中国循证医学杂志

中国循证医学杂志

抗癫痫药物对成人骨密度和骨代谢影响的 meta 分析

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目的系统评价抗癫痫药物对成人骨密度和骨代谢的影响。方法计算机检索 PubMed、EMbase、CNKI、CBM、VIP 和 WanFang Data 数据库,搜集抗癫痫药物对成人骨密度和骨代谢影响的队列研究和横断面研究,检索时限均从建库至 2018 年 4 月 1 日。由 2 名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用 RevMan 5.3 软件进行 meta 分析。结果共纳入 14 个研究。meta 分析结果显示:丙戊酸(VPA)可降低腰椎骨密度[SMD=–0.39,95%CI(–0.65,–0.13),P=0.003];卡马西平(CBZ)及 VPA 均可降低股骨颈骨密度[SMD=–0.71,95%CI(–1.08,–0.33),P=0.000 2;SMD=–0.3,95%CI(–0.58,–0.02),P=0.03];CBZ 可降低髋骨骨密度[SMD=–0.47,95%CI(–0.84,–0.10),P=0.01]。奥卡西平(OXC)可降低血 25(OH)D3 浓度[SMD=–0.67,95%CI(–1.28,–0.05),P=0.03];CBZ、左乙拉西坦(LEV)及 OXC 均可降低血钙浓度[SMD=–0.49,95%CI(–0.78,–0.20),P=0.000 8;SMD=–0.83,95%CI(–1.15,–0.51),P<0.000 01;SMD=–0.48,95%CI(–0.90,–0.05),P=0.03];LEV 可降低血磷浓度[SMD=–11.36,95%CI(–12.97,–9.76),P<0.000 01];LEV 及 CBZ 均可增加血 ALP 浓度[SMD=6.79,95%CI(5.78,7.80),P<0.000 01;SMD=1.90,95%CI(1.35,2.44),P<0.000 01]。结论当前证据显示,抗癫痫药物可能降低成人癫痫患者的骨密度并可影响其骨代谢,但不同抗癫痫药物对不同部位的骨密度影响不同。受纳入研究质量和数量的限制,上述结论尚需更多研究予以验证。

ObjectivesTo systematically review the influence of antiepileptic drugs on bone mineral density and bone metabolism in adults.MethodsPubMed, EMbase, CNKI, CBM, VIP and WanFang Data databases were electronically searched to collect studies on the influence on antiepileptic drugs on the bone mineral density and bone metabolism in adults from inception to April 1st, 2018. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 14 studies were included. The results of meta-analysis showed that: VPA could decline the bone mineral density of lumbar spine (SMD=–0.39, 95%CI –0.65 to –0.13, P=0.003); CBZ (SMD=–0.71, 95%CI –1.08 to –0.33, P=0.000 2) and VPA (SMD=–0.3, 95%CI –0.58 to –0.02, P=0.03) could decline the bone mineral density of femoral neck; CBZ could decline the bone mineral density of total hip (SMD=–0.47, 95%CI –0.84 to –0.10, P=0.01). Serum 25-hydroxy vitamin D3 was decreased in OXC group (SMD=–0.67, 95%CI –1.28 to –0.05, P=0.03); serum calcium was decreased in CBZ (SMD=–0.49, 95%CI –0.78 to –0.20, P=0.000 8), LEV (SMD=–0.83, 95%CI –1.15 to –0.51, P<0.000 01) and OXC (SMD=–0.48, 95%CI –0.90 to –0.05,P=0.03) group; serum phosphorus was decreased in LEV group (SMD=–11.36, 95%CI –12.97 to –9.76, P<0.000 01). Serum alkaline phosphatase was increased significantly in LEV (SMD=6.79, 95%CI 5.78 to 7.80,P<0.000 01) and CBZ (SMD=1.90, 95%CI 1.35 to 2.44,P<0.000 01) group.ConclusionsCurrent evidence shows that treatment with antiepileptic drugs may be associated with an decreasing bone mineral density and influence bone metabolism in epileptic adults. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusion.

关键词: 癫痫; 抗癫痫药; 骨密度; 骨代谢; 成人; meta分析; 系统评价

Key words: Epilepsy; Antiepileptic drugs; Bone mineral density; Bone metabolism; Adults; meta-analysis; Systematic review

引用本文: 樊丹旸, 苗婕, 侯玉立, 孙美珍. 抗癫痫药物对成人骨密度和骨代谢影响的 meta 分析. 中国循证医学杂志, 2019, 19(2): 189-198. doi: 10.7507/1672-2531.201809077 复制

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