系统评价导引治疗骨质疏松症的Meta分析

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Rev Man 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),P0.00001]、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。

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

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.