丙戊酸对癫痫患儿骨代谢影响的Meta分析

目的采用Meta分析方法定量分析丙戊酸对癫痫患儿骨代谢的影响。方法电子检索中国维普科技期刊数据库、万方数据库、中国知网、中国生物医学文献数据库、EMCC、PubMed、OVID及Cochrance图书馆，纳入丙戊酸对癫痫患儿骨代谢影响的观察性研究，采用NOS量表评估纳入文献的质量。采用RevMan5．2软件进行Meta分析。结果14篇文献（英文10篇，中文4篇）进入Meta分析，均为病例对照研究，累计病例组507例，对照组480例。Meta分析结果显示，丙戊酸对血钙（MD=0．0l，95％CI：-0．05—0．06，P=0．13）、血磷（MD=-0．03，95％CI：-0．19—0．13，P=0．67）、碱性磷酸酶（MD=0．37，95％CI：-19．02～19．77，P=0．97）无明显影响，但丙戊酸组骨密度低于对照组，MD=-0．03，95％CI：-0．06～-0．00，P=0．03；丙戊酸组甲状旁腺激素水平显著高于对照组，MD=4．83，95％CI：1．15～8．50，P=0．01；丙戊酸组25-羟维生素D水平显著低于对照组，MD=-2．46，95％CI：-4．37～-0．55，P=0．01。结论现有证据表明，丙戊酸对癫痢患儿血钙、血磷和ALP无显著影响．但对骨密度、25-OH—VtiD和PTH有影响。

Meta-analysis of bone metabolism in epileptic children receiving valproic acid

Objective Through meta analysis to study the bone metabolism in epileptic children receiving valproic acid. Methods VIP,wanfang,CNKI, CBM,EMCC,Pubmed, OVID databases and Cochrance library were searched, included studies were all case-control studies and Review Manager 5.2 was used to analyze the data. The Newcastle Ottawa Scale （NOS） was used to evaluated the bias of included studies. Results A total of lg case-control studies （ 10 in English, 4 in Chinese） were included. Meta analysis showed that valproic acid had influenced bone mineral density, 25-OH-VtiD, parathyroid hormone, but no influence on calcium（ MD = 0.01,95% CI ： - 0.05 to 0.06, P = 0.13 ）, phosphorus （ MD = - O. 03,95% CI ： - 0.19 to O. 13, P = 0.67 ）, alkaline phosphatase（ MD =0.37,95% CI： -19.02 to 19.77 ,P--0.97）. Bone mineral density and 25-OH- VitD levels were lower in the VPA group than in the control group（ MD = - 0.03,95% CI ： - 0.06 to - 0.00,P = 0.03 ; MD -- - 2.46,95% CI ： - 4.37 to -0.55 ,P = 0.01, respectively）. Significantly higher parathyroid hormone level was found in valporic aid group than in control group（ MD = 4.83, 95% CI ： 1.15 to 8.50, P = O. 01 ）. Conclusion The study results indicated that valpruic acid did affect bone metabolism in epileptic children