吸入性糖皮质激素与骨质疏松

目的吸入糖皮质激素为支气管哮喘缓解期治疗的一线药物,探讨哮喘患者长期大量吸入糖皮质激素是否有引起骨质疏松的危险. 资料来源应用计算机检索 Medline 1980- 01/2003- 12和 Embase 1980- 01/2003- 12 期间的有关糖皮质激素和骨质疏松关系的文献,检索词" asthma, bone density, bone metabolism, Inhaled glucocorticoids",并限定文章语言种类为 English.同时计算机检索 CBM、 CBMdisc系统,手工检索<中国临床康复>等杂志 1990- 01/2004- 04期间的相关文献,限定文章语言种类为中文,检索词"哮喘、骨密度、骨代谢、吸入糖皮质激素".研究对象为服用糖皮质激素的成年男性和绝经前女性哮喘患者. 资料选择选取试验包括吸入糖皮质激素治疗组和对照组的骨密度、骨代谢变化比较的相关文献,进行初审,删除明显不随机临床试验( RCT)的研究,然后查找余下的文献全文,进一步判断是否为 RCT.纳入标准① RCT,无论是否为单盲、双盲或非盲法;②平行对照组,即未使用激素的哮喘患者或健康对照;治疗组为吸入激素的哮喘患者.排除标准明显不随机的临床试验.质量评价主要考察资料的真实性 ,调查设计是否严密 ,实施过程是否严格 ,统计学处理是否合理. 资料提炼共检索 30篇关于研究吸入糖皮质激素对哮喘患者骨密度和骨代谢的影响的随机和未随机试验, 18个试验符合纳入标准.排除的 12篇试验中, 8篇是因重复的同一研究, 4篇是 Meta分析研究. 资料综合 18个试验包括 1153例患者,分别对使用吸入性激素的哮喘患者和未使用激素的对照组的骨密度和 (或 )骨代谢进行比较分析. 结论虽然长期吸入激素治疗哮喘对骨量影响的研究结果不相一致,但无充分证据证明长期吸入糖皮质激素治疗哮喘会引起骨质疏松.

Inhaled glucocorticoids and osteoporosis

OBJECTIVE:Inhaled glucocorticoids(GC) are the first-line medicine for bronchial asthma during relieve phase, thereby this study was designed to explore if patient tends to suffer osteoporosis due to long term inhalation of glucocorticoids. DATA SOURCES:Literatures about GC and osteoporosis were computer-searched in Medline and Embase from January 1980 to December 2003, with the key word of " asthma, bone density, bone metabolism and inhaled glucocorticoids" and language limited to English.Meanwhile it was also computer-searched in CBM, CBM disc and manually searched in Chinese Journal of Clinical Rehabilitation between January 1990 and April 2004 with language limited to Chinese. DATA SELECTION: Literatures about the comparison of bone density and bone metabolic change between inhaled GC group and control group were consorted deleting randomized controlled trial(RCT) so as to look up the whole content of healthy controls;While patients in the treatment group received GC inhalation.Exclusive standards:obvious non-RCT. Quality assessment is mainly focused on the reality of data,the strictness of design and implementation,and the rationality of statistical management. DATA EXTRACTION:Totally 30 randomized and nonrandomized studies about the influence of inhaled GC on the bone density and bone metabolism of patients with asthma were referred to amongst which 18 studies were admitted with the other 12 excluded for similarity in content in 8 and Meta-analysis in 4. DATA SYNTHESIS:A total of 1 153 asthmatic patients in 18 studies were divided into GC inhalation group and non-inhalation control group for comparing the difference of bone density and/or bone metabolism between them. CONCLUSION:Although the results of studies on the influence of long-term inhaled GC on bone quantity were different, but there was still not enough evidence to demonstrate that osteoporosis was due to long-term GC inhalation.