| Objective1.To evaluate the clinical efficacy and safety of acupuncture in postmenopausal osteoporosis(PMOP),and provide evidence-based medicine for acupuncture in PMOP.2.To analyze the related factors that affect the bone mass of postmenopausal women,and analyze the correlation between the GH/IGF-1 axis and the bone mass of postmenopausal women.It is expected to provide a reference for the prevention and treatment of PMOP.3.To compare the efficacy of Lingnan Chen's acupuncture and Western medicine in PMOP,and explore the mechanism of Lingnan Chen's acupuncture in the treatment of PMOP,so as to provide objective basis and new ideas for clinical use of Lingnan Chen's acupuncture in PMOP.Methods1.Search the Chinese and English databases,select the randomized controlled studies about acupuncture for PMOP,sort and analyze the literature,and use Revman 5.3 to conduct a meta-analysis.The Nfs0.05 was used for the evaluation of publication bias.2.The 238 postmenopausal patients were divided into osteoporosis group,low bone mass group and normal bone mass group.The clinical data of the three groups were compared:?general clinical data:age,height,weight,BMI.menarche age,menopausal age,number of children born;? complex diseases:hypertension,coronary heart disease,hyperuricemia,diabetes,lumbar disc herniation,limb fractures,chronic gastroenteritis and malignant tumors;?bone mineral density(BMD):lumbar spine(L1-4)BMD,left femoral neck BMD,left upper end of femoral neck BMD;?Serum biochemical indicators:total bilirubin(TBIL),direct bile Red pigment(DBIL),total protein(TP),albumin(ALB),white ball ratio(A/G),alanine aminotransferase(ALT),aspartate aminotransferase(AST),alkaline phosphatase(ALP),lactate dehydrogenation Enzyme(LDH),urea nitrogen(BUN),creatinine(SCr),cystatin C(CYS-C),triglycerides(TG),serum total cholesterol(TC),high density lipoprotein(HDL-C),Low-density lipoprotein(LDL-C),calcium(Ca),phosphorus(P);?bone metabolism markers:parathyroid hormone(PTH),total type I collagen N-terminal propeptide(PINP),?-Collagen degradation products(?-CTX),N-terminal osteocalcin(OC);?sex hormones:luteinizing hormone(LH),estradiol(E2),prolactin(PRL),follicle stimulating hormone(FSH).progesterone(P),testosterone(T);?growth hormone(GH),insulin-like growth factor-1(IGF-1);? vitamin D.The correlation between GH,IGF-1 and BMD was analyzed.The subjects were analyzed by multiple ordered logistic regression analysis,with different levels of bone mass as response variables,and the factors with differences among the three groups as explanatory variables.Logistic regression analysis was performed to screen out indicators related to PMOP,and the correlation between the GH/IGF-1 axis and the bone mass of postmenopausal women was analyzed.3.Carry out randomized controlled studies,and randomly divide PMOP patients into acupuncture group and control group.All patients were given calcium carbonate D3 orally.The patients in the acupuncture group were given acupuncture treatment with acupuncture prescription:Shenshu(BL23),Pishu(BL20),Guanyuan(RN4),Zusanli(ST36),Xuanzhong(GB39),Sanyinjiao(SP6).The Lingnan Chen's acupuncture is used for acupuncture treatment for 12 weeks.The control group was given calcitriol capsules orally for 12 weeks.The clinical effective rate of the two groups was observed.The changes of BMD and the levels of serum PIMP,?-CTX,LH,FSH,E2,IGF-1 and GH were compared.The changes of TCM syndromes and quality of life in two groups before treatment,after treatment of 4 weeks,8 weeks and 12 weeks were evaluated,and the adverse reactions during treatment were recorded.Results1.Literature reviewA total of 10 studies with 756 patients were included.The results of the Meta analysis were as follows:(1)The effect of acupuncture alone was better than that of Western medicine in improving the clinical effective rate and TCM symptoms and signs score of PMOP patients,and the difference was statistically significant(P<0.05);(2)The effect of acupuncture treatment group was better than that of the western medicine treatment group in improving the bone mineral content of lumbar spine,femoral neck,ward triangle and femoral trochanter in PMOP patients,and the difference was statistically significant(P<0.05);(3)There was no statistically significant difference between the acupuncture treatment group and the western medicine treatment group in improving the serum E2,ALP,Ca,P,IGF-1 in PMOP patients(P>0.05).(4)The Nfs0.05 with the clinical effective rate was 36.8631.2.Retrospective studyA total of 238 cases were divided into three groups:osteoporosis group(n=63),low bone mass group(n=108)and normal group(n=67).(1)Comparing the general data of the population,it was found that there were significant differences in age,weight and BMI among the three groups(P<0.05).The age of the osteoporosis group was significantly higher than that of the low bone mass group and the normal group(P<0.05),and the weight and BMI were significantly lower than that of the low bone mass group and the normal group(P<0.05);(2)There was no statistical difference in the combined diseases among the three groups(P>0.05);(3)The comparison of serum biochemical indicators showed that there were significant differences in ALP and P among the three groups(P<0.05).The level of ALP in osteoporosis group was significantly higher than that in low bone mass group and normal group,while the level of P in osteoporosis group was significantly lower than that in low bone mass group and normal group(P<0.05);(4)The comparison of sex hormones showed that there were significant differences in E2 and FSH among the three groups(P<0.05),but there was no statistical difference in P,T,PRL,and LH(P>0.05).The level of E2 in normal group was significantly higher than that of the osteoporosis group and the low bone mass group,and the level of FSH in osteoporosis group was significantly higher than that of the low bone mass group and the normal group,the differences were statistically significant(P<0.05);(5)The comparison of bone metabolism markers showed that:the level of PINP,?-CTX,OC were statistically different among the three groups(P<0.05),but there was no statistical difference in PTH(P>0.05).The level of PINP and ?-CTX in the osteoporosis group were significantly higher than those in the low bone mass group and the normal group(P<0.05),the level of OC in osteoporosis group was significantly higher than that in normal group(P<0.05);(6)Compared the level of GH and IGF-1 of the three groups,it was found that there were significant differences in GH and IGF-1 among the three groups(P<0.05).The level of GH in normal group was significantly higher than that in osteoporosis group and low bone mass group,the difference was statistically significant(P<0.05).The level of IGF-1 in normal group was significantly higher than that in osteoporosis group(P<0.05).(7)There were significant differences in BMD of lumbar spine(L1?4),left femoral neck and left upper femur among the three groups(P<0.05).The BMD in osteoporosis group was significantly lower than that in low bone mass group and normal group(P<0.05);(8)The results showed that IGF-1 was positively correlated with lumbar(L1?4)BMD(r=0.200,P<0.05),GH was positively correlated with the BMD of the lumbar spine(L1?4),the left femoral neck and the upper end of the left femur(r=0.372,0.249,0.276,P<0.05);(9)Multiple logistic regression analysis showed that age(OR=1.090,95%CI:1.036?1.146,P=0.001)and ?-CTX(OR=3.222,95%CI:1.196?8.680,P=0.021))were independent risk factors for osteoporosis in postmenopausal women.BMI(OR=0.85 1,95%CI:0.236?0.918,P=0.000),E2(OR=0.998,95%CI:0.002?0.995,P=0.044),phosphorus(OR=0.121,95%CI:0.031?0.462,P=0.002),GH(OR=0.047,95%CI:0.016?0.137,P=0.000)and IGF-1(OR=0.989,95%CI:0.819?0.998,P=0.014)were the protective factors for osteoporosis in postmenopausal women.3.Randomized controlled studyA total of 70 cases were included in this study,with 35 cases in each of the acupuncture group and control group.A total of 7 cases fell off during the treatment,and finally 31 cases were included in the acupuncture group and 32 cases in the control group.(1)General information,BMD,serum PINP,?-CTX,LH,FSH,E2,IGF-1 and GH levels,quantitative scores of TCM syndromes and quality of life scores between the two groups was not statistically significant before treatment(P>0.05).(2)Clinical effective rateAfter 12 weeks of treatment,the clinical effective rate in acupuncture group was 83.87%,which was significantly higher than 59.38%of the control group(P<0.05).(3)Serum GH and IGF-1 levelsCompared with before treatment,the levels of serum GH and IGF-1 in the acupuncture group were significantly increased after treatment,and the difference was statistically significant(P<0.05),while there was no statistical difference in the control group(P>0.05).Compared with the control group,the levels of serum GH and IGF-1 in the acupuncture group were significantly increased,and the difference was statistically significant(P<0.05).(4)Serum E2,FSH,LH levelsCompared with before treatment,the serum E2 level of the acupuncture group and the control group was significantly increased,and the levels of serum FSH and LH were significantly decreased(P<0.05);Compared with the control group,the serum E2 level of the acupuncture group was significantly increased,and the serum FSH and LH levels were significantly decreased,the difference was statistically significant(P<0.05).(5)Serum PINP and ?-CTX levelsCompared with before treatment,the levels of serum PINP and ?-CTX in the acupuncture group were significantly decreased after treatment,and the difference was statistically significant(P<0.05).Serum PINP and ?-CTX levels in the control group were lower than before treatment,but the difference was not statistically significant(P>0.05).Compared with the control group,the levels of serum PINP and ?-CTX in the acupuncture group were significantly decreased after 12 weeks of treatment(P<0.05).(6)BMDComparison between groups found that the BMD in the acupuncture group and the control group increased after 12 weeks of treatment,but the difference between the two groups was not statistically significant(P>0.05).There was no significant difference in BMD between the two groups before and after treatment(P>0.05).(7)TCM syndrome quantitative scoreThe results showed that compared with before treatment,the TCM syndrome scores of the two groups were significantly decreased at 4 weeks,8 weeks and 12 weeks of treatment,and the difference was statistically significant(P<0.05).The TCM syndrome score in acupuncture group was significantly lower than that of the control group at 4 weeks,8 weeks and 12 weeks of treatment,and the difference was statistically significant(P<0.05).(8)Quality of life(SF-36)scoreAfter 4 weeks of treatment,the scores of PF,RP,BP,GH,VT,SF,RE and MH in the acupuncture group were improved,the difference was statistically significant(P<0.05)).The scores of PF?RP?BP?VT?SF?RE and MH in the control group were improved(P<0.05).The acupuncture group was significantly higher than the control group in BP?RE scores(P<0.05).After 8 weeks of treatment,the eight dimensions of quality of life in the acupuncture group and the control group were significantly improved compared with those before treatment(P<0.05),and the acupuncture group was significantly higher than the control group in RP,BP,VT,RE and MH scores(P<0.05).After 12 weeks of treatment,the eight dimensions of quality of life in the acupuncture group and the control group were significantly improved compared with those before treatment(P<0.05),and the acupuncture group was significantly higher than the control group in PF,RP,BP,VT,RE and MH scores(P<0.05).(9)Adverse reactionsOne patient in the acupuncture group had local hematoma,while no obvious adverse reactions were found in control group.Conclusion1.Compared with western medicine treatment,acupuncture alone is more effective in improving the clinical efficiency,BMD and TCM scores in PMOP patients,which is worthy of clinical promotion.However,due to the low quality of the included literatures,the clinical efficacy and safety of acupuncture alone for PMOP still need to be verified by higher quality evidence.2.Osteoporosis in postmenopausal women is related to age,BMI,serum sex hormones,bone metabolism and GH/IGF-1 axis.Age and ?-CTX are independent risk factors for osteoporosis in postmenopausal women.BMI,E2,P(Phosphorus),GH and IGF-1 are protective factors for osteoporosis in postmenopausal women.The GH/IGF-1 axis is of great significance in the pathogenesis of PMOP,which provides basis and new ideas for early detection and treatment of PMOP.3.Lingnan Chen's acupuncture has a definite effect for PMOP,which can improve the TCM symptoms,quality of life,serum IGF-1,GH,PINP,?-CTX,LH,FSH,E2 levels in PMOP patients,considering its therapeutic mechanism involves the regulation of acupuncture on sex hormones,bone metabolism and the GH/IGF-1 axis.This provides an objective basis for the clinical use of Lingnan Chen's acupuncture for PMOP,and enriches the mechanism of acupuncture for PMOP. |
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