甲状旁腺激素预防和治疗绝经后骨质疏松症疗效的系统评价

目的系统评价甲状旁腺激素（PTH）预防和治疗绝经后骨质疏松症的疗效和安全性。方法计算机检索MEDLINE（1966～2008．3）、EMBASE（1974—2008．3）、Cochrane图书馆临床试验资料库（2008年第1期）、Current Controlled Trials、The National Reseach Register、中国生物医学文献数据库（1983—2008．3）、中国期刊全文数据库（1994～2008．3），并手工检索相关领域其它杂志。检索不受语种限制，时间截至2008年3月。纳入以患原发性质疏松症或骨量减少的绝经后女性为研究对象、比较甲状旁腺激素与其它疗法疗效的随机对照试验，评价纳入研究的质量，并用RevMan4．2．10软件进行Meta分析。结果共纳入12个随机对照试验，包括5550例患者。Meta分析结果显示：PTH单用或与其它药物联用与对照组比较，减少椎体骨折风险达66％RR=0．34，95％CI（0．26，0．45），P〈0．00001]；增加腰椎SMD=0．41，95％CI（0．19，O．63），P=0．0003]和股骨颈SMD=0．19，95％CI（0．10，0．28），P〈0．0001]的骨密度优于对照组。PTH发生副作用导致的退出和失访多于对照组Peto—OR=1．69，95% CI（1．39，2．05），P〈0．00001]。结论PTH预防和治疗绝经后骨质疏松症疗效肯定，能提高腰椎及股骨颈的骨密度，降低椎体骨折的风险。PFH对绝经后骨质疏松症的疗效优于阿伦磷酸盐，但不宜和阿伦磷酸盐联合使用，骨量严重低下和有骨质疏松性骨折的绝经后女性是PTH较适合的人群。

Parathyroid Hormone for the Prevention and Treatment of Postmenopausal Osteoporosis: A Systematic Review

Objective To assess the efficacy and safety of parathyroid hormone （PTH） on bone mineral density （BMD） and fractures in postmenopausal women with osteoporosis. Methods We searched MEDLINE （1966 to March 2008）, EMBASE （1974 to March 2008）, The Cochrane Library （Issue 1, 2008）, Current Controlled Trials, The National Research Register, CBM （1983 to March 2008） and CNKI （1994 to March 2008）. Some related journals were hand searched as well. The quality of included randomized controlled trials （RCTs） was evaluated and meta-analysis was conducted by The Cochrane Collaboration＇s software RevMan 4.2.10. Results Twelve studies involving 5550 patients were included. PTH alone or in combination with antiresorptive drugs reduced the risk of vertebral fracture （RR=0.34, 95% CI 0.26 to 0.45, P〈0.000 01）, and increased spine BMD （SMD 0.41, 95% CI 0.17 to 0.65, P=0.0009） and femoral neck BMD （SMD 0.13, 95% CI 0.03 to 0.22, P=0.008）. The rate of drop out and loss to follow-up because of adverse events was significantly higher in the PTH group （Peto-OR=l.69, 95%CI 1.39 to 2.05, P〈0.000 01）. Conclusion PTH is effective in the prevention and treatment of postmenopausal osteoporosis, especially in patients with preexisting osteoporotic fractures or with very low bone density. PTH alone or in combination with antiresorptive drugs can reduce the risk of vertebral fractures and increase spine and femoral neck BMD. PTH is more effective than alendronate, but these two should not be used as a combined treatment.