中国组织工程研究

中国组织工程研究 ›› 2024, Vol. 28 ›› Issue (4): 639-645.doi: 10.12307/2024.963

• 组织构建循证医学 evidence-based medicine in tissue construction • 上一篇    下一篇

特立帕肽和双膦酸盐治疗绝经后骨质疏松性骨折有效及安全性的Meta分析

阿卜杜吾普尔·海比尔1，2，阿里木江·玉素甫1，2，买合木提·亚库甫1，2，麦麦提敏·阿卜力米提1，2，吐尔洪江·阿布都热西提1，2   

  1. 1新疆医科大学，新疆维吾尔自治区乌鲁木齐市  830054；2新疆医科大学第六附属医院，新疆维吾尔自治区乌鲁木齐市  830002
  • 收稿日期:2022-12-06 接受日期:2023-01-11 出版日期:2024-02-08 发布日期:2023-07-14
  • 通讯作者: 吐尔洪江·阿布都热西提，硕士，主任医师，硕士生导师，新疆医科大学第六附属医院，新疆维吾尔自治区乌鲁木齐市 830002
  • 作者简介:阿卜杜吾普尔·海比尔，男，1995年生，新疆维吾尔自治区和田市人，维吾尔族，新疆医科大学在读硕士，主要从事脊柱创伤、骨质疏松症治疗等相关研究。

Meta-analysis of efficacy and safety of terlipatide and bisphosphate in the treatment of postmenopausal osteoporosis fractures

Abuduwupuer·Haibier1, 2, Alimujiang·Yusufu1, 2, Maihemuti·Yakufu1, 2, Maimaitimin·Abulimiti1, 2, Tuerhongjiang·Abudurexiti1, 2   

  1. 1Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China; 2The Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi 830002, Xinjiang Uygur Autonomous Region, China
  • Received:2022-12-06 Accepted:2023-01-11 Online:2024-02-08 Published:2023-07-14
  • Contact: Tuerhongjiang·Abudurexiti, Master, Chief physician, Master’s supervisor, Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China; The Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi 830002, Xinjiang Uygur Autonomous Region, China
  • About author:Abuduwupuer·Haibier, Master candidate, Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China; The Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi 830002, Xinjiang Uygur Autonomous Region, China

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摘要：


文题释义：

特立帕肽：是推荐用于治疗骨质疏松症的最新合成代谢药物，可促进骨形成并改善骨质量。在骨质疏松椎体压缩性骨折的患者中，应用特立帕肽治疗能够显著降低椎体再发骨折的风险。
双膦酸盐：是一种复杂的膦酸盐，可以与骨表面紧密结合，能抑制破骨细胞活性，加速程序性细胞的死亡。阿仑膦酸盐、利塞膦酸盐和唑来膦酸盐是最常用的推荐药物，能降低非脊柱骨折的风险，包括髋关节骨折。


目的：通过Meta分析比较特立帕肽和双膦酸盐治疗绝经后骨质疏松性骨折有效性与安全性。

方法：通过检索PubMed、Cochrane Library、EMbase、中国知网、万方和维普数据库，根据纳入及排除标准筛选出关于特立帕肽和双膦酸盐治疗绝经后骨质疏松性骨折的随机对照试验文章18篇，使用EndNote X9软件管理文献，使用RevMan 5.3软件对所提取的数据进行Meta分析，主要分析绝经后骨质疏松患者接受特立帕肽和双膦酸盐药物治疗后椎体骨折、非椎体骨折及不良反应发生率。
结果：共纳入18项随机对照试验，其中10篇文献属于中高质量文献，8篇文献属于低质量文献。Meta 结果显示：①特立帕肽组骨折发生率(RR=0.56，95%CI：0.48-0.66，P < 0.000 01)低于双膦酸盐组，特立帕肽在预防绝经后骨质疏松症妇女骨折方面优于阿仑膦酸钠(RR=0.50，95%CI：0.35-0.69，P < 0.000 1)和其他双膦酸盐(RR=0.58，95%CI：0.49-0.70，P < 0.000 01)。②根据不同随访时间，在超过18个月的研究中，特立帕肽在预防绝经后骨质疏松妇女骨折方面均优于双膦酸盐(RR=0.56，95%CI：0.48-0.69，P < 0.000 01)。③此外，文章发现特立帕肽预防绝经后骨质疏松妇女椎体骨折(RR=0.48，95%CI：0.37-0.62，P < 0.000 01)和非椎体骨折(RR=0.63，95%CI：0.51-0.78，P < 0.000 1)方面均优于双膦酸盐。④特立帕肽在增加腰椎骨密度(OR=4.16，95%CI：2.96-5.36，P < 0.000 1)和股骨颈骨密度(OR=1.02，95%CI：0.04-2.01，P=0.04)方面优于双膦酸盐。⑤特立帕肽与双膦酸盐之间的不良反应无显著差异(RR=0.95，95%CI：0.85-1.06，P=0.37)。

结论：①特立帕肽预防绝经后骨质疏松妇女椎体骨折和非椎体骨折方面均优于双膦酸盐，但安全性及药物不良反应方面特立帕肽和双膦酸盐基本相似。②特立帕肽无论是短期(< 18个月)还是长期(≥18个月)使用，在预防骨折发生率、提高腰椎骨密度和股骨颈骨密度方面，均优于双膦酸盐。

https://orcid.org/0000-0001-7420-9761(阿卜杜吾普尔·海比尔)；https://orcid.org/0000-0002-2604-0049(吐尔洪江·阿布都热西提)

中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程

关键词: 特立帕肽, 双膦酸盐, 骨质疏松症, 绝经后妇女, 骨折, 椎体骨折, 骨密度, Meta分析

Abstract: OBJECTIVE: To compare the efficacy and safety of terlipatide and bisphosphate in the treatment of postmenopausal osteoporosis fractures through a Meta-analysis.
METHODS: By searching PubMed, Cochrane Library, EMbase, CNKI, WanFang and VIP databases, 18 randomized controlled studies on terlipatide and bisphosphate in the treatment of postmenopausal osteoporosis fractures were included according to inclusion and exclusion criteria. Endnote X9 software was used to manage the literature and Revman 5.3 software was used to perform a Meta-analysis on the extracted data. The incidences of vertebral fracture, non-vertebral fracture and adverse reaction in postmenopausal osteoporosis patients treated with terlipatide and bisphosphate were analyzed.
RESULTS: A total of 18 randomized controlled studies were included, of which 10 were of medium and high quality and 8 were of low quality. Meta-analysis results showed that the fracture incidence in the teriparatide group [risk ratio (RR)=0.56, 95% confidence interval (CI): 0.48-0.66, P < 0.000 01] was lower than that in the bisphosphonate group, and teriparatide was superior to alendronate in preventing fractures in postmenopausal women with osteoporosis (RR=0.50, 95%CI: 0.35-0.69, P < 0.000 1) and other bisphosphonates (RR=0.58, 95%CI: 0.49-0.70, P < 0.000 01). During the follow-up over 18 months, teriparatide was superior to bisphosphonates in preventing fractures in postmenopausal women with osteoporosis (RR=0.56, 95%CI: 0.48-0.69, P < 0.000 01). In addition, we found that teriparatide was superior to bisphosphonates in preventing vertebral fractures (RR=0.48, 95%CI: 0.37-0.62, P < 0.000 01) and non-vertebral fractures (RR=0.63, 95%CI: 0.51-0.78, P < 0.000 1) in postmenopausal women with osteoporosis. Teriparatide was superior to bisphosphonates in increasing lumbar bone density [odds ratio=4.16, 95%CI: 2.96-5.36, P < 0.000 1) and femoral neck bone density (odds ratio=1.02, 95%CI: 0.04-2.01, P=0.04). There was no significant difference in adverse reactions between teriparatide and bisphosphonates (RR=0.95, 95%CI: 0.85,1.06, P=0.37).
CONCLUSION: Teriparatide is superior to bisphosphonates in preventing vertebral and non-vertebral fractures in postmenopausal women with osteoporosis, but the safety and adverse drug reactions of teriparatide and bisphosphonates are basically similar. Teriparatide is superior to bisphosphonate in preventing fracture and improving lumbar and femoral neck bone density regardless of short-term (< 18 months) or long-term (≥ 18 months) use.

Key words: teriparatide, bisphosphonates, osteoporosis, postmenopausal woman, fracture, vertebral fracture, bone mineral density, Meta-analysis

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