中华内科杂志
中華內科雜誌
중화내과잡지
CHINESE JOURNAL OF INTERNAL MEDICINE
2013年
10期
838-843
,共6页
杨琳%田金徽%何智余%汤旭磊%杨克虎
楊琳%田金徽%何智餘%湯旭磊%楊剋虎
양림%전금휘%하지여%탕욱뢰%양극호
糖皮质激素类%骨质疏松%阿仑膦酸钠%Meta分析
糖皮質激素類%骨質疏鬆%阿崙膦痠鈉%Meta分析
당피질격소류%골질소송%아륜련산납%Meta분석
Glucocorticoids%Osteoporosis%Alendronate%Meta-analysis
目的 评价阿仑膦酸钠防治糖皮质激素导致的骨质疏松(GIOP)的有效性和安全性.方法 检索PubMed、EMBASE、Cochrane Library、Web of Science、中国生物医学文献数据库(CBM)、万方数据库,收集有关阿仑膦酸钠与安慰剂比较防治GIOP的随机对照试验(RCT),依据Jadad评分评价纳入RCT的质量,采用RevMan 5.1进行统计分析.结果 纳入7篇文献,共1111例患者.Meta分析显示,与安慰剂相比,阿仑膦酸钠治疗12个月可增加腰椎和股骨颈的骨密度(BMD)[均数差(MD)＝3.35,95％ CI(2.67 ～4.02),P=0.000;MD=1.90,95％ CI(0.89 ～2.92),P=0.000],治疗24个月增加腰椎BMD[MD＝3.91,95％ CI(2.37 ～5.45),P＜0.000],但没有增加股骨颈BMD[MD=1.91,95％ CI(-1.15 ～5.02),P＝0.22].在降低椎骨和非椎骨骨折风险方面与安慰剂相比差异无统计学意义[RR＝1.00,95％ CI (0.49 ～2.07),P=0.99;RR=1.02,95％ CI (0.49～2.14),P=0.95].阿仑膦酸钠与安慰剂相比不良事件发生率的差异无统计学意义[RR =0.97,95％CI (0.90～1.05),P＝0.47].结论 阿仑膦酸钠能增加患者腰椎和股骨颈BMD,且不良反应低,还没有证据表明可以降低骨折风险.今后,尚需要开展大样本RCT观察阿仑膦酸钠对股骨BMD的影响是否与用药时间有关以及进一步探索其能否降低骨折发生率.
目的 評價阿崙膦痠鈉防治糖皮質激素導緻的骨質疏鬆(GIOP)的有效性和安全性.方法 檢索PubMed、EMBASE、Cochrane Library、Web of Science、中國生物醫學文獻數據庫(CBM)、萬方數據庫,收集有關阿崙膦痠鈉與安慰劑比較防治GIOP的隨機對照試驗(RCT),依據Jadad評分評價納入RCT的質量,採用RevMan 5.1進行統計分析.結果 納入7篇文獻,共1111例患者.Meta分析顯示,與安慰劑相比,阿崙膦痠鈉治療12箇月可增加腰椎和股骨頸的骨密度(BMD)[均數差(MD)＝3.35,95％ CI(2.67 ～4.02),P=0.000;MD=1.90,95％ CI(0.89 ～2.92),P=0.000],治療24箇月增加腰椎BMD[MD＝3.91,95％ CI(2.37 ～5.45),P＜0.000],但沒有增加股骨頸BMD[MD=1.91,95％ CI(-1.15 ～5.02),P＝0.22].在降低椎骨和非椎骨骨摺風險方麵與安慰劑相比差異無統計學意義[RR＝1.00,95％ CI (0.49 ～2.07),P=0.99;RR=1.02,95％ CI (0.49～2.14),P=0.95].阿崙膦痠鈉與安慰劑相比不良事件髮生率的差異無統計學意義[RR =0.97,95％CI (0.90～1.05),P＝0.47].結論 阿崙膦痠鈉能增加患者腰椎和股骨頸BMD,且不良反應低,還沒有證據錶明可以降低骨摺風險.今後,尚需要開展大樣本RCT觀察阿崙膦痠鈉對股骨BMD的影響是否與用藥時間有關以及進一步探索其能否降低骨摺髮生率.
목적 평개아륜련산납방치당피질격소도치적골질소송(GIOP)적유효성화안전성.방법 검색PubMed、EMBASE、Cochrane Library、Web of Science、중국생물의학문헌수거고(CBM)、만방수거고,수집유관아륜련산납여안위제비교방치GIOP적수궤대조시험(RCT),의거Jadad평분평개납입RCT적질량,채용RevMan 5.1진행통계분석.결과 납입7편문헌,공1111례환자.Meta분석현시,여안위제상비,아륜련산납치료12개월가증가요추화고골경적골밀도(BMD)[균수차(MD)＝3.35,95％ CI(2.67 ～4.02),P=0.000;MD=1.90,95％ CI(0.89 ～2.92),P=0.000],치료24개월증가요추BMD[MD＝3.91,95％ CI(2.37 ～5.45),P＜0.000],단몰유증가고골경BMD[MD=1.91,95％ CI(-1.15 ～5.02),P＝0.22].재강저추골화비추골골절풍험방면여안위제상비차이무통계학의의[RR＝1.00,95％ CI (0.49 ～2.07),P=0.99;RR=1.02,95％ CI (0.49～2.14),P=0.95].아륜련산납여안위제상비불량사건발생솔적차이무통계학의의[RR =0.97,95％CI (0.90～1.05),P＝0.47].결론 아륜련산납능증가환자요추화고골경BMD,차불량반응저,환몰유증거표명가이강저골절풍험.금후,상수요개전대양본RCT관찰아륜련산납대고골BMD적영향시부여용약시간유관이급진일보탐색기능부강저골절발생솔.
Objective To assess the efficiency and safety of alendronate for the prevention and treatment of glucocorticoid-induced osteoporosis (GIOP).Methods The electronic databases of PubMed,EMBASE,Cochrane Library,Web of Science,Chinese BioMedical Literature Database (CBM) and Wanfang Data were searched for all randomized controlled trials (RCT) of alendronate vs.placebo.Two reviewers independently selected trials for inclusion,assessed trial quality using Jadad's scale and extracted the data.RevMan 5.1 software was used for data synthesis and Meta-analysis.Results Seven studies with 1111 patients were included.Compared with placebo,alendronate significantly increased bone mineral density (BMD) at the lumbar spine[MD ＝3.35,95％CI (2.67-4.02),P =0.000] and the femoral neck[MD =1.90,95％ CI (0.89-2.92),P =0.000] after 12 months of therapy.After 24 months of therapy,alendronate significantly increascd BMD at the lumbar spine [MD =3.91,95％ CI (2.37-5.45),P =0.000],but not at the femoral neck [MD =1.91,95％ CI (-1.15-5.02),P =0.22].Compared with placebo,no significant reduction was found by the use of alendronate in the incidence of vertebral fractures [RR =1.00,95％ CI (0.49-2.07),P =0.99] or nonvertebral fractures[RR ＝ 1.02,95％ CI (0.49-2.14),P =0.95].No difference was shown with the adverse event between the two groups[RR =0.97,95％ CI (0.90-1.05),P =0.47].Conclusions Alendronate is effective for the prevention and treatment of glucocorticoid-induced bone loss at the lumbar spine and the femoral neck with relatively good safety profile.Yet,there is no significant difference between the two groups in reducing the incidence of vertebral fractures and non-vertebral fractures.Large-scale RCT designed to observe whether different lengths of alendronate therapy will influence the efficiency should be conducted in the future and to further explore whether it can reduce the incidence of fractures.
