原发性骨质疏松症中医证候分布频率的Meta分析  

Meta-analysis of Distribution Frequency of Traditional Chinese Medicine Syndrome in Primary Osteoporosis

作　　者：吴海龙 常天瀛 卢焱 罗宗键[3] 冷向阳[1] 廖星[4] WU Hailong;CHANG Tianying;LU Yan;LUO Zongjian;LENG Xiangyang;LIAO Xing(Changchun University of Chinese Medicine,Changchun 130117,China;Evidence-based Medicine Center,Changchun University of Chinese Medicine,Changchun 130117,China;Affiliated Hospital of Changchun University of Chinese Medicine,Changchun 130021,China;Institute of Basic Research in Clinical Medicine,China Academy of Chinese Medical Sciences,Beijing 100700,China)

机构地区：[1]长春中医药大学,长春130117 [2]长春中医药大学循证医学中心,长春130117 [3]长春中医药大学附属医院,长春130021 [4]中国中医科学院中医临床基础医学研究所,北京100700

出　　处：《中国实验方剂学杂志》2024年第5期111-117,共7页Chinese Journal of Experimental Traditional Medical Formulae

基　　金：国家中医临床研究基地业务建设科研专项(JDZX-2015077);吉林省教育厅研究项目(JJKH20210948KJ);吉林省自然科学基金项目(20210101233JC);长春中医药大学附属医院基本中医药循证能力建设项目。

摘　　要：目的:运用循证医学方法,系统评价我国原发性骨质疏松症(POP)中医证候分布情况,了解其证候分布规律。方法:检索中国知识基础设施工程(CNKI)、维普中文科技期刊数据库(VIP)、万方数据知识服务平台(WanFang)及中国生物医学文献数据库(CBM),获得代表性文献,各个数据库检索时间均为1994年世界卫生组织定义骨质疏松症诊断标准至2023年5月1日。由2位研究者根据筛选标准独立筛选文献、提取资料并交叉核对,采用R 4.1.3软件进行Meta分析并进行亚组分析。结果:共纳入56篇中文文献,涉及14415例患者。证候标准化分类后排除11篇文献,最终纳入的45篇中文文献的Meta分析结果显示,12723例患者肝肾阴虚证、脾肾阳虚证、肾虚血瘀证的证候分布频率分别为27%[95%置信区间(CI)0.24~0.31]、32%(95%CI 0.29~0.36)、36%(95%CI 0.30~0.42)。亚组分析结果显示,上述3种中医证候在南北方分布差异具有统计学意义(P<0.05)。此外,不同类型POP中医证候骨折发生率分别为肝肾阴虚证15%(95%CI 0.09~0.24)、脾肾阳虚证20%(95%CI 0.12~0.30)、肾虚血瘀证31%(95%CI 0.25~0.39)。结论:POP患者的证候分布以肾虚为主,兼见肝脾功能失调。肝肾阴虚证、脾肾阳虚证、肾虚血瘀证均是POP及骨质疏松性骨折发生的主要证候,且肾虚血瘀证与骨质疏松性骨折的发病关系最为密切。纳入研究间证候判定参考标准不一致,未来要重点围绕其判定标准,获得共识性研究结果;同时,开展大样本的证候调研,获得具有代表性的研究结果,为临床实践和研究提供依据。Objective:To systematically evaluate the distribution of traditional Chinese medicine(TCM)syndromes of primary osteoporosis(POP)in China by using evidence-based medicine methods,and to understand the distribution law of the syndromes.Method:China National Knowledge Infrastructure(CNKI),VIP Chinese Science and Technology Journal Database(VIP),WanFang Data Knowledge Service Platform(WanFang)and China Biology Medicine(CBM)were searched to obtain representative literature,and each database was searched from the 1994 World Health Organization defined diagnostic criteria for osteoporosis until May 1,2023.Two researchers independently screened literature according to the criteria,extracted data,and cross-checked them.Meta analysis was conducted using R4.1.3,and subgroup analysis was performed.Result:A total of 56 Chinese papers were included,involving 14415 patients.After standardized classification of syndromes,11 articles were excluded,and Meta analysis results of the ultimately included 45 Chinese articles showed that the distribution frequencies of liver-kidney Yin deficiency syndrome,spleen-kidney Yang deficiency syndrome and kidney deficiency and blood stasis syndrome in 12723 patients were 27%[95%confidence interval(CI)0.24-0.31],32%(95%CI 0.29-0.36),36%(95%CI 0.30-0.42).Subgroup analysis showed that there was a statistically significant difference in the distribution of the three TCM syndromes in the north and south(P<0.05).In addition,the incidence of TCM syndrome fractures in different types of POP was 15%(95%CI 0.09-0.24)for liver-kidney Yin deficiency syndrome,20%(95%CI 0.12-0.30)for spleen-kidney Yang deficiency syndrome,and 31%(95%CI 0.25-0.39)for kidney deficiency and blood stasis syndrome.Conclusion:The distribution of syndromes in POP patients is mainly kidney deficiency,accompanied by liver and spleen dysfunction.Liver-kidney Yin deficiency syndrome,spleen-kidney Yang deficiency syndrome and kidney deficiency and blood stasis syndrome are all the main syndromes of POP and osteoporotic fractures,and kid

关 键 词：原发性骨质疏松症(POP) 中医证候 系统综述 META分析 横断面研究 循证医学方法 骨折 

分 类 号：R22[医药卫生—中医基础理论] R24[医药卫生—中医学] R273[理学—数学] O279