补肾健脾活血法治疗绝经后骨质疏松症疗效的Meta分析  

Meta analysis of the effect of method of invigorating kidney,invigorating spleen and promoting blood circulation on postmenopausal osteoporosis

作　　者：马学智 马勇[1] 郭杨[1] MA Xuezhi;MA Yong;GUO Yang(Department of Orthopedics and Traumatology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, China)

机构地区：[1]南京中医药大学附属医院骨伤科,江苏南京210029

出　　处：《中国骨质疏松杂志》2022年第4期527-535,共9页Chinese Journal of Osteoporosis

摘　　要：目的系统评价补肾健脾活血法治疗绝经后骨质疏松症的疗效。方法利用计算机检索各大数据库,如Cochrane图书馆、知网(CNKI)、万方(Wanfang)、荷兰医学文献数据库、维普(VIP)、Web of Science、PubMed、Medline等数据库,检索各库建库时间至2021年2月补肾健脾活血法治疗绝经后骨质疏松症的随机对照试验(randomized controlled trial,RCT),并采用RevMan5.3软件对符合纳入条件的文献进行定量Meta分析。结果共纳入14篇RCT文献进行定量分析,研究共涉及1218名患者,分析结果显示,①补肾健脾活血法方药在提高绝经后骨质疏松患者临床有效率[OR=2.57,95%CI(1.37~4.83),P=0.003]、血清E2水平[MD=3.15,95%CI(0.28~6.02),P=0.03]以及降低患者B-ALP水平[MD=-17.63,95%CI(-26.01~-9.25),P<0.0001]、尿Ca/Cr比值[MD=-0.14,95%CI(-0.27~-0.01),P<0.0001]方面明显优于常规西药;补肾健脾活血法方药在提高患者腰椎BMD[MD=0.01,95%CI(-0.02~0.04),P=0.42]、股骨颈BMD[MD=0.00,95%CI(-0.06~0.05),P=0.91]、IGF-1水平[MD=31.71,95%CI(-18.54~81.96),P<0.0001]以及降低患者血清IL-6水平[MD=-5.72,95%CI(-14.05~2.61),P=0.18]、TNF-α水平[MD=-13.51,95%CI(-39.89~12.86),P<0.0001]与西药相比无统计学意义,具有相同疗效;②补肾健脾活血方联合西药在提高临床有效率[OR=5.44,95%CI(2.71~10.89),P<0.00001]、提高患者腰椎BMD[MD=0.07,95%CI(0.04~0.11),P<0.00001]、股骨颈BMD[MD=0.06,95%CI(0.02~0.09),P=0.0008]、E2水平[MD=5.20,95%CI(1.35~9.06),P=0.008]以及降低患者血清B-ALP水平[MD=-4.31,95%CI(-5.53~-3.09),P<0.00001]、IL-6水平[MD=-18.06,95%CI(-26.56~-9.57),P<0.0001]与西药相比效果更佳;③根据临床有效率、腰椎BMD、股骨颈BMD、血清E2、IL-6水平各指标亚组间比较结果显示,相比于单纯补肾健脾活血法方药,补肾健脾活血法方药与西药二者具有联合增效之功。结论补肾健脾活血法方药治疗绝经后骨质疏松症具有显著疗效,并可与西药联合具有增效之功,但仍需更多RCTs�Objective To systematically evaluate the efficacy of method of invigorating kidney,invigorating spleen and promoting blood circulation on postmenopausal osteoporosis.Methods Used computers to search major databases,such as Cochrane Library,CNKI,Wanfang,Embase,VIP,web of science,PubMed,Medline and other databases,and search the randomized controlled trial of invigorating kidney,invigorating spleen and promoting blood circulation on postmenopausal osteoporosis from February 2021,Revman5.3 software was used to conduct quantitative meta-analysis on the literature that met the inclusion conditions.Results A total of 14 RCT literatures were included for quantitative analysis.The study involved 1218 patients.The analysis result showed that:①compared with the western medicine,the method of invigorating kidney,invigorating spleen and promoting blood circulation had advantages in increasing effective rate of postmenopausal Osteoporosis[OR=2.57,95%CI(1.37,4.83),P=0.003],E2 level[MD=3.15,95%CI(0.28,6.02),P=0.03]and decreasing B-ALP level[MD=-17.63,95%CI(-26.01,-9.25),P<0.0001],Ca/Cr level[MD=-0.14,95%CI(-0.27,-0.01),P<0.0001];there was no significant difference in bone mineral density of lumbar[MD=0.01,95%CI(-0.02,0.04),P=0.42],bone mineral density of femoral neck[MD=0.00,95%CI(-0.06,0.05),P=0.91],IGF-1 level[MD=31.71,95%CI(-18.54,81.96),P<0.0001],IL-6 level[MD=-5.72,95%CI(-14.05,2.61),P=0.18],TNF-αlevel[MD=-13.51,95%CI(-39.89,12.86),P<0.0001]between the method of invigorating kidney,invigorating spleen and promoting blood circulation and the western medicine.②Compared with the western medicine,the method of invigorating kidney,invigorating spleen and promoting blood circulation combine with the western medicine had advantagesin increasing effective rate of postmenopausal osteoporosis[OR=5.44,95%CI(2.71,10.89),P<0.00001],bone mineral density of lumbar[MD=0.07,95%CI(0.04,0.11),P<0.00001],bone mineral density of femoral neck[MD=0.06,95%CI(0.02,0.09),P=0.0008],E2 level[MD=5.20,95%CI(1.35,9.06),P=0.008]and decreasing B-ALP

关 键 词：补肾 健脾 活血 绝经后骨质疏松症 META分析 

分 类 号：R589.5[医药卫生—内分泌]