摘要
目的系统评价临床随机对照试验是否能够证明双膦酸盐类药物的应用与骨质疏松症患者的死亡率降低相关。方法依据Meta分析要求,对CBM、CNKI、MEDLINE、PubMed、Springer、Embase、万方、维普、Cochrane Library、中国科技论文统计与分析网、专利数据库等进行检索,严格评价纳入以双膦酸盐药物作为主要干预措施治疗骨质疏松症的临床随机对照实验研究文献,并收录有效的相关的数据资料,检索年限从建库至2020年5月。采用NOS文献质量评价标准对符合纳入排除标准的文献进行质量评价。采用RR值及其95%可信区间评估关联强度。根据是否存在异质性,采用固定效应模型合并效应量,并根据单因素敏感性分析法进行敏感性分析。结果最终纳入21篇文献,受试者共42849例,双膦酸盐组患者22605例,死亡855例,安慰剂组20244例,死亡880例。双膦酸盐治疗骨质疏松症与总死亡率相关性的为RR=0.949(95%CI:0.866,1.040,P=0.264)。阿仑膦酸盐治疗骨质疏松症与总死亡率相关性的为RR=0.996(95%CI:0.705,1.407,P=0.982),伊班膦酸盐为RR=0.802(95%CI:0.496,1.298,P=0.369),利塞膦酸盐为RR=0.915(95%CI:0.757,1.105,P=0.354),唑来膦酸盐为RR=0.898(95%CI:0.770,1.047,P=0.168),尚未发现双磷酸盐治疗骨质疏松症与总死亡率的关联性。结论经meta分析发现双膦酸盐治疗骨质疏松症患者的总死亡率未见明显降低。
Objective To systematically evaluate whether clinical randomized controlled trials can demonstrate that bisphosphonates,especially zoledronic acid,are associated with reduced mortality in patients with osteoporosis.Methods According to the requirements of meta-analysis,CBM,CNKI,MEDLINE,PubMed,Springer,EMBASE,Wanfang,VIP and Cochrane were analyzed Library,China Science and Technology Papers Statistics and analysis network,patent database,etc.were searched to strictly evaluate the included clinical randomized controlled trials with bisphosphonates as the main intervention measures in the treatment of osteoporosis,and included effective related data.The retrieval period was from the establishment of the database to may 2020.The NOS standard was used to evaluate the quality of the literatures that met the inclusion and exclusion criteria.RR and its 95%confidence interval were used to evaluate the association strength.According to the existence of heterogeneity,the fixed effect model was used to merge the effect amount,and the single factor sensitivity analysis method was used to analyze the sensitivity.Results A total of 21 articles including 42,849 subjects,22,605 patients in the bisphosphonate group,855 patients died,20,244 patients in the placebo group and 880 deaths in the placebo group were analyzed.The correlation between bisphosphonate therapy and total mortality was 0.949(95%CI:0.866,1.040,P=0.264).The correlation between alendronate and total mortality was 0.996(95%CI:0.705,1.407,P=0.982),ibandronate was RR=0.802(95%CI:0.496,1.298,P=0.369),risedronate was RR=0.915(95%CI:0.757,1.105,P=0.354)and zoledronate was RR=0.898(95%CI:0.770,1.047,P=0.168).There was no association between bisphosphonate therapy and total mortality.Conclusion The meta-analysis showed that bisphosphonates did not reduce the overall mortality of patients with osteoporosis.
作者
张亚玲
王琳
王敬贤
何新霞
ZhangYaling;WangLin;Wang Jingxian;He Xinxia(Department of general practice medicine,,Hengshui people's Hospital,Hengshui 053000,China;Department of joint sports medicine,Hengshui people's Hospital,Hengshui 053000,China)
出处
《中华老年骨科与康复电子杂志》
2020年第5期304-311,共8页
Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition)
