补肾中成药对绝经后骨质疏松症骨代谢影响的Meta分析
|
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
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
引文
[1] 中华医学会骨质疏松和骨矿盐疾病分会.原发性骨质疏松症诊疗指南(2017)[J].中华骨质疏松和骨矿盐疾病杂志,2017,10(5):413-443.
[2] Rosen CJ.Romosozumab-promising or practice changing? [J].N Engl J Med, 2017,377(15):1479-1480.
[3] Tabatabaei-Malazy O, Salari P, Khashayar P, et al. New horizons in treatment of osteoporosis[J]. Daru,2017,25(1):2.
[4] Tabatabaei-Malazy O,Larijani B,Abdollahi M.Targeting metabolic disorders by natural products[J].J Diabetes Metab Disord,2015,14(1):57.
[5] Moher David,Liberati Alessandro,Tetzlaff Jennifer,等. 系统综述和荟萃分析优先报告的条目:PRISMA声明[J].中西医结合学报,2009,7(9):889-896.
[6] 王丽丽,房经武,王金国.补肾生骨颗粒对肾虚血瘀型绝经后骨质疏松症BMD、E_2、BALP、N-MID的影响[J].世界中医药,2017,12(2):293-298.
[7] 展磊,魏秋实.补肾活血药对绝经后骨质疏松妇女血清骨代谢因子的调控作用[J].中国骨质疏松杂志,2016,22(9):1128-1132.
[8] 杨通宇,胡建山,李文忠,等.鹿角壮骨胶囊治疗绝经后骨质疏松症患者的临床疗效观察[J].中国妇幼保健,2016,31(5):1034-1036.
[9] 李萍,沈霖,杨艳萍,等.青娥丸治疗绝经后骨质疏松症(肾虚血瘀证)的临床研究[J].中西医结合研究, 2014,6(6):281-285.
[10] Hwang YC,Jeong IK,Ahn KJ,et al.The effects of acanthopanax senticosus extract on bone turnover and bone mineral density in Korean postmenopausal women[J].J Bone Miner Metab, 2009,27(5):584-590.
[11] 周广文,向楠,沈霖,等.加味青娥丸对绝经后骨质疏松症患者的骨密度、骨转换标志物及血清MGP水平的影响[J].中国中医骨伤科杂志,2016,24(3):4-8.
[12] 余海,徐晓娟,沈霖,等.青娥丸对绝经后骨质疏松症患者骨密度、骨转换标志物及骨桥蛋白的影响[J].中国中医骨伤科杂志,2016,24(1):21-23.
[13] 徐晓娟. 绝经后骨质疏松Wnt/β-catenin信号通路与骨代谢相关因子的临床研究与青娥丸的治疗作用[D]. 武汉:华中科技大学, 2013.
[14] 王晓东,邓伟民,洪曼杰,等.护骨胶囊治疗绝经后妇女骨质疏松症的临床研究[J].实用医学杂志,2011,27(9):1662-1664.
[15] 郑文奎,刘春颖,韩翠玉,等.金乌骨通胶囊治疗绝经后骨质疏松症的临床研究[J].中国中医骨伤科杂志,2007,15(3):30-32.
[16] 曾明,卢培,杨冰,等.金天格胶囊在绝经后骨质疏松症的治疗效果分析[J].中国骨质疏松杂志, 2016,22(4):480-482.
[17] 卞庆来,邹小娟,沈霖.青娥丸治疗绝经后骨质疏松症肾虚血瘀证的疗效观察[J].中华中医药杂志,2018,33(1):308-312.
[18] 魏圣青.左归丸联合阿仑膦酸钠治疗绝经后骨质疏松症的临床研究[J].现代药物与临床,2017,32(6):1048-1051.
[19] 戴燚,沈霖,杨艳萍,等.密骨片对绝经后骨质疏松症骨密度、血清骨保护蛋白及其配体水平和骨代谢指标的影响[J].中国中西医结合杂志,2007,27(8):696-699.
[20] Zhang RH,Chen KJ,Lu DX.A clinical study of Yigu capsule in treating postmenopausal osteoporosis[J]. Chin J Integr Med,2005,11(2):97-103.
[21] Vickers A,Goyal N,Harland R,et al. Do certain countries produce only positive results? A systematic review of controlled trials[J].Control Clin Trials,1998,19(2):159-166.
[22] 肖亚平,曾杰,焦琳娜,等.补肾中药对骨质疏松症的治疗及其信号通路调节作用的研究进展[J].中国中药杂志,2018,43(1):21-30.
[23] 郭晓宇,李唯,陈克明,等.淫羊藿苷通过PI3K/AKT-eNOS信号途径促进大鼠骨髓基质细胞的成骨性分化[J].中国药理学通报,2013,29(7):966-970.
[24] 王明宁,胡琳,侯成荣,等.刺五加、黄芪、参麦、生脉注射液对大鼠骨髓间充质干细胞增殖的影响比较[J].山东医药,2009,49(6):38-39.
[25] 赵亮,刘静.治疗原发性骨质疏松症的单味中药研究进展[J].现代中西医结合杂志,2017,26(4):451-454.
[26] Liu Y,Liu JP,Xia Y.Chinese herbal medicines for treating osteoporosis[J].Cochrane Database of Systematic Reviews, 2014, 3(3):CD005467.
[2] Rosen CJ.Romosozumab-promising or practice changing? [J].N Engl J Med, 2017,377(15):1479-1480.
[3] Tabatabaei-Malazy O, Salari P, Khashayar P, et al. New horizons in treatment of osteoporosis[J]. Daru,2017,25(1):2.
[4] Tabatabaei-Malazy O,Larijani B,Abdollahi M.Targeting metabolic disorders by natural products[J].J Diabetes Metab Disord,2015,14(1):57.
[5] Moher David,Liberati Alessandro,Tetzlaff Jennifer,等. 系统综述和荟萃分析优先报告的条目:PRISMA声明[J].中西医结合学报,2009,7(9):889-896.
[6] 王丽丽,房经武,王金国.补肾生骨颗粒对肾虚血瘀型绝经后骨质疏松症BMD、E_2、BALP、N-MID的影响[J].世界中医药,2017,12(2):293-298.
[7] 展磊,魏秋实.补肾活血药对绝经后骨质疏松妇女血清骨代谢因子的调控作用[J].中国骨质疏松杂志,2016,22(9):1128-1132.
[8] 杨通宇,胡建山,李文忠,等.鹿角壮骨胶囊治疗绝经后骨质疏松症患者的临床疗效观察[J].中国妇幼保健,2016,31(5):1034-1036.
[9] 李萍,沈霖,杨艳萍,等.青娥丸治疗绝经后骨质疏松症(肾虚血瘀证)的临床研究[J].中西医结合研究, 2014,6(6):281-285.
[10] Hwang YC,Jeong IK,Ahn KJ,et al.The effects of acanthopanax senticosus extract on bone turnover and bone mineral density in Korean postmenopausal women[J].J Bone Miner Metab, 2009,27(5):584-590.
[11] 周广文,向楠,沈霖,等.加味青娥丸对绝经后骨质疏松症患者的骨密度、骨转换标志物及血清MGP水平的影响[J].中国中医骨伤科杂志,2016,24(3):4-8.
[12] 余海,徐晓娟,沈霖,等.青娥丸对绝经后骨质疏松症患者骨密度、骨转换标志物及骨桥蛋白的影响[J].中国中医骨伤科杂志,2016,24(1):21-23.
[13] 徐晓娟. 绝经后骨质疏松Wnt/β-catenin信号通路与骨代谢相关因子的临床研究与青娥丸的治疗作用[D]. 武汉:华中科技大学, 2013.
[14] 王晓东,邓伟民,洪曼杰,等.护骨胶囊治疗绝经后妇女骨质疏松症的临床研究[J].实用医学杂志,2011,27(9):1662-1664.
[15] 郑文奎,刘春颖,韩翠玉,等.金乌骨通胶囊治疗绝经后骨质疏松症的临床研究[J].中国中医骨伤科杂志,2007,15(3):30-32.
[16] 曾明,卢培,杨冰,等.金天格胶囊在绝经后骨质疏松症的治疗效果分析[J].中国骨质疏松杂志, 2016,22(4):480-482.
[17] 卞庆来,邹小娟,沈霖.青娥丸治疗绝经后骨质疏松症肾虚血瘀证的疗效观察[J].中华中医药杂志,2018,33(1):308-312.
[18] 魏圣青.左归丸联合阿仑膦酸钠治疗绝经后骨质疏松症的临床研究[J].现代药物与临床,2017,32(6):1048-1051.
[19] 戴燚,沈霖,杨艳萍,等.密骨片对绝经后骨质疏松症骨密度、血清骨保护蛋白及其配体水平和骨代谢指标的影响[J].中国中西医结合杂志,2007,27(8):696-699.
[20] Zhang RH,Chen KJ,Lu DX.A clinical study of Yigu capsule in treating postmenopausal osteoporosis[J]. Chin J Integr Med,2005,11(2):97-103.
[21] Vickers A,Goyal N,Harland R,et al. Do certain countries produce only positive results? A systematic review of controlled trials[J].Control Clin Trials,1998,19(2):159-166.
[22] 肖亚平,曾杰,焦琳娜,等.补肾中药对骨质疏松症的治疗及其信号通路调节作用的研究进展[J].中国中药杂志,2018,43(1):21-30.
[23] 郭晓宇,李唯,陈克明,等.淫羊藿苷通过PI3K/AKT-eNOS信号途径促进大鼠骨髓基质细胞的成骨性分化[J].中国药理学通报,2013,29(7):966-970.
[24] 王明宁,胡琳,侯成荣,等.刺五加、黄芪、参麦、生脉注射液对大鼠骨髓间充质干细胞增殖的影响比较[J].山东医药,2009,49(6):38-39.
[25] 赵亮,刘静.治疗原发性骨质疏松症的单味中药研究进展[J].现代中西医结合杂志,2017,26(4):451-454.
[26] Liu Y,Liu JP,Xia Y.Chinese herbal medicines for treating osteoporosis[J].Cochrane Database of Systematic Reviews, 2014, 3(3):CD005467.
© 2004-2018 中国地质图书馆版权所有 京ICP备05064691号 京公网安备11010802017129号 地址：北京市海淀区学院路29号 邮编：100083 电话：办公室：(+86 10)66554848；文献借阅、咨询服务、科技查新：66554700 |