唑来膦酸注射液治疗糖尿病性骨质疏松疗效以及安全性Meta分析
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摘要
目的:评价唑来膦酸注射液治疗糖尿病性骨质疏松(Diabetic Osteoporosis,DO)的临床疗效及安全性。方法:依据Meta分析要求,对CBM、CNKI、PubMed、Springer、Embase Databases、Cochrane Library、中国科技论文统计与分析网、专利数据库等进行检索,纳入以唑来膦酸注射液作为主要干预措施治疗原发性骨质疏松症临床试验的研究文献,检索年限从建库至2018年8月,检索资料由两名研究人员独立进行提取,若有分歧,则由第三方协助并解决;采用Review Manager 5.3对有效性、骨密度进行系统评价。结果:最终纳入12篇文献,受试者共1034例。Meta分析结果显示,治疗组各项血液指标[包括血钙、血磷、血清I型胶原C末端肽(s-CTX)、抗酒石酸酸性磷酸酶(TRACP-5b)、血清骨钙素蛋白(BGP)]显著优于对照组,差异具有统计学意义。治疗组不同部位的视觉模拟评分(VAS)、骨密度值(腰椎、股骨颈、股骨大转子、华氏三角区)的改善情况显著优于对照组,差异有统计学意义。6篇文献发现明确的唑来膦酸注射液引起的药品不良反应,且对症治疗后症状均可消失。结论:唑来膦酸注射液对治疗DO有一定疗效,且具有一定安全性,但还需更多高质量的RCT进行分析才能对其疗效及安全性得出肯定性结论。
Objective :To systematically evaluate the efficacy of Zoledronic Acid Injection in the treatment of diabetic osteoporosis. Methods :According to Meta-analysis requirements,papers were searched in CBM,CNKI,PubMed,Springer,Embase Databases,Cochrane Library,Chinese Technical Paper Statistics and Analysis,Patent Databases,etc,and brought into clinical studies on the treatment of primary diabetic osteoporosis with Zoledronic Acid Injection as the main intervention measure from database founded to August 2018. All the information were extracted independently by two researchers and assisted and resolved by a third party if there gets some disagreement. The effectiveness and bone mineral density(BMD)are evaluated systematically by using the Review Manager 5.3. Results :12 references were finally included,and a total of 1034 subjects were enrolled. Meta-analysis showed that the treatment group in the blood of the indicators(including blood calcium,blood phosphorus,s-CTX,TRACP-5 b,BGP)significantly better than the control group,the difference had statistical meaning. The improvement of visual analogue score(VAS),bone mineral density(lumbar spine,femoral neck,femur big rotor and Fahrenheit triangle)in different parts of the treatment group was significantly better than that of the control group,and the difference was statistically justified. The adverse drug reactions caused by Zoledronic Acid Injection were found in 6 literatures,and symptoms disappeared after symptomatic treatment. Conclusion :Zoledronic Acid Injection has a certain effect on the treatment of DO,and has a certain degree of safety,but more high-quality RCTs are needed for analysis to reach a positive conclusion on its efficacy and safety.
Objective :To systematically evaluate the efficacy of Zoledronic Acid Injection in the treatment of diabetic osteoporosis. Methods :According to Meta-analysis requirements,papers were searched in CBM,CNKI,PubMed,Springer,Embase Databases,Cochrane Library,Chinese Technical Paper Statistics and Analysis,Patent Databases,etc,and brought into clinical studies on the treatment of primary diabetic osteoporosis with Zoledronic Acid Injection as the main intervention measure from database founded to August 2018. All the information were extracted independently by two researchers and assisted and resolved by a third party if there gets some disagreement. The effectiveness and bone mineral density(BMD)are evaluated systematically by using the Review Manager 5.3. Results :12 references were finally included,and a total of 1034 subjects were enrolled. Meta-analysis showed that the treatment group in the blood of the indicators(including blood calcium,blood phosphorus,s-CTX,TRACP-5 b,BGP)significantly better than the control group,the difference had statistical meaning. The improvement of visual analogue score(VAS),bone mineral density(lumbar spine,femoral neck,femur big rotor and Fahrenheit triangle)in different parts of the treatment group was significantly better than that of the control group,and the difference was statistically justified. The adverse drug reactions caused by Zoledronic Acid Injection were found in 6 literatures,and symptoms disappeared after symptomatic treatment. Conclusion :Zoledronic Acid Injection has a certain effect on the treatment of DO,and has a certain degree of safety,but more high-quality RCTs are needed for analysis to reach a positive conclusion on its efficacy and safety.
引文
[1]李晓宇,冯正平.糖尿病性骨质疏松发病机制的研究进展[J].中国骨质疏松杂志,2014,20(5):580-583.
[2]罗巧彦,徐勇.糖尿病与骨质疏松的研究进展[J].大连医科大学学报,2014,36(2):190-194.
[3]阿婷仁,马晓梅. 2型糖尿病合并骨质疏松的研究进展[J].世界最新医学信息文摘,2018,18(38):48-49.
[4]王寒啸.糖尿病并发骨质疏松发病机制的探究[J].中国医药指南,2018,16(21):19-20.
[5]冯正平,邓华聪.糖尿病性骨质疏松发病机制的研究进展[J].中国骨质疏松杂志,2012,18(3):281-285.
[6]史晶晶,胡玲.糖尿病性骨质疏松发病机制的研究进展[J].实用临床医学,2017,18(8):97-100.
[7]茹志成,杜凌超,郭彩霞. 2型糖尿病与骨质疏松的关系研究[J].中国当代医药,2018,25(24):53-55.
[8]何黎. 2型糖尿病并发骨质疏松临床分析[J].中国社区医师:医学专业,2012,14(5):58.
[9]张在慧,关小宏,吴石白.糖尿病骨质疏松发病机制的研究进展[J].医学综述,2012,18(21):3644-3646.
[10]张竹萍.糖尿病合并骨质疏松患者的安全管理[J].中西医结合心血管病电子杂志,2018,6(26):88.
[11]陈发秀,彭乐.唑来膦酸注射液治疗老年2型糖尿病并原发性骨质疏松症患者的疗效[J].南昌大学学报:医学版,2015,55(3):54-57.
[12]姜光萍.唑来膦酸治疗糖尿病合并骨质疏松患者的疗效观察[J].医学信息,2015,28(46):33-34.
[13]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].中国全科医学,2017,20(32):3963-3982.
[14]王玮琪,茹选良,刘春,等.阿托伐他汀联合阿仑膦酸钠治疗老年性骨质疏松的临床疗效及安全性评价[J].中国临床药理学杂志,2016,32(4):312-314.
[15]周彩云.唑来膦酸治疗2型糖尿病骨质疏松的临床疗效[J].保健医学研究与实践,2016,13(6):37-39.
[16]解皓,李海涛.唑来膦酸治疗糖尿病性骨质疏松症的疗效观察[J].临床合理用药杂志,2015,8(34):66-67.
[17]李国华,杨晓秋,晋利华.唑来膦酸注射液治疗糖尿病骨质疏松的临床疗效观察及对骨代谢的作用[J].贵州医药,2018,42(6):705-707.
[18]刘萍,吴明,王丽娟,等.唑来膦酸注射液治疗糖尿病骨质疏松患者的疗效研究[J].世界最新医学信息文摘,2015,15(98):10-16.
[19]郗华敏.唑来膦酸注射液治疗糖尿病骨质疏松患者的疗效研究[J].医药前沿,2017,7(33):181-183.
[20]朱红霞,王敏哲,李英,等.唑来膦酸钠治疗糖尿病性骨质疏松症的临床疗效研究[J].实用心脑肺血管病杂志,2013,21(12):40-42.
[21]边英.唑来膦酸联合辛伐他汀对老年糖尿病并骨质疏松临床疗效及骨代谢的影响[J].社区医学杂志,2016,14(17):73-75.
[22]韩瑞旸,武子朝,刘少军,等.唑来膦酸联合钙尔奇D治疗糖尿病性骨质疏松的临床疗效研究[J].现代生物医学进展,2015,15(1):104-106.
[23]赵伟平.唑来膦酸联合胰岛素治疗老年糖尿病骨质疏松症患者的临床疗效及其对骨相关代谢指标的影响[J].中国慢性病预防与控制,2017,25(6):457-459.
[24]钟方.唑来膦酸联合瑞舒伐他汀治疗老年糖尿病合并骨质疏松对患者骨代谢的影响[J].中外医疗,2017(35):21-23.
[25]刘莹,周晶,刘艳.补中益气汤联合钙剂、活性维生素D治疗糖尿病性骨质疏松症疗效观察[J].现代中西医结合杂志,2018,27(22):2424-2426.
[26]王燕君.唑来膦酸治疗糖尿病合并骨质疏松患者的临床疗效研究[J].双足与保健,2017,26(16):197-198.
[27]张帆,陈昆婵,李春芳.唑来膦酸治疗糖尿病性骨质疏松症的护理体会[J].浙江医学,2016,38(17):1454-1456.
[28]唐久阳,胡益雄,吴元成.唑来膦酸治疗糖尿病性骨质疏松症的疗效观察[J].现代诊断与治疗,2016,27(11):2047-2048.
[29]黄冰.唑来膦酸注射液联合钙尔奇D治疗糖尿病骨质疏松的临床效果及安全性[J].中国当代医药,2017,24(16):24-26.
[30]易佳佳,徐泽鹤.唑来膦酸联合碳酸钙D3治疗糖尿病性骨质疏松症的临床疗效[J].临床合理用药杂志,2018,11(24):52-53.
[2]罗巧彦,徐勇.糖尿病与骨质疏松的研究进展[J].大连医科大学学报,2014,36(2):190-194.
[3]阿婷仁,马晓梅. 2型糖尿病合并骨质疏松的研究进展[J].世界最新医学信息文摘,2018,18(38):48-49.
[4]王寒啸.糖尿病并发骨质疏松发病机制的探究[J].中国医药指南,2018,16(21):19-20.
[5]冯正平,邓华聪.糖尿病性骨质疏松发病机制的研究进展[J].中国骨质疏松杂志,2012,18(3):281-285.
[6]史晶晶,胡玲.糖尿病性骨质疏松发病机制的研究进展[J].实用临床医学,2017,18(8):97-100.
[7]茹志成,杜凌超,郭彩霞. 2型糖尿病与骨质疏松的关系研究[J].中国当代医药,2018,25(24):53-55.
[8]何黎. 2型糖尿病并发骨质疏松临床分析[J].中国社区医师:医学专业,2012,14(5):58.
[9]张在慧,关小宏,吴石白.糖尿病骨质疏松发病机制的研究进展[J].医学综述,2012,18(21):3644-3646.
[10]张竹萍.糖尿病合并骨质疏松患者的安全管理[J].中西医结合心血管病电子杂志,2018,6(26):88.
[11]陈发秀,彭乐.唑来膦酸注射液治疗老年2型糖尿病并原发性骨质疏松症患者的疗效[J].南昌大学学报:医学版,2015,55(3):54-57.
[12]姜光萍.唑来膦酸治疗糖尿病合并骨质疏松患者的疗效观察[J].医学信息,2015,28(46):33-34.
[13]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].中国全科医学,2017,20(32):3963-3982.
[14]王玮琪,茹选良,刘春,等.阿托伐他汀联合阿仑膦酸钠治疗老年性骨质疏松的临床疗效及安全性评价[J].中国临床药理学杂志,2016,32(4):312-314.
[15]周彩云.唑来膦酸治疗2型糖尿病骨质疏松的临床疗效[J].保健医学研究与实践,2016,13(6):37-39.
[16]解皓,李海涛.唑来膦酸治疗糖尿病性骨质疏松症的疗效观察[J].临床合理用药杂志,2015,8(34):66-67.
[17]李国华,杨晓秋,晋利华.唑来膦酸注射液治疗糖尿病骨质疏松的临床疗效观察及对骨代谢的作用[J].贵州医药,2018,42(6):705-707.
[18]刘萍,吴明,王丽娟,等.唑来膦酸注射液治疗糖尿病骨质疏松患者的疗效研究[J].世界最新医学信息文摘,2015,15(98):10-16.
[19]郗华敏.唑来膦酸注射液治疗糖尿病骨质疏松患者的疗效研究[J].医药前沿,2017,7(33):181-183.
[20]朱红霞,王敏哲,李英,等.唑来膦酸钠治疗糖尿病性骨质疏松症的临床疗效研究[J].实用心脑肺血管病杂志,2013,21(12):40-42.
[21]边英.唑来膦酸联合辛伐他汀对老年糖尿病并骨质疏松临床疗效及骨代谢的影响[J].社区医学杂志,2016,14(17):73-75.
[22]韩瑞旸,武子朝,刘少军,等.唑来膦酸联合钙尔奇D治疗糖尿病性骨质疏松的临床疗效研究[J].现代生物医学进展,2015,15(1):104-106.
[23]赵伟平.唑来膦酸联合胰岛素治疗老年糖尿病骨质疏松症患者的临床疗效及其对骨相关代谢指标的影响[J].中国慢性病预防与控制,2017,25(6):457-459.
[24]钟方.唑来膦酸联合瑞舒伐他汀治疗老年糖尿病合并骨质疏松对患者骨代谢的影响[J].中外医疗,2017(35):21-23.
[25]刘莹,周晶,刘艳.补中益气汤联合钙剂、活性维生素D治疗糖尿病性骨质疏松症疗效观察[J].现代中西医结合杂志,2018,27(22):2424-2426.
[26]王燕君.唑来膦酸治疗糖尿病合并骨质疏松患者的临床疗效研究[J].双足与保健,2017,26(16):197-198.
[27]张帆,陈昆婵,李春芳.唑来膦酸治疗糖尿病性骨质疏松症的护理体会[J].浙江医学,2016,38(17):1454-1456.
[28]唐久阳,胡益雄,吴元成.唑来膦酸治疗糖尿病性骨质疏松症的疗效观察[J].现代诊断与治疗,2016,27(11):2047-2048.
[29]黄冰.唑来膦酸注射液联合钙尔奇D治疗糖尿病骨质疏松的临床效果及安全性[J].中国当代医药,2017,24(16):24-26.
[30]易佳佳,徐泽鹤.唑来膦酸联合碳酸钙D3治疗糖尿病性骨质疏松症的临床疗效[J].临床合理用药杂志,2018,11(24):52-53.