摘要
目的探索补肾中成药对绝经后骨质疏松症(postmenopausal osteoporosis,PMOP)骨代谢的影响。方法检索PubMed、Cochrane Library、中国知网、万方数据和CBM数据库,收集补肾中成药单用或联合西药治疗绝经后骨质疏松症的随机对照试验和临床对照试验,按PRISMA声明进行定性分析和定量分析,定量分析采用RevMan 5.3和R3.4.3完成。结果共纳入15项研究,共有患者1 388例。定性分析表明中成药能下调I型原胶原氨基端前肽(N-terminal propeptide of type I procollagen,P1NP)和I型胶原交联羧基末端肽(beta C-terminal telopeptide of type I collagen,β-CTX),上调骨碱性磷酸酶(bone specific alkaline phosphatase,BALP),上调或下调骨钙素。定量分析显示,与对照组相比,补肾中成药对P1NP无显著影响[WMD=-4.10,95%CI(-9.18,0.98),P=0.11],下调β-CTX[WMD=-66.85,95%CI(-125.83,-7.87),P=0.03],上调BALP[WMD=10.12,95%CI(7.35,12.90),P<0.01],上调骨钙素[WMD=2.70,95%CI(0.46,4.94),P=0.02]。针对骨钙素进行亚组分析,非升高亚组补肾中成药能下调骨钙素[WMD=-2.76,95%CI(-3.99,-1.53),P<0.01],上升亚组补肾中成药能上调骨钙素[WMD=4.22,95%CI(1.80,6.63),P=0.0006]。结论补肾中成药能够抑制PMOP的骨吸收,对骨形成的影响尚不确定。补肾中成药对骨形成的影响可能与具体使用的药物相关,淫羊藿、刺五加能促进骨形成,其他药物的影响不明显。但由于纳入的文献质量较低,仍需要更严谨的研究加以证实。
Objective To assess the efficacy of Kidney-tonifying Chinese Patent Medicine on bone turnover makers in the treatment of postmenopausal osteoporosis(PMOP). Methods Databases including PubMed, Cochrane Library, CNKI, WanFang Data and CBM were searched to collect randomized controlled trials and controlled clinical trial related to Kidney-tonifying Chinese Patent Medicine versus other method in the treatment of PMOP. Systematic review was conducted based on the declaration of PRISMA, and meta-analysis was completed using RevMan 5.3 and R3.4.3. Results A total of 15 studies were included in the analysis, including 1388 patients. Qualitative analysis showed that compared with the control group, the kidney-tonifying Chinese patent medicine group had no significant effect on P1 NP [WMD=-4.10, 95% CI [-9.18, 0.98 ], P=0.11], and could down-regulate β-CTX [WMD=-66.85, 95% CI(-125.83,-7.87), P=0.03], up-regulate BALP [WMD=10.12, 95% CI(7.35, 12.90), P<0.01], and up-regulate Osteocalcin [WMD=2.70, 95% CI(0.46, 4.94), P=0.02]. In the subgroup analysis of osteocalcin, the kidney-tonifying Chinese patent medicine in the non-elevated subgroup could down-regulate osteocalcin [WMD=-2.76, 95% CI(-3.99,-1.53), P<0.01], while in the ascending subgroup could up-regulate osteocalcin [WMD=4.22, 95% CI(1.80, 6.63), P=0.0006]. Conclusion Kidney-tonifying Chinese Patent Medicine can inhibit bone resorption level in PMOP, but its effect on bone formation is still uncertain. The influence of kidney-tonifying Chinese patent medicines on bone formation may be related to the specific drugs used. Epimedium and acanthopanax senticosus can promote bone formation, but the influence of other drugs is not obvious. However, due to the low quality of the literature included, more rigorous research is still needed to confirm the findings.
作者
詹魁骏
安艳军
牟新
ZHAN Kuijun;AN Yanjun;MOU Xin(Zhejiang Chinese Medicine University, Hangzhou 310053;Department of Endocrinology, Hangzhou Redcross Hospital, Hangzhou 310003 , China)
出处
《中国骨质疏松杂志》
CAS
CSCD
北大核心
2019年第2期202-211,共10页
Chinese Journal of Osteoporosis
关键词
中成药
中药
绝经后骨质疏松症
骨转换标志物
骨吸收
骨形成
META分析
Chinese Patent Medicine
traditional Chinese medicine
postmenopausal osteoporosis
bone turnover makers
boneresorption
bone osteogenesis
meta-analysis
