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Received:August 11, 2021 Published Online:October 20, 2021
Received:August 11, 2021 Published Online:October 20, 2021
中文摘要: 目的 评价补肾法对乳腺癌内分泌治疗相关骨丢失的疗效。
方法 运用计算机检索中国期刊全文数据库（CNKI）、万方数据库、中国生物医学文献数据库（CBM）、PubMed、Cochrance对照试验中心数据库、EBSCO数据库等有关乳腺癌内分泌治疗导致骨丢失的随机对照试验文献，检索时限2010年1月至2020年5月，利用Cochrance系统进行质量评价，应用RevMan 5.3软件进行Meta分析，对补肾法治疗乳腺癌内分泌治疗导致骨丢失的研究进行分析总结。
结果共纳入22篇（均为中文文献）符合标准的文献，1 570例患者，其中试验组（以中医药或中西医结合治疗为干预措施）792例，对照组（只进行西医治疗或空白对照）778例。Meta分析结果显示，试验组在改善骨丢失临床症状[ OR =3.45，95% CI （1.80，6.62）， P ＜0.01]、提高腰椎骨密度[ MD =0.08，95% CI （0.06，0.09）， P ＜0.01]、提高骨密度T值[ MD =0.38,95% CI （0.28，0.47）， P ＜0.01]及提高股骨颈骨密度[ MD =0.07,95% CI （0.06，0.08）， P ＜0.01]方面均显著优于对照组，差异均有统计学意义。所有试验患者均未报道严重不良反应。
结论 补肾法对乳腺癌内分泌治疗导致骨丢失在改善骨丢失临床症状及提高骨密度方面有确切而显著的疗效，且优于单纯西药治疗,但由于纳入文献质量参差不齐，需要多中心、大样本，设计严谨、符合国际要求的临床研究进一步深入探讨。
Abstract:Objective To evaluate the effect of kidney-tonifying therapy on bone loss associated with endocrine therapy in breast cancer.
Methods The following databases were searched for randomized controlled trials on endocrine therapy and bone loss in breast cancer, including China National Knowledge Internet (CNKI), Wanfang Database, China Biomedical Literature Database (CBM), PubMed, Cochrance Control Center Database and EBSCO database, etc. The retrieval time limit was from January 2010 to May 2020. Two researchers independently screened and identified the search Results, and Cochrane system was used for quality evaluation. RevMan 5.3 software was used for Meta-analysis to summarize the studies, and the research on bone loss caused by endocrine therapy in breast cancer treated by the method of invigorating the kidney is summarized.
Results A total of 22 literatures (all in Chinese literatures) were finally included, involving 1 570 patients. There were 792 cases in experimental group (treated with traditional Chinese medicine or integrated traditional Chinese and Western medicine) and 778 cases in control group (treated with western medicine or blank control). Meta-analysis Results showed that the improvement of clinical symptoms of bone loss[ OR =3.45，95% CI （1.80，6.62）],the improvement of the lumbar spine bone density [ MD =0.08, 95% CI (0.06, 0.09)],the increase of T value in bone mineral density [ MD =0.38,95% CI （0.28，0.47）] and the increase of femoral neck bone mineral density[ MD =0.07,95% CI （0.06，0.08）] in experimental group were significantly better than those in control group( P ＜0.01). No serious adverse reactions were reported in all trials.
Conclusions For the breast cancer patients with bone loss caused by endocrine therapy, kidney-tonifying therapy has a definite and significant effect in improving the clinical symptoms of bone loss and increasing bone density, and is better than western medicine alone. However, due to the uneven quality of the included literature, it is necessary to conduct multicenter, large-sample and rigorous design clinical research in line with international requirements.
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基金项目:国家自然科学基金（81403408）；山东省医药科技发展计划项目（2018WS191）；山东省中医经典方协同创新中心开放课题（2018KFY10）
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