中医药治疗慢性阻塞性肺疾病合并骨质疏松症的疗效与安全性：系统评价与荟萃分析。
完整摘要 · 中文译文
这项关于中医药（TCM）作为慢性阻塞性肺疾病（COPD）合并骨质疏松症（OP）常规治疗辅助疗法的疗效与安全性的全面荟萃分析，旨在为临床实践提供证据和指导。我们系统检索了四个国际数据库和四个中文数据库，以识别截至2025年11月发表的随机对照试验（RCT）。使用R软件中的meta和gemtc包进行荟萃分析和敏感性分析。采用修订版Cochrane偏倚风险工具（ROB2）评估纳入研究的质量，以确保其严谨性和临床适用性。共纳入11项符合条件的研究，涉及944例患者。结果表明，与单独使用常规西医治疗（CWMT）相比，CWMT联合中医药在主要结局方面显示出一定程度的改善，即骨密度（BMD）（标准化均数差[SMD] = 0.71，95%置信区间[CI]：0.34-1.07，I2 = 83.8%，PHEW < 0.001）和第一秒用力呼气容积（FEV1）（SMD = 0.54，95% CI：0.17-0.90，I2 = 76.5%，PHEW = 0.007）。部分次要结局观察到具有统计学意义的改善。原始研究未充分报告不良事件。现有数据仅提示短期耐受性。根据网络荟萃分析结果，在三种治疗方案中，TLKRBS（补肺益肾活血）方案成为最佳方案的概率最高。 在提高骨密度（BMD）（累积排名曲线下面积[SUCRA]=98.82%）和FEV1（SUCRA=99.99%）方面排名第一，表明对改善具有显著效果。与单用CWMT相比，CWMT与TCM联合治疗慢性阻塞性肺疾病（COPD）伴骨质疏松症（OP）可能产生更有利的结局。Meta分析结果表明，与单用CWMT相比，TCM联合CWMT的治疗疗效可能在一定程度上提高。然而，由于样本量小、异质性高和偏倚风险，证据确定性有限。未来需要设计严谨、样本量更大、结局指标标准化的高质量随机对照试验（RCT），以加强TCM应用于COPD合并OP患者的证据基础，并进一步确认其疗效。
完整摘要 · 英文原文
This comprehensive meta-analysis on the efficacy and safety of traditional Chinese medicine (TCM) as an adjunctive therapy to conventional treatment of chronic obstructive pulmonary disease (COPD) with osteoporosis (OP) aimed to provide evidence and guidance for clinical practice. We systematically searched four international databases and four Chinese databases to identify relevant randomized controlled trials (RCTs) published up to November 2025. Meta-analysis and sensitivity analysis were performed in R using the meta and gemtc packages. The revised Cochrane risk of bias tool (ROB2) was employed to assess the quality of included studies to ensure their rigor and clinical applicability. A total of 11 eligible studies involving 944 patients were identified. The results indicated that compared with conventional Western medical therapy (CWMT) alone, CWMT plus TCM demonstrated a certain degree of improvement in the primary outcomes, namely bone mineral density (BMD) (standardized mean difference [SMD] = 0.71, 95% confidence interval [CI]: 0.34-1.07, I2 = 83.8%, PHEW < 0.001) and forced expiratory volume in 1 second (FEV1) (SMD = 0.54, 95% CI: 0.17-0.90, I2 = 76.5%, PHEW = 0.007). Statistically significant improvements were observed in some secondary outcomes. The original studies did not adequately report adverse events. The available data only suggested short-term tolerability. According to network meta-analysis results, among the three treatment approaches, the TLKRBS (tonifying the lung and kidney and resolving blood stasis) approach had the highest probability of being ranked first for increasing BMD (surface under the cumulative ranking curve [SUCRA] = 98.82%) and FEV1 (SUCRA = 99.99%), indicating a substantial effect on improvement. The combination of CWMT and TCM may yield more favorable outcomes compared to CWMT alone for treating COPD with OP. The meta-analysis results indicate that the therapeutic efficacy of TCM combined with CWMT may be improved to a certain extent compared with CWMT alone. However, the certainty of the evidence is limited due to small sample sizes, high heterogeneity, and risks of bias. Future high-quality RCTs with rigorous designs, larger sample sizes, and standardized outcome measures are warranted to strengthen the evidence base for the application of TCM in patients with COPD and comorbid OP and to further confirm its efficacy.