骨质疏松患者首次静脉滴注唑来膦酸致急性期反应危险因素的Meta分析  

Risk factors of acute-phase reaction following the first-dose administration of zoledronic acid in osteoporotic patients： a Meta-analysis

作　　者：李萍[1] 李潇潇[1] 赵荣生[1] 

机构地区：[1]北京大学第三医院药剂科,100191

出　　处：《药物不良反应杂志》2017年第6期425-431,共7页Adverse Drug Reactions Journal

摘　　要：目的 评价骨质疏松患者首次静脉滴注唑来膦酸后发生急性期反应（APR）的危险因素.方法 检索国内外相关数据库,收集首次静脉滴注唑来膦酸致骨质疏松患者APR危险因素的观察性研究,检索时间截至2017年7月.依据纽尔卡斯-渥太华量表（NOS）对纳入文献进行质量评价,应用RevMan 5.3软件进行Meta分析,效应指标为OR或均数差（MD）及其95％CI.结果 共17篇文献、1981例首次静脉滴注唑来膦酸的骨质疏松患者纳入Meta分析,其中APR（＋）组979例,APR（-）组1002例.17篇文献NOS评分均≥6分.Meta分析结果显示,APR（＋）组患者年龄低于APR（-）组,差异有统计学意义（MD=-3.27,95％CI：-4.54～-2.01,P〈0.00001）;有口服含氮双膦酸盐（NBP）史者APR发生率显著低于无口服NBP史者,差异有统计学意义（OR=0.27,95％CI：0.17～0.41,P〈0.00001）;有骨折史者APR发生率显著高于无骨折史者,差异有统计学意义（OR=2.31,95％CI：1.29～4.13,P=0.005）;预防性使用解热镇痛药者APR发生率显著低于未预防性使用解热镇痛药者,差异有统计学意义（OR=0.14,95％CI：0.05～0.37,P〈0.0001）.体重指数、内生肌酐清除率、钙剂使用史、骨化三醇使用史和性别与APR的发生均无相关性.结论 低龄、骨折史是发生APR的危险因素,既往口服NBP、预防性使用解热镇痛药是有助于减少APR的保护性因素.Objective To evaluate the risk factors of acute-phase reaction （APR）following the first-dose administration of zoledronic acid in osteoporotic patients. Methods The documents of the observational studies about risk factors of APR following the first-dose administration of zoledronic acid in osteoporotic patients were searched from correlative data base until July,2017. The quality of the literature enrolled into the Meta-analysis was evaluated by Newcastle-Ottawa Scale （NOS）,and then Meta-analysis was conducted using RevMan 5. 3 software. The effective measurements were expressed as adds ratio （OR） or difference in means （MD）and 95% confidence interval （CI）. Results A total of 17 studies involving 1981 patients with osteoporotic and having the first-dose administration of zoledronic acid were enrolled into the Meta-analysis. Nine hundred and seventy-nine patients had APR （APR ＋ group）and 1002 patients without APR （APR - group）. The scores of NOS in 17 articles were all greater than or equal to 6. The results of Meta-analysis showed that the patients in the APR（＋）group were significantly younger then those in the APR（-）group （MD = - 3. 27,95% CI：- 4. 54- - 2. 01,P 〈 0. 00001）. The incidence rate of APR in the patients who had the history of administration of nitrogenous bisphosphonates （NBP）were lower than those without history of administration of NBP,and the difference was statistically significant （OR =0. 27,95% CI：0. 17-0. 41,P 〈 0. 00001）. The incidence rate of APR in the patients having the history of fracture were higher than those without history of fracture,and the difference was statistically significant （OR =2. 31,95% CI：1. 29-4. 13,P = 0. 005）. The incidence rate of APR in the patients who had analgesic-antipyretic preventability treatment were lower than those who had no analgesic-antipyretic preventability treatment,and the difference was statistically significant （OR = 0. 14,95% CI：0. 05-0. 37,P 〈 0. 0001）. There were no stati

关 键 词：唑来膦酸 急相反应 危险因素 META分析 

分 类 号：R580[医药卫生—内分泌]