补肾活血法治疗骨质疏松症对骨密度、骨代谢疗效的Meta分析  

The Meta-analysis of the therapeutic effects of tonifying the kidney and promoting blood circulation method on bone density and bone metabolism in the treatment of osteoporosis

作　　者：熊浪 唐芳 马武开 兰维娅 蒋总 蔡珊珊 陈学勇 XIONG Lang;TANG Fang;MA Wukai;LAN Weiya;JIANG Zong;CAI Shanshan;CHEN Xueyong(Guizhou University of Traditional Chinese Medicine,Guiyang 550002;The Second Affiliated Hospital of Guizhou University of Traditional Chinese Medicine,Guiyang 550003,China)

机构地区：[1]贵州中医药大学,贵州贵阳550002 [2]贵州中医药大学第二附属医院,贵州贵阳550003

出　　处：《中国骨质疏松杂志》2024年第7期1013-1020,1050,共9页Chinese Journal of Osteoporosis

基　　金：国家自然科学基金(82160917);贵州省教育厅青年科技人才成长项目[黔教合KY字(2022)262号];贵州省科技计划项目[黔科合基础-ZK(2023)一般435];贵州省中医风湿免疫病临床研究中心项目[黔科合平台人才(2020)2202];贵州省高等学校中西医结合防治疾病转化医学重点实验室[黔教技(2023)017号];贵州中医药大学国家与省级科技创新人才团队培育项目[贵中医TD合字(2022)004号];贵州中医药大学大学生创新创业训练计划项目[贵中医大创合字(2021)57号]。

摘　　要：目的 系统评价补肾活血法治疗骨质疏松症(osteoporosis, OP)对骨密度(bone mineral density, BMD)与骨代谢标志物的疗效。方法 检索的中文数据库为知网、维普、万方,英文数据库为PubMed、Embase、Web of Science、Cochrane,检索运用补肾活血法的中药制剂或联合常规疗法治疗OP的BMD与骨代谢标志物的随机对照试验。对纳入文献进行Cochrane推荐的改良Jadad评分量表与随机对照试验偏倚风险工具的质量评价,采用RevMan5.3软件进行Meta统计分析。结果 共纳入16篇文献,共1 851例患者。分析结果:(1)补肾活血法中药制剂联合常规疗法治疗OP,与对照组相比,有以下优势临床效果:中医证候积分[MD=-2.99,95%CI:-4.11~-1.86,P<0.000 01]、腰椎BMD[MD=0.06,95%CI:0.04~0.08,P<0.000 01]、股骨颈BMD[MD=0.04,95%CI:0.03~0.06,P<0.000 01]、骨钙素(BGP)[MD=1.41,95%CI:0.68~2.14,P=0.000 1]及I型胶原羧基端肽β特殊序列(β-CTX)[MD=-0.28,95%CI:-0.42~-0.14,P=0.000 1];同时,治疗OP后的Ward三角BMD、骨源性碱性磷酸酶(BALP)、I型原胶原N-端前肽(PINP)及抗酒石酸性磷酸酶(TRACP-5B)与对照组相比无明显差异;(2)亚组结果:补肾活血法中药制剂联合常规疗法治疗三种类型OP的腰椎BMD、BGP的疗效明显优于对照组,且治疗老年骨质疏松症(senile osteoporosis, SOP)和原发性骨质疏松症(primary osteoporosis, POP)的BGP疗效明显优于绝经后骨质疏松症(postmenopausal osteoporosis, PMOP)。结论 (1)补肾活血法中药制剂联合常规疗法在治疗OP方面,对中医证候、BMD(腰椎、股骨颈)、BGP、β-CTX的疗效更为显著;(2)补肾活血法中药制剂联合常规疗法在治疗3种类型OP腰椎BMD、BGP的疗效明显优于对照组,且治疗SOP、POP的BGP疗效明显优于PMOP;(3)对于这两种结果,需进行统一性、规范性、高标准和高质量的大样本、多中心试验研究进行分析和评估。Objective To systematically evaluate the efficacy of kidney-tonifying and blood-activating therapy on bone mineral density(BMD)and bone metabolism markers in the treatment of osteoporosis(OP).Methods Chinese databases(CNKI,VIP,and Wanfang)and English databases(PubMed,Embase,Web of Science,and Cochrane)were screened.Randomized controlled trials that used kidney-tonifying and blood-activating therapy in combination with traditional Chinese medicine preparations or conventional therapy to treat BMD and bone metabolism markers in OP were included.The quality of the included literature was evaluated using the modified Jadad rating scale recommended by Cochrane and the risk of bias tool for randomized controlled trials.Meta-statistical analysis was performed using RevMan5.3 software.Results A total of 16 articles including 1851 patients were included.①The result of the analysis indicated the following advantages of combining traditional Chinese medicine preparations with conventional therapy for the treatment of OP compared to the control group,including Traditional Chinese Medicine Syndrome Score[MD=-2.99,95%CI(-4.11~-1.86),P<0.00001],lumbar spine BMD[MD=0.06,95%CI(0.04-0.08),P<0.00001],femoral neck BMD[MD=0.04,95%CI(0.03-0.06),P<0.00001],bone glaprotein(BGP)[MD=1.41,95%CI(0.68-2.14),P=0.0001],and type I collagen carboxy terminal peptideβspecial sequence(β-CTX)[MD=-0.28,95%CI(-0.42--0.14),P=0.0001].Additionally,there were no significant differences observed in Wards triangle BMD after OP,bone specific alkaline phosphatase(BALP),N-terminal propeptide of type I procollagen(PINP),and tartrate-resistant acid phosphatase 5B(TRACP-5B)when compared to those in the control group.②Subgroup analysis revealed that the combination of traditional Chinese medicine preparations with conventional therapy was significantly more effective than the control group in treating lumbar spine BMD and BGP for all three types of OP.Additionally,it demonstrated greater efficacy in treating senile osteoporosis(SOP)and primary osteoporosis(P

关 键 词：补肾活血 骨质疏松症 骨密度 骨代谢 META分析 

分 类 号：R259[医药卫生—中西医结合] R589.5[医药卫生—中医内科学]