六味地黄丸治疗绝经后骨质疏松症疗效的系统评价和Meta分析

目的系统评价六味地黄丸治疗绝经后骨质疏松症(postmenopausal osteoporosis,PMOP)的疗效。方法系统检索CNKI、CBM、VIP、WanFang、PubMed、Embase、Cochrane图书馆,对纳入研究进行方法学质量评价,并采用Review Manager 5.3软件进行Meta分析。共纳入12篇文献,14个研究。结果Meta分析得出:六味地黄丸+常规治疗方案在治疗PMOP的有效率OR=1.22,95%CI(1.13~1.32),P<0.00001]、减轻患者疼痛方面MD=-0.50,95%CI(-0.77^-0.22),P=0.0004]疗效较好,对髋关节骨密度MD=0.55,95%CI(0.26~0.84),P=0.0002]的改善效果优于常规西药组。而单独使用六味地黄丸及联合单一常规干预措施对腰椎骨密度MD=0.05,95%CI(0.03~0.07),P<0.0001]改善情况优于常规西药。单独使用六味地黄丸对桡骨骨密度MD=0.02,95%CI(0.02~0.03),P<0.00001],尺骨骨密度MD=0.02,95%CI(0.01~0.03),P<0.0001]改善有一定的临床优势。结论六味地黄丸可以提高髋关节、腰椎、尺骨、桡骨的骨密度,并且在提高临床治疗绝经后骨质疏松症的有效率及减轻骨质疏松所造成的疼痛方面具有良好的效果。但在提高股骨颈密度方面证据不足,可能受多种因素影响。同时,六味地黄丸与常规治疗联用具有增强的效果,但联合多种药物时是否对绝经后骨质疏松有明确增效尚待研究。

The effect of Liuwei Dihuang pill on the treatment of postmenopausal osteoporosis: A systematic review and meta-analysis

Objective To evaluate the efficacy of Liuwei Dihuang pill on the treatment of postmenopausal osteoporosis (PMOP). Methods CNKI, CBM, VIP, WanFang, PubMed, Embase, and Cochrane library were systematically retrieved and the included studies were evaluated for the methodological quality. Meta-analysis was used with Review Manager 5.3 software for data analysis. A total of 12 literatures and 14 studies were included. Results Meta-analysis showed that Liuwei Dihuang pill + conventional treatment regimen was effective in the treatment of postmenopausal osteoporosis OR=1.22, 95%CI (1.13-1.32), P<0.00001]. The pain reduction was better MD=-0.50, 95% CI (-0.77-0.22), P=0.0004]. The improvement effect on hip bone mineral density was better than that of conventional Western medicine group MD= 0.55, 95% CI (0.26 - 0.84), P= 0.0002]. However, the improvement of lumbar vertebra density MD= 0.05, 95% CI (0. 03~0. 07), P<0.0001] by using Liuwei Dihuang pill alone or combined with a single routine intervention was better than that of conventional Western medicine. Liuwei Dihuang pill alone had certain clinical advantages in improving radial bone mineral density MD=0.02, 95% CI (0.02-0.003), P<0.00001], ulna bone mineral density MD=0.02, 95% CI (0.01-0.03), P<0.0001]. Conclusion Liuwei Dihuang pill is effective in improving bone mineral density of the hip, the lumbar vertebra, the ulna, and the radius. It improves the efficacy and relieves the pain of PMOP. However, there is insufficient evidence to improve femoral neck density, which may be affected by various factors. At the same time, Liuwei Dihuang pill has an enhanced effect in combination with conventional treatment. Whether the combination of multiple drugs is effective remains to be studied.