硫酸/盐酸氨基葡萄糖治疗骨关节炎的Meta分析
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摘要
目的评价硫酸/盐酸氨基葡萄糖治疗骨关节炎的有效性及安全性。方法系统检索Medline数据库、Embase数据库和Cochrane图书馆硫酸/盐酸氨基葡萄糖治疗骨关节炎的随机对照研究,采用Cochrane质量评价标准进行定量化质量评估,采用Rev Man 5.3进行系统统计分析。结果共纳入15项随机对照研究,Meta分析研究结果发现,氨基葡萄糖可减轻骨关节炎疼痛程度(ES=-0.37,P<0.001)。进一步结果显示,与安慰剂相比,硫酸氨基葡萄糖可减轻骨关节炎疼痛,且差别具有统计学意义(ES=-0.54,P<0.001);而盐酸氨基葡萄糖亦可减轻骨关节炎疼痛,但差别无统计学意义(ES=-0.04,P=0.22)。硫酸/盐酸氨基葡萄糖不良反应发生率均较低。结论氨基葡萄糖可减轻骨关节炎疼痛,且安全性较好。
Objective To study the effectiveness and safety of sulphate/hydrochloride glucosamine for osteoarthritis(OA).Methods Databases of Medline, Embase and Cochrane library were searched for randomised, doubleblind, placebo-controlled trials(RCTs) concerning glucosamine treatment of OA. Quality evaluation were assessed by Cochrane quality evaluation standards and Meta-analysis by using Rev Man 5.3 were performed.Results A total of 15 studies contributed to the meta-analysis, revealing a large degree of inconsistency among the trials in terms of pain-reduction outcome: the combined ES in glucosamine trials was-0.37, P<0.001. Further, the combined ES in glucosamine sulphate trials was-0.54, P<0.001, the combined ES in glucosamine hydrochloride trials was-0.04, P=0.22. And safety analysis showed that the adverse event rate in the glucosamine group was low.Conclusions Glucosamine is effective for pain reduction in patients with knee OA and has a good safety.
Objective To study the effectiveness and safety of sulphate/hydrochloride glucosamine for osteoarthritis(OA).Methods Databases of Medline, Embase and Cochrane library were searched for randomised, doubleblind, placebo-controlled trials(RCTs) concerning glucosamine treatment of OA. Quality evaluation were assessed by Cochrane quality evaluation standards and Meta-analysis by using Rev Man 5.3 were performed.Results A total of 15 studies contributed to the meta-analysis, revealing a large degree of inconsistency among the trials in terms of pain-reduction outcome: the combined ES in glucosamine trials was-0.37, P<0.001. Further, the combined ES in glucosamine sulphate trials was-0.54, P<0.001, the combined ES in glucosamine hydrochloride trials was-0.04, P=0.22. And safety analysis showed that the adverse event rate in the glucosamine group was low.Conclusions Glucosamine is effective for pain reduction in patients with knee OA and has a good safety.
引文
[1] 中华医学会风湿病学分会. 骨关节炎诊断及治疗指南[J].中华风湿病学杂志,2010,14(6):416-419.
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[3] 陈庆奇,龚敬乐.基于国内外指南的适用于我国全科医疗的膝骨关节炎诊治流程[J].中国全科医学,2016,19(2):125-129.
[4] WANDEL S, JüNI P, TENDAL B, et al. Effects of glucosamine, chondroitin, or placebo in patients with osteoarthritis of hip or knee: network meta-analysis[J]. BMJ, 2010, 341(7775): 711.
[5] WU D, HUANG Y, GU Y, et al. Efficacies of different preparations of glucosamine for the treatment of osteoarthritis: a meta-analysis of randomised, double-blind, placebo-controlled trials[J]. International Journal of Clinical Practice, 2013, 67(6): 585-594.
[6] EEIKSEN P, BARTELS E M, ALTMAN R D, et al. Risk of Bias and Brand Explain the Observed Inconsistency in Trials on Glucosamine for Symptomatic Relief of Osteoarthritis: A Meta‐Analysis of Placebo‐Controlled Trials [J]. Osteoarthritis & Cartilage, 2014, 66(12): 1844-1855.
[7] ZENG C, WEI J, LI H, et al. Effectiveness and safety of Glucosamine, chondroitin, the two in combination, or celecoxib in the treatment of osteoarthritis of the knee[J]. Scientific Reports, 2015, 5: 16827.
[8] HIGGINS JP, OMPSON SG, DEEKS JJ, et al. Measuring inconsistency in meta-analyses [J]. BMJ, 2003, 327(7414): 557-560.
[9] PUIALTE JM, LLAVORE EP, YLESCUPIDEZ FR. Double-blind clinical evaluation of oral glucosamine sulphate in the basic treatment of osteoarthrosis[J]. Current Medical Research & Opinion, 1980, 7(2): 110-114.
[10] HOUPT JB, MCMILLAN R, WEIN C, et al. Effect of glucosamine hydrochloride in the treatment of pain of osteoarthritis of the knee[J]. Journal of Rheumatology, 1999, 26(11): 2423.
[11] REGINSTER JY, DEROISY R, ROVATI LC, et al. Long-term effects of glucosamine sulphate on osteoarthritis progression: a randomised, placebo-controlled clinical trial [J]. The Lancet, 2001, 357(9252): 251-256.
[12] ZENK JL, HELMER TR, KUSKOWSKI MA. The effects of milk protein concentrate on the symptoms of osteoarthritis in adults: an exploratory, randomized, double-blind, placebo-controlled trial [J]. Current Therapeutic Research, 2002, 63(7): 430-442.
[13] PAVELKA K, GATTEROVA JM, MACHACEK S, et al. Glucosamine sulfate use and delay of progression of knee osteoarthritis: a 3-year, randomized, placebo-controlled, double-blind study[J]. Archives of Internal Medicine, 2002, 162(18): 2113.
[14] MCALINDON T, FORMICA M, LAVALLEY M, et al. Effectiveness of glucosamine for symptoms of knee osteoarthritis: results from an internet-based randomized double-blind controlled trial [J]. The American journal of medicine, 2004, 117(9): 643-649.
[15] CIBERE J, KOPEC JA, THORNE A, et al. Randomized, double-blind, placebo-controlled glucosamine discontinuation trial in knee osteoarthritis[J]. Arthritis & Rheumatism, 2004, 51(5): 738-745.
[16] CLEGG DO, REDA DJ, HARRIS CL, et al. Glucosamine, chondroitin sulfate, and the two in combination for painful knee osteoarthritis[J]. New England Journal of Medicine, 2006, 354(8): 795.
[17] HERRERO-BEAUMONT G, IVORRA JA, DEL CARMEN TRABADO M, et al. Glucosamine sulfate in the treatment of knee osteoarthritis symptoms: a randomized, double-blind, placebo-controlled study using acetaminophen as a side comparator[J]. Arthritis and rheumatism, 2007, 56(2): 555-567.
[18] FRESTEDT JL, WALSH M, KUSKOWSKI MA, et al. A natural mineral supplement provides relief from knee osteoarthritis symptoms: a randomized controlled pilot trial [J]. Nutrition journal, 2008, 17: 79.
[19] GIORDANO N, FIORAVANTI A, PAPAKOSTAS P, et al. The efficacy and tolerability of glucosamine sulfate in the treatment of knee osteoarthritis: A randomized, double-blind, placebo-controlled trial [J]. Current therapeutic research, clinical and experimental, 2009, 70(3): 185-196.
[20] ROZENDAAL RM, UITTERLINDEN EJ, VAN OSCH GJ, et al. Effect of glucosamine sulphate on joint space narrowing, pain and function in patients with hip osteoarthritis; subgroup analyses of a randomized controlled trial[J]. Osteoarthritis and cartilage, 2009, 17(4): 427-432.
[21] SAWITZKE AD, SHI H, FINCO MF, et al. Clinical efficacy and safety of glucosamine, chondroitin sulphate, their combination, celecoxib or placebo taken to treat osteoarthritis of the knee: 2-year results from GAIT [J]. Annals of the rheumatic diseases, 2010, 69(8): 1459-1464.
[22] KWOH CK, ROEMER FW, HANNON MJ, et al. Effect of oral glucosamine on joint structure in individuals with chronic knee pain: a randomized, placebo-controlled clinical trial [J]. Arthritis & rheumatology, 2014, 66(4): 930-939.
[23] FRANSEN M, AGALIOTIS M, NAIN L, et al. Glucosamine and chondroitin for knee osteoarthritis: a double-blind randomised placebo-controlled clinical trial evaluating single and combination regimens[J]. Annals of the rheumatic diseases, 2015, 74(5): 851-858.
[24] VLAD SC, LAVALLEY M P, MCALINDON TE, et al. Glucosamine for pain in osteoarthritis: Why do trial results differ[J]. Arthritis Rheum, 2007, 56(7): 2267-2277.
[2] 张伟滨.氨基葡萄糖治疗骨关节炎的专家共识[J].中华外科杂志,2008,46(18):1437-1438.
[3] 陈庆奇,龚敬乐.基于国内外指南的适用于我国全科医疗的膝骨关节炎诊治流程[J].中国全科医学,2016,19(2):125-129.
[4] WANDEL S, JüNI P, TENDAL B, et al. Effects of glucosamine, chondroitin, or placebo in patients with osteoarthritis of hip or knee: network meta-analysis[J]. BMJ, 2010, 341(7775): 711.
[5] WU D, HUANG Y, GU Y, et al. Efficacies of different preparations of glucosamine for the treatment of osteoarthritis: a meta-analysis of randomised, double-blind, placebo-controlled trials[J]. International Journal of Clinical Practice, 2013, 67(6): 585-594.
[6] EEIKSEN P, BARTELS E M, ALTMAN R D, et al. Risk of Bias and Brand Explain the Observed Inconsistency in Trials on Glucosamine for Symptomatic Relief of Osteoarthritis: A Meta‐Analysis of Placebo‐Controlled Trials [J]. Osteoarthritis & Cartilage, 2014, 66(12): 1844-1855.
[7] ZENG C, WEI J, LI H, et al. Effectiveness and safety of Glucosamine, chondroitin, the two in combination, or celecoxib in the treatment of osteoarthritis of the knee[J]. Scientific Reports, 2015, 5: 16827.
[8] HIGGINS JP, OMPSON SG, DEEKS JJ, et al. Measuring inconsistency in meta-analyses [J]. BMJ, 2003, 327(7414): 557-560.
[9] PUIALTE JM, LLAVORE EP, YLESCUPIDEZ FR. Double-blind clinical evaluation of oral glucosamine sulphate in the basic treatment of osteoarthrosis[J]. Current Medical Research & Opinion, 1980, 7(2): 110-114.
[10] HOUPT JB, MCMILLAN R, WEIN C, et al. Effect of glucosamine hydrochloride in the treatment of pain of osteoarthritis of the knee[J]. Journal of Rheumatology, 1999, 26(11): 2423.
[11] REGINSTER JY, DEROISY R, ROVATI LC, et al. Long-term effects of glucosamine sulphate on osteoarthritis progression: a randomised, placebo-controlled clinical trial [J]. The Lancet, 2001, 357(9252): 251-256.
[12] ZENK JL, HELMER TR, KUSKOWSKI MA. The effects of milk protein concentrate on the symptoms of osteoarthritis in adults: an exploratory, randomized, double-blind, placebo-controlled trial [J]. Current Therapeutic Research, 2002, 63(7): 430-442.
[13] PAVELKA K, GATTEROVA JM, MACHACEK S, et al. Glucosamine sulfate use and delay of progression of knee osteoarthritis: a 3-year, randomized, placebo-controlled, double-blind study[J]. Archives of Internal Medicine, 2002, 162(18): 2113.
[14] MCALINDON T, FORMICA M, LAVALLEY M, et al. Effectiveness of glucosamine for symptoms of knee osteoarthritis: results from an internet-based randomized double-blind controlled trial [J]. The American journal of medicine, 2004, 117(9): 643-649.
[15] CIBERE J, KOPEC JA, THORNE A, et al. Randomized, double-blind, placebo-controlled glucosamine discontinuation trial in knee osteoarthritis[J]. Arthritis & Rheumatism, 2004, 51(5): 738-745.
[16] CLEGG DO, REDA DJ, HARRIS CL, et al. Glucosamine, chondroitin sulfate, and the two in combination for painful knee osteoarthritis[J]. New England Journal of Medicine, 2006, 354(8): 795.
[17] HERRERO-BEAUMONT G, IVORRA JA, DEL CARMEN TRABADO M, et al. Glucosamine sulfate in the treatment of knee osteoarthritis symptoms: a randomized, double-blind, placebo-controlled study using acetaminophen as a side comparator[J]. Arthritis and rheumatism, 2007, 56(2): 555-567.
[18] FRESTEDT JL, WALSH M, KUSKOWSKI MA, et al. A natural mineral supplement provides relief from knee osteoarthritis symptoms: a randomized controlled pilot trial [J]. Nutrition journal, 2008, 17: 79.
[19] GIORDANO N, FIORAVANTI A, PAPAKOSTAS P, et al. The efficacy and tolerability of glucosamine sulfate in the treatment of knee osteoarthritis: A randomized, double-blind, placebo-controlled trial [J]. Current therapeutic research, clinical and experimental, 2009, 70(3): 185-196.
[20] ROZENDAAL RM, UITTERLINDEN EJ, VAN OSCH GJ, et al. Effect of glucosamine sulphate on joint space narrowing, pain and function in patients with hip osteoarthritis; subgroup analyses of a randomized controlled trial[J]. Osteoarthritis and cartilage, 2009, 17(4): 427-432.
[21] SAWITZKE AD, SHI H, FINCO MF, et al. Clinical efficacy and safety of glucosamine, chondroitin sulphate, their combination, celecoxib or placebo taken to treat osteoarthritis of the knee: 2-year results from GAIT [J]. Annals of the rheumatic diseases, 2010, 69(8): 1459-1464.
[22] KWOH CK, ROEMER FW, HANNON MJ, et al. Effect of oral glucosamine on joint structure in individuals with chronic knee pain: a randomized, placebo-controlled clinical trial [J]. Arthritis & rheumatology, 2014, 66(4): 930-939.
[23] FRANSEN M, AGALIOTIS M, NAIN L, et al. Glucosamine and chondroitin for knee osteoarthritis: a double-blind randomised placebo-controlled clinical trial evaluating single and combination regimens[J]. Annals of the rheumatic diseases, 2015, 74(5): 851-858.
[24] VLAD SC, LAVALLEY M P, MCALINDON TE, et al. Glucosamine for pain in osteoarthritis: Why do trial results differ[J]. Arthritis Rheum, 2007, 56(7): 2267-2277.