中国骨质疏松杂志

唑来膦酸与阿仑膦酸钠治疗原发性骨质疏松疗效及安全性的Meta分析

Meta-analysis of the efficacy and safety of zoledronic acid and alendronate in the treatment of primary osteoporosis

DOI：10.3969/j.issn.1006-7108.2020.06.023

中文关键词: 唑来膦酸阿仑膦酸钠原发性骨质疏松症 Meta 分析

英文关键词:zoledronic acid alendronate sodium primary osteoporosis Meta-analysis

基金项目:

作者	单位
吴荣海1 魏锦强1 王慧敏2* 李嘉晖1 黄俊霖1 陈培友1	1.广州中医药大学第二临床医学院，广东广州 510405 2.广东省中医院，广东广州 510120

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中文摘要:

目的系统评价唑来膦酸与阿仑膦酸钠治疗原发性骨质疏松的有效性与安全性。方法计算机检索PubMed、Embase、Cochrane Library、CNKI、CBM、万方数据库，检索时间均为建库至2018年12月，采用改良Jadad量表及Cochrane风险偏倚评估工具评价纳入研究的方法学质量。使用Rev Man5.3及Stata15.0软件进行Meta分析。结果共纳入12篇文献，1 344例患者。Meta分析结果表明：在疗效方面，腰椎骨密度（bone mineral density, BMD)在治疗12个月后[SMD=0.96,95% CI(0.03,1.90),P=0.04]、24个月后[SMD=1.70,95% CI(0.30,3.11),P=0.02]，股骨颈BMD在治疗12个月后[SMD=0.34,95% CI (0.19,0.50),P<0.000 1]，VAS评分[MD=-0.76,95% CI(-0.93,-0.58),P<0.000 01]，Oswestry功能障碍指数(ODI)［MD=-10.48,95% CI(-11.38,-9.58),P<0.000 01］，差异具有统计学意义(P<0.05)，唑来膦酸治疗效果优于阿仑膦酸钠。在安全性方面，不良反应[RR=1.79,95% CI(1.41,2.28),P<0.000 01]差异具有统计学意义，唑来膦酸安全性小于阿仑膦酸钠。结论与阿仑膦酸钠相比，唑来膦酸在治疗后期能明显提高患者腰椎、股骨颈BMD，有效降低VAS评分、Oswestry功能障碍指数，进而显著提升患者的生活质量,但不良反应相对较多。

英文摘要:

Objective To systematically evaluate the efficacy and safety of zoledronic acid and alendronate sodium in the treatment of primary osteoporosis. Methods Used computer search PubMed, Embase, Cochrane Library, CNKI, CBM, Wanfang database, the search time was from the establishment of the database to December 2018, The modified Jadad scale and Cochrane risk bias assessment tool were used to evaluate the methodological quality of the included studies.Data were analyzed by Rev Man 5.3 and Stata15.0 software.Results Twelve studies involving 1 344 patients were included. Meta analysis results show that:There were significant difference(P<0.05)in the treatment of lumbar spine BMD after 12 months[SMD=0.96,95% CI(0.03,1.90),P=0.04] and 24 months[SMD=1.70,95% CI(0.30,3.11),P=0.02],and femoral neck BMD after 12 months[SMD=0.34,95% CI(0.19,0.50),P<0.000 1],VAS score[MD=-0.76,95% CI(-0.93, -0.58),P<0.000 01],ODI[MD=-10.48,95% CI(-11.38,-9.58),P<0.000 01]. The therapeutic effect of zoledronic acid was more effective than alendronate sodium.There were significant difference in adverse reaction[RR=1.79, 95% CI(1.41,2.28),P<0.000 01].Zoledronic acid was less safe than alendronate sodium. Conclusion Compared with alendronate sodium,zoledronic acid could remarkably improve lumbar spine BMD,femoral neck BMD,effectively reduce VAS score,ODI,for which it could improve the quality of patient’s life significantly.However,there were relatively many adverse reactions.

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