摘要
目的:系统评价中药复方治疗甲状腺功能亢进症致骨代谢异常的有效性和安全性。方法:检索中英文数据库,收集中药复方治疗甲状腺功能亢进症致骨量减少或骨质疏松的随机对照试验[研究组患者采用中药复方(汤剂、颗粒及中成药等剂型)或联合常规西药治疗;对照组患者采用常规西药治疗],检索时间为建库至2022年12月20日。应用Cochrane协作网偏倚风险评价工具进行文献质量评估后,采用RevMan 5.3软件进行Meta分析。结果:最终纳入15项研究,包含1 407例受试者。Meta分析结果表明,研究组患者的有效率高于对照组(RR=1.20,95%CI=1.15~1.26,P<0.000 01),不良反应发生率低于对照组(RR=0.53,95%CI=0.34~0.84,P=0.007),差异均有统计学意义。研究组治疗方案在调节患者甲状腺功能(血清游离三碘甲状腺原氨酸:SMD=-1.24,95%CI=-1.78~-0.69;血清游离甲状腺素:SMD=-1.31,95%CI=-1.98~-0.65;血清促甲状腺激素:SMD=1.05,95%CI=0.49~1.62),降低尿钙水平(SMD=-1.07,95%CI=-1.72~-0.41),提高血清甲状旁腺激素水平(SMD=0.39,95%CI=0.03~0.74),降低血清降钙素(SMD=-0.94,95%CI=-1.36~-0.52)、骨钙素(SMD=-1.19,95%CI=-1.83~-0.55)、碱性磷酸酶(SMD=-0.40,95%CI=-0.77~-0.02)水平,以及提高各部位骨密度(腰椎:SMD=1.24,95%CI=0.62~1.86;髋部:SMD=1.06,95%CI=0.71~1.41;前臂:SMD=0.88,95%CI=0.44~1.32)方面均优于对照组,差异均有统计学意义(P<0.05);但在降低血钙、血磷和尿磷水平方面作用不明显,与对照组的差异无统计学意义(P>0.05)。结论:中药复方治疗甲状腺功能亢进症致骨代谢异常疗效显著且安全性高,可有效减少骨丢失,改善骨代谢,降低骨转换率,提高骨密度。基础用药以白芍、黄芪、熟地黄等补益肝脾肾类中药为主。
OBJECTIVE:To systematically evaluate the efficacy and safety of traditional Chinese medicine compounds in the treatment of abnormal bone metabolism induced by hyperthyroidism.METHODS:Randomized controlled trials of traditional Chinese medicine compounds in the treatment of osteopenia or osteoporosis induced by hyperthyroidism were retrieved from Chinese and English databases[the study group was treated with traditional Chinese medicine compound(decoction,granule and Chinese patent medicine and other dosage forms)or combined with conventional western medicine;the control group received conventional western medicine].The retrieval time was from the establishment of the database to Dec.20th,2022.Cochrane Collaboration Network was used to evaluate the literature quality,RevMan 5.3 software was used for Meta-analysis.RESULTS:A total of 15 randomized controlled trials were enrolled,including 1407 cases.Meta-analysis showed that the effective rate of study group was higher than that of the control group(RR=1.20,95%CI=1.15-1.26,P<0.00001),and the incidence of adverse drug reactions was lower than that of the control group(RR=0.53,95%CI=0.34-0.84,P=0.007),with statistically significant difference.The treatment regimen in the treatment group was superior to the control group in regulating thyroid function(serum free triiodothyronin:SMD=-1.24,95%CI=-1.78--0.69;serum free thyroxine:SMD=-1.31,95%CI=-1.98--0.65;serum thyroid stimulating hormone:SMD=1.05,95%CI=0.49-1.62),reducing urinary calcium(SMD=-1.07,95%CI=-1.72--0.41),increasing the level of serum parathyroid hormone(SMD=0.39,95%CI=0.03-0.74),reducing the level of serum calcitonin(SMD=-0.94,95%CI=-1.36--0.52),osteocalcin(SMD=-1.19,95%CI=-1.83--0.55)and alkaline phosphatase(SMD=-0.40,95%CI=-0.77--0.02),and increasing bone mineral density in all parts(lumbar vertebra:SMD=1.24,95%CI=0.62-1.86;Hip:SMD=1.06,95%CI=0.71-1.41;forearm:SMD=0.88,95%CI=0.44-1.32),with statistically significant differences(P<0.05),yet had no significant difference in decreasing blood calcium,blood phosphorus and urinary phosphorus,there was no significant difference between the two groups(P>0.05).CONCLUSIONS:Traditional Chinese medicine compounds have significant clinical efficacy and higher safety in the treatment of abnormal bone metabolism induced by hyperthyroidism,which can effectively reduce bone loss,regulate bone metabolism,reduce bone conversion rate and increase bone mineral density.The basic drugs are mainly traditional Chinese medicines that tonify the liver,spleen and kidney,such as radix paeoniae alba,radix astragali and radix rehmanniae.
作者
刘晓炜
高城翰
高天舒
LIU Xiaowei;GAO Chenghan;GAO Tianshu(Graduate School,Liaoning University of Traditional Chinese Medicine,Shenyang 110847,China;Dept.of Orthopaedics,Affiliated Hospital of Liaoning University of Traditional Chinese Medicine,Shenyang 110032,China;Dept.of Endocrinology,Affiliated Hospital of Liaoning University of Traditional Chinese Medicine,Shenyang 110032,China)
出处
《中国医院用药评价与分析》
2023年第10期1221-1226,共6页
Evaluation and Analysis of Drug-use in Hospitals of China
基金
国家自然科学基金项目(No.81874441)
辽宁省中医药临床学(专)科能力建设项目(No.LNZYXZK201902)
沈阳市临床医学研究中心项目(No.沈科发[2018]75号)。
关键词
甲状腺功能亢进症
骨代谢
骨质疏松
中药
META分析
Hyperthyroidism
Bone metabolism
Osteoporosis
Traditional Chinese medicine
Meta-analysis
Data mining
