中国骨质疏松杂志

系统评价导引治疗骨质疏松症的Meta分析

A systematic evaluation of meta-analysis of guided therapy for osteoporosis

DOI：10.3969/j.issn.1006-7108.2020.07.003

英文关键词:osteoporosis guided bone mineral density meta-analysis

基金项目:国家自然科学基金（81603635）；国家重大疑难疾病中西医临床协作试点课题[ZY(2018-2020)-FWTX-2006]；上海市申康医院发展中心课题（16CR3074B，16CR4011A）；上海市科学技术委员会课题（16401930600，17401934400，18401903200）；上海市卫生与计划生育委员会课题（20164Y0081，ZYKC201701003，201840010）

作者	单位
周晓宁1 许金海1 王国栋1 尹萌辰1 叶洁1 马俊明1 莫文1，2，3* 施杞1，2，3	1.上海中医药大学附属龙华医院，上海 200032 2.上海中医药大学脊柱病研究所，上海 200032 3.上海市施杞名中医工作室，上海 200032

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中文摘要:

目的系统评价导引治疗骨质疏松症的有效性及安全性。方法计算机检索中、英文数据库(自建库至2019年4月)中收录的导引治疗骨质疏松症的临床随机对照文献，依据JADAD评估质量，并用RevMan 5.3 进行Meta分析。结果检索文献共289篇，纳入9篇，总样本量808例。Meta分析得出：导引+常规VS常规干预改善VAS评分[MD=-1.06，95％CI(-1.31，-0.82)，P＜0.00001]、腰椎骨密度[MD=0.09，95％CI(0.01，0.16)，P=0.02]、股骨颈骨密度[MD=0.13，95％CI(0.00，0.25)，P=0.05]、血清磷[MD=0.02，95CI(0.00，0.04)，P=0.05]均优于常规治疗，且差异有统计学意义。对血清钙[MD=-0.53，95％CI(-1.48，0.41)，P=0.27]、血清碱性磷酸酶[MD=-0.18，95％CI(-11.90，11.53)，P=0.98]的改善未见明显差异。导引VS传统锻炼改善VAS评分[MD=-1.66，95％CI(-2.57，-0.74)，P=0.0004]、腰椎骨密度[MD=0.11，95％CI(0.02，0.20)，P=0.01]、股骨颈骨密度[MD=0.08，95CI(0.01，0.14)，P=0.02]疗效均优于传统锻炼。结论导引治疗骨质疏松症在改善VAS评分、腰椎骨密度、股骨颈骨密度均优于常规干预，且与西药联用具有增效作用。

英文摘要:

Objective To evaluate the effectiveness and safety of guided therapy for osteoporosis. Methods The literatures of randomized controlled clinical trials on the treatment of osteoporosis included in Chinese and English databases (from inception to April 2019) were screened. The quality was evaluated according to JADAD. Meta-analysis was performed using a RevMan 5.3 software. Results A total of 289 references were retrieved, and 9 were included, with 808 cases. Meta-analysis showed that guided therapy + conventional vs. conventional therapy relieved VAS score [MD=-1.06, 95%CI(-1.31,-0.82), P<0.00001], and improved bone mineral density of the lumbar spine [MD=0.09, 95%CI(0.01,0.16), P=0.02], bone mineral density of the femoral neck [MD=0.13, 95%CI(0.00,0.25), P=0.05], and serum phosphorus [MD=0.02, 95%CI(0.00,0.04), P=0.05], and the differences were statistically significant. The difference of serum calcium [MD=0.53, 95%CI(1.48, 0.41), P=0.27] and serum alkaline phosphatase [MD=0.18, 95%CI(11.90, 11.53), P=0.98] were not obvious. The efficacy of guided therapy vs conventional exercise in relieving VAS [MD=-1.66, 95%CI(-2.57, -0.74), P=0.0004], and improving bone mineral density of the lumbar spine [MD=0.11, 95%CI(0.02, 0.20), P=0.01] and the femoral neck [MD=0.08, 95%CI(0.01, 0.14), P=0.02] were better than that of traditional exercise. Conclusion The guided therapy for the treatment of osteoporosis is superior to conventional intervention in relieving VAS score, improving bone mineral density of the lumbar spine and femoral neck. It has synergistic effect when combined with Western medicine.

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