 0. 89,95% CI( 0. 56,1. 39),P = 0. 600;OR = 0. 75,95% CI( 0. 55,1. 02),P = 0. 070). Conclusion: Available evidences suggest that the Yang-deficiency constitution,Qi-deficiency constitution,Stagnant-blood constitution and Yin-deficiency constitution are the main TCM constitutional types of osteoporosis patients.