长期服用质子泵抑制剂对骨密度和骨代谢影响的Meta分析  

Effect of long-term use of proton pump inhibitors on bone mineral density and bone metabolism:a Meta-analysis

作　　者：陈嘉韵 李安安 吕朝晖[2] 伍紫炫 蔡旻捷 黄栩研 Chen Jiayun;Li Anan;Lü Zhaohui;Wu Zixuan;Cai Minjie;Huang Xuyan(Guangzhou University of Chinese Medicine,Guangzhou 510405,Guangdong Province,China;Guangdong Second Hospital of Traditional Chinese Medicine,Guangzhou 510095,Guangdong Province,China;Southern Medical University,Guangzhou 510080,Guangdong Province,China)

机构地区：[1]广州中医药大学,广东省广州市510405 [2]广东省第二中医院,广东省广州市510095 [3]南方医科大学,广东省广州市510080

出　　处：《中国组织工程研究》2021年第17期2775-2780,共6页Chinese Journal of Tissue Engineering Research

基　　金：广东省中医药局科研项目(20202013)。

摘　　要：目的:质子泵抑制剂临床上多用于治疗胃酸分泌过多的疾病,但目前发现长期服用质子泵抑制剂可引起骨质疏松症的发生,但两者之间的关系与机制尚未有明确定论。文章通过系统的Meta分析从骨密度和骨代谢角度,探讨长期服用质子泵抑制剂与骨质疏松之间的联系。方法:以"骨质疏松""骨代谢""质子泵抑制剂""Osteoporosis""Bone Metabolism""Proton Pump Inhibitor""PPI"等为主要检索词检索中国知网、CBM、维普、万方、PubMed、Web of Science、EMBASE和Cochrane Library数据库有关长期服用PPI对骨密度、骨代谢影响的研究,设定文献发表时间为各数据库建库至2020年3月1日。并根据不同文献类型使用相对应的评价方法严格对文献进行质量评价,并准确提取相关文献信息与数据,应用RevMan 5.3进行Meta分析。结果:共纳入9篇文献,包括1236例研究对象。①Meta结果显示:质子泵抑制剂组腰椎L_(1-4)、股骨颈、股骨近端和髋关节总体骨密度均低于对照组,差异均具有显著性意义,其中腰椎骨密度以T值表示:MD=-0.24,95%CI:-0.45至-0.04,P=0.02;腰椎骨密度以g/cm^2表示:MD=-0.12,95%CI:-0.22至-0.03,P=0.010;股骨颈骨密度:MD=-0.31,95%CI:-0.44至-0.18,P<0.00001;股骨近端骨密度:MD=-0.17,95%CI:-0.20至-0.14,P<0.00001;髋关节总体骨密度:MD=-0.27,95%CI:-0.51至-0.02,P=0.04;②质子泵抑制剂组骨钙素水平高于对照组(MD=0.23,95%CI:0.19-0.27,P<0.00001);③质子泵抑制剂组甲状旁腺素水平略低于对照组,但差异无显著性意义(MD=-0.19,95%CI:-1.91-1.53,P=0.83)。结论:长期服用质子泵抑制剂可降低骨密度,并使骨钙素含量升高,易发生骨质疏松,但对甲状旁腺素影响尚不明确,上述结论尚需要更多高质量的研究进行验证。BACKGROUND:Proton pump inhibitors(PPI)are often used for the clinical treatment of gastroxia,and the long-term use of PPI can lead to osteoporosis.However,their relationship and mechanism are not yet clear.This systematic review aimed to clarify the relationship between the long-term use of PPI and osteoporosis from the perspective of bone mineral density(BMD)and bone metabolism.METHODS:A search of CNKI,CBM,VIP,WanFang,PubMed,Web of Science,EMBASE,and Cochrane Library was performed using the main keywords of“osteoporosis;bone metabolism;proton pump inhibitor;PPI”in Chinese and English,respectively.The search time was from inception until March 1,2020.Literature about the effect of long-term use of PPI on BMD and bone metabolism were retrieved and strictly assessed for literature quality.Relevant information and data were accurately extracted from the literature.The meta-analysis was performed using RevMan5.3.RESULTS:A total of 9 studies involving 1236 individuals were included.Meta-analysis results showed that:the BMD of the lumbar L1-4,femoral neck,and proximal femur as well as the overall BMD of the hip joint in the PPI group were significantly lower than those in the control group.Lumbar vertebra BMD:expressed as T value,mean difference(MD)=-0.24,95%confidence interval(CI):-0.45 to-0.04,P=0.02,and expressed in g/cm^2,MD=-0.12,95%CI:-0.22 to-0.03,P=0.010);femoral neck BMD:MD=-0.31,95%CI:-0.44 to-0.18,P<0.00001);proximal femoral BMD:MD=-0.17,95%CI:-0.20 to-0.14,P<0.00001;overall BMD of the hip joint:MD=-0.27,95%CI:-0.51 to-0.02,P=0.04.The level of osteocalcin in the PPI group was significantly higher than that in the control group(MD=0.23,95%CI:0.19-0.27,P<0.00001).The level of parathyroid hormone in the PPI group was lower than that in the control group,and the difference was not statistically significant(MD=-0.19,95%CI:-1.91 to 1.53,P=0.83).In conclusion,the long-term use of PPI can reduce BMD and increase osteocalcin level,which easily lead to osteoporosis but the effects on parathyroid hormone level is y

关 键 词：骨 髋 股骨 腰椎 骨钙素 甲状旁腺素 骨密度 骨代谢 META分析 

分 类 号：R452[医药卫生—治疗学] R453[医药卫生—临床医学]