不同药物治疗原发性骨质疏松症的网状Meta分析  

Network meta-analysis of different drugs for the treatment of primary osteoporosis

作　　者：阙敏强 石础硕 黄英杰 詹群璋 霍晨星 周驰 杨仁轩[3] Que Minqiang;Shi Chushuo;Huang Yingjie;Zhan Qunzhang;Huo Chenxing;Zhou Chi;Yang Renxuan(Guangzhou University of Chinese Medicine,Guangzhou 510045,Guangdong Province,China;Guangzhou Orthopedic Hospital,Guangzhou 510045,Guangzhou Province,China;Zhuhai Hospital of Guangdong Traditional Chinese Medicine Hospital,Zhuhai 519000,Guangdong Province,China)

机构地区：[1]广州中医药大学,广东省广州市510045 [2]广州市正骨医院,广东省广州市510045 [3]广东省中医院珠海医院,广东省珠海市519000

出　　处：《中国组织工程研究》2020年第35期5715-5722,共8页Chinese Journal of Tissue Engineering Research

基　　金：国家自然科学基金(81774339),项目负责人:周驰;广东省自然科学基金(2015A030310203),项目负责人:周驰;广东省中医药管理局项目(20191099),项目参与人:周驰;广东省高水平大学建设项目(A1-AFD018171Z11057),项目负责人:周驰。

摘　　要：背景:临床研究发现阿仑膦酸钠联合降钙素类、钙剂类等其他药物治疗原发性骨质疏松症能提高疗效、降低其不良反应发生率,但尚乏系统评价。目的:系统评价不同药物治疗原发性骨质疏松症的临床疗效、骨密度、安全性的差异。方法:计算机检索PubMed、CNKI、VIP、万方数据库、Embase、CBM、Cochrane图书馆,收集不同药物治疗原发性骨质疏松的随机对照试验(RTC)。文献筛选,数据提取,采用Cochrane系统评价及RevMan 5.3对纳入文献进行质量评价;运用马尔科夫链-蒙特卡洛方法,采用Stata 15.0进行贝叶斯网状Meta分析。结果与结论:①共纳入14项RCT,共计1822例患者,涉及阿仑膦酸钠、唑来膦酸、钙剂、钙剂联合唑来膦酸、阿仑膦酸钠联合钙剂、阿仑膦酸钠联合骨肽注射液、钙剂联合骨肽注射液、阿仑膦酸钠联合特立帕肽注射液、鲑鱼降钙素等9种干预措施;②在提高总有效率方面,共涉及9种干预措施,网状Meta排序结果为钙剂联合骨肽注射液>阿仑膦酸钠联合骨肽注射液>阿仑膦酸钠联合唑来膦酸>唑来膦酸>唑来膦酸联合钙剂>鲑鱼降钙素>阿仑膦酸钠联合钙剂>阿仑膦酸钠>钙剂;③在提高治疗后骨密度方面,共涉及5种干预措施,网状Meta排序结果为阿仑膦酸钠联合钙剂>钙剂>钙剂联合唑来膦酸>唑来膦酸>阿仑膦酸钠;④在降低不良反应发生率方面,共涉及7种干预措施,网状Meta排序结果为钙剂>阿仑膦酸钠联合钙剂>阿仑膦酸钠联合骨肽注射液>唑来膦酸联合钙剂>唑来膦酸>阿仑膦酸钠>阿仑膦酸钠联合特立帕肽注射液;⑤结论:骨肽注射液的联合用药能显著提高治疗总有效率,其中钙剂联合骨肽注射液效果最佳;钙剂在提高治疗后骨密度的疗效确切,而联合阿仑膦酸钠具有增效作用,且不良反应的发生率较低,效果最好。BACKGROUND:Clinical studies have found that alendronate combined with other drugs such as calcitonin and calcium can improve the clinical efficacy on primary osteoporosis and reduce the incidence of adverse reactions,but there is no systematic review.OBJECTIVE:To systematically evaluate the clinical efficacy,bone density,and safety of different drugs in the treatment of primary osteoporosis.METHODS:A computer search of PubMed,China Knowledge Network database,VIP,WanFang database,Embase,CBM and the Cochrane Library was performed for randomized controlled trials of different drugs for the treatment of primary osteoporosis.After literature screen and data extraction,the quality of the included literatures was assessed using the Cochrane System and RevMan 5.3.Bayesian network meta-analysis was performed using Stata 15.0 software and Markov chain-Monte Carlo method.RESULTS AND CONCLUSION:A total of 14 randomized controlled trials with 1822 patients were enrolled,involving alendronate,zoledronic acid,calcium,calcium combined with zoledronic acid,alendronate combined with calcium,alendronate combined with bone peptide injection,calcium combined with bone peptide injection,alendronate combined with teriparatide injection,and salmon calcitonin.The results of the network meta-analysis showed that there were nine interventions in terms of improving the total effective rate,which ranked as follows:calcium combined with bone peptide injection>alendronate combined with bone peptide injection>alendronate combined with zoledronic acid>zoledronic acid>zoledronic acid combined with calcium>salmon calcitonin>alendronate combined with calcium>alendronate>calcium.In terms of improving bone mineral density after treatment,there are five interventions,which ranked as follows:alendronate combined with calcium>calcium>calcium combined with zoledronic acid>zoledronic acid>alendronate.In terms of reducing the incidence of adverse reactions,seven interventions were involved,which ranked as follows:calcium>alendronate combined with calcium>a

关 键 词：原发性骨质疏松 阿仑磷酸钠 钙剂 鲑鱼降钙素 唑来膦酸 

分 类 号：R453[医药卫生—治疗学] R496[医药卫生—临床医学]