口服中成药治疗2型糖尿病性骨质疏松症的网状Meta分析

Network Meta-analysis of oral Chinese patent medicine in the treatment of type 2 diabetic osteoporosis

关键词:  糖尿病性骨质疏松症  2型糖尿病  骨质疏松症  中成药  网状Meta分析

Key words:  diabetic osteoporosis  type 2 diabetes mellitus  osteoporosis  Chinese patent medicine  network Meta-analysis

摘要:

[目的] 运用网状Meta分析的方法，评价不同中成药治疗2型糖尿病性骨质疏松症（T2DOP）的临床效果及安全性。[方法] 运用计算机检索建库至2023年8月中国知网、维普、PubMed、CochraneLibrary等八大中英文数据库，搜寻有关中成药治疗T2DOP的随机对照试验。通过偏倚风险评价工具Cochrane评估纳入研究的偏倚风险，对符合质量标准的研究采用R语言完成网状Meta分析。[结果] 最终纳入27篇文献，包括6种中成药和2930例患者，中成药联合常规治疗方案（CT）均优于常规治疗。糖脉康颗粒+CT在提高总有效率方面相对较优[OR=1.93，95%CI（1.22，2.75）]；金天格胶囊+CT在提高腰椎骨密度、股骨颈骨密度、骨钙素方面效果较优[MD=0.10，95%CI（0.08，0.14）；MD=0.11，95%CI（0.06，0.16）；MD=2.58，95%CI（1.82，3.37）]；六味地黄丸+CT在降低治疗后空腹血糖、糖化血红蛋白方面效果较佳[MD=-1.53，95%CI（-2.34，-0.77）；MD=-1.00，95%CI（-1.64，-0.37）]；在安全性方面纳入文献较少无法定量分析，所有治疗均未发生严重不良反应。[结论] 糖脉康颗粒对于T2DOP患者的临床症状改善效果显著，金天格胶囊对于T2DOP患者骨密度的改善效果明显，六味地黄丸对T2DOP患者降糖的效果更加明显。因纳入研究存在有限性，所得结论需进一步验证。

Abstract:

[Objective] To evaluate the clinical efficacy and safety of different proprietary Chinese medicines in the treatment of T2DOP by network Meta-analysis. [Methods] Eight Chinese and English databases, including CNKI, VIP, PubMed, Cochrane Library and so on, were searched by computer until August 2023 to search for randomized controlled trials related to T2DOP. Bias risk assessment tool Cochrane was used to assess the bias risk included in the study, and R language was used to complete network Meta-analysis of the studies that met the quality standards. [Results] The 27 RCTs were eventually included, including 6 proprietary Chinese medicines and 2 930 patients, Chinese patent medicine combined with conventional treatment is superior to conventional treatment. The total effective rate of Tangmaikang Granule combined with CT is relatively better[OR=1.93, 95%CI(1.22, 2.75)]. Jintiange Capsule combined with CT has better effect on improving lumbar vertebrae bone density, femoral neck bone density and osteocalcin[MD=0.10, 95%CI(0.08, 0.14); MD=0.11, 95%CI(0.06, 0.16); MD=2.58, 95%CI(1.82, 3.37)]. Liuwei Dihuang Pill combined with CT has a better effect on reducing fasting blood glucose and glycosylated hemoglobin after treatment[MD=-1.53,95%CI(-2.34, -0.77);MD=-1.00,95%CI(-1.64, -0.37)]. In terms of safety, no serious adverse reactions occurred in all treatments, and there were few literatures included for quantitative analysis. [Conclusion] Tangmaikang Granule can significantly improve the clinical symptoms of T2DOP patients. Jintiange Capsule has obvious effect on bone mineral density in T2DOP patients, and Liuwei Dihuang Pill has more obvious effect on hypoglycemic effect. Limited by the quality of the included studies, the conclusions still need to be further verified.