目的 系统评价奥卡西平对癫痫患者骨代谢的影响。方法 计算机检索Pubmed、EMbase、Cochrane Library、CNKI、维普、万方和CBM数据库,纳入奥卡西平对癫痫患者骨代谢影响的队列研究。根据纽卡斯-渥太华量表(NOS量表)完成对纳入研究的质量评价。采用RevMan5.3软件进行Meta分析。结果 共纳入11篇文献,NOS评分均为7~8分。Meta分析结果提示:与对照组相比,奥卡西平组血钙、血清25-OH-VitD均降低(P＜0.05);用药疗程≤0.5年时,奥卡西平组25-OH-VitD低于对照组(P＜0.05),血钙无统计学差异(P＞0.05),用药疗程＞0.5年时,奥卡西平组血钙低于对照组(P＜0.05),25-OH-VitD 无统计学差异(P＞0.05);奥卡西平儿童用药组血钙、25-OH-VitD均低于对照组(P＜0.05),成人用药组血钙、25-OH-VitD与对照组无统计学差异(P≥0.05)。与对照组相比,奥卡西平组血磷、甲状旁腺素、骨钙素均无统计学差异(P＞0.05);用药疗程＞0.5年时,奥卡西平组甲状旁腺素高于对照组(P＜0.05),用药疗程及治疗对象年龄对其余指标无影响。与对照组相比,奥卡西平组不同部位的骨密度均无统计学差异(P＞0.05)。结论 奥卡西平可能降低血钙、血清25-OH-VitD,且在儿童表现更为明显。无论成人或儿童,奥卡西平用药半年内血清25-OH-VitD降低,用药半年后血钙降低、甲状旁腺素升高。奥卡西平对血磷、骨钙素及骨密度无明显影响。本研究纳入研究均为队列研究,易受偏倚风险的影响,存在一定的局限性。
Abstract
OBJECTIVE To systematically review the bone metabolism in the epileptic patients receiving oxcarbazepine monotherapy. METHODS Literatures were searched from Pubmed, EMbase, Cochrane Library, CNKI, VIP, Wanfang and CBM database. The included studies were all cohort studies. The quality of studies was evaluated according to the Newcastle-Ottawa Quality Scale (NOS scale). Meta-analysis was performed by the Cochrane Collaboration′s software RevMan5.3. RESULTS Eleven cohort studies were included, all of which were high quality researches (7-8 according to NOS scale). Compared with the control group, serum calcium and 25-OH-VitD declined in the OXC group (P<0.05). In less than half a year of therapy, the 25-OH-VitD level in the OXC group was lower than the control group (P<0.05), but no statistical difference for the serum calcium (P>0.05). In more than half a year of therapy, the serum calcium level in the OXC group was lower than the control group (P<0.05), but no statistical difference for the 25-OH-VitD (P>0.05). For children in the OXC group, both the serum calcium and 25-OH-VitD were decreased (P<0.05) while there was no statistical difference for adults (P>0.05). Besides, all of the serum phosphorus, parathyroid hormone, osteocalcin were not statistically different between the OXC and control groups (P>0.05). In more than half a year of therapy, parathyroid hormone rose above the control group (P<0.05), while both the therapy duration and age of the therapy subjects had no influence in the remaining indexes. Moreover, there was no statistical difference between the two groups for the bone mineral density in different body parts (P>0.05). CONCLUSION Oxcarbazepine may reduce serum calcium and serum 25-OH-VitD, especially for children. Regardless of age, the serum 25-OH-VitD may decline in less than half a year of therapy, while the serum calcium may decline and parathyroid hormone may increase in more than half a year of therapy. Oxcarbazepine had no significant effect on the serum phosphorus, osteocalcin and bone mineral density. All of the included studies in this article are cohort studies with certain limitations as a result of bias risk.
关键词
奥卡西平 /
单药治疗 /
骨代谢 /
系统评价
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Key words
oxcarbazepine /
monotherapy /
bone metabolism /
systematic review
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中图分类号：
R969.3
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参考文献
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脚注
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基金
国家自然科学基金资助项目(81200887)
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