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[中医药治疗绝经后骨质疏松症的随机对照试验结局指标]

[Randomized controlled trial outcome indicators of postmenopausal osteoporosis treated by traditional Chinese medicine].

作者信息

Li Hui-Min, Yang Wei, Zhang Yi-Li, Zhi Ying-Jie

机构信息

Center for Evidence-based Chinese Medicine, Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences Beijing 100700, China.

Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences Beijing 100700, China.

出版信息

Zhongguo Zhong Yao Za Zhi. 2021 Aug;46(16):4274-4286. doi: 10.19540/j.cnki.cjcmm.20210426.501.

Abstract

This study evaluated the outcome indicators of the randomized controlled trials(RCTs) of traditional Chinese medicine(TCM) in the treatment of postmenopausal osteoporosis(PMOP) to provide a reference for the related research. Four Chinese databa-ses(CNKI, VIP, Wanfang and CBM) and three English databases(Cochrane Library, EMbase and PubMed) were searched syste-matically to screen RCTs of TCM in the treatment of PMOP according to the pre-set criteria, and the quality of the included trials was evaluated by the Cochrane risk-of-bias tool. A total of 29 627 articles were initially retrieved, and finally, 43 articles were included, including 34 in Chinese and 9 in English. As revealed by the results, the outcome indicators of 43 RCTs were mainly divided into six categories, with biochemical indicators accounting for 54.59%, bone mineral density(BMD) for 26.57%, quality of life for 6.28%, fracture for 1.94%, safety for 5.31%(including adverse reactions or events) and others for 5.31%. Biochemical indicators showed the maximum occurrence, followed by BMD. Many problems were found in the selection of outcome indicators of the TCM RCTs in the treatment of PMOP, such as the confusion of primary and secondary outcome indicators, the lack of endpoint criteria and vital clinical outcome indicators substituted by intermediate indicators, inconsistent evaluation standard of syndrome curative efficacy and neglected blinding in the measurement of subjective outcome indicators. The problems also included importance given to the efficacy indicators instead of the adverse outcome indicators, unnormalized indicator name, large quantitative range of the indicators, unconventional application of TCM efficacy criteria, seldom used confidence interval, relative effect indicator and absolute effect indicator.

摘要

本研究评估了中医治疗绝经后骨质疏松症(PMOP)的随机对照试验(RCT)的结局指标,为相关研究提供参考。系统检索了四个中文数据库(中国知网、维普、万方和中国生物医学文献数据库)和三个英文数据库(考克兰图书馆、EMbase和PubMed),根据预设标准筛选中医治疗PMOP的RCT,并采用考克兰偏倚风险工具评估纳入试验的质量。初步检索到29627篇文章,最终纳入43篇文章,其中中文34篇,英文9篇。结果显示,43项RCT的结局指标主要分为六类,生化指标占54.59%,骨密度(BMD)占26.57%,生活质量占6.28%,骨折占1.94%,安全性占5.31%(包括不良反应或事件),其他占5.31%。生化指标出现次数最多,其次是BMD。中医治疗PMOP的RCT结局指标选择存在诸多问题,如主次结局指标混淆、缺乏终点标准、重要临床结局指标被中间指标替代、证候疗效评价标准不统一、主观结局指标测量时忽视盲法等。问题还包括重视疗效指标而非不良结局指标、指标名称不规范、指标定量范围大、中医疗效标准应用不规范、很少使用置信区间、相对效应指标和绝对效应指标。

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