中医辩证治疗膝骨性关节炎的网状Meta分析

Effectiveness of Traditional Chinese Medicine Therapy for Knee Osteoarthritis:A Network Meta-analysis

目的系统评价中医疗法及非甾体抗炎药(NSAIDs)治疗膝骨性关节炎(KOA)的安全性和有效性。方法计算机检索PubMed、The Cochrane Library(2015年5期)、EMbase、CNKI、CBM、VIP和WanFang Data数据库,搜集有关中医疗法治疗KOA的临床随机对照试验(RCT),检索时间均为建库至2015年6月14日。由2位研究者独立筛选文献、提取数据和评价纳入研究的方法学质量后,采用Stata 12.0和WinBUGS 1.4.3软件进行统计分析。结果最终纳入56个RCT,共计7 256例KOA患者,涉及中医疗法及其综合疗法19种,均为短期疗效观察。网状Meta分析共产生33个直接比较和138个间接比较,其中76个比较具有统计学意义。中医疗法总并发症率低于NSAIDs。疗效排序前6位依次为:针灸+推拿、推拿+熏洗、外治+推拿、内治+针灸+推拿、推拿+熏洗+热灸、内治+熏洗+热灸。NSAIDs在19种治疗措施中排序位于第十八位。结论中医疗法安全性较NSAIDs好,除热灸外中医疗法短期疗效均优于NSAIDs,疗效排序前6的中医疗法疗效更显著。在中医疗法中,综合疗法优于单一疗法。基于现有研究的局限性,中医疗法远期疗效有待于进一步研究,另外,本研究结论仍需大量设计合理、方法得当的RCT予以证实。

Objective To systematically review the efficacy and safety of traditional Chinese medicine （TCM） therapies versus non-steroidal anti-inflammatory drugs （NSAIDs） for knee osteoarthritis （KOA）. Methods We electronically searched databases including PubMed, The Cochrane Library （Issue 5, 2015）, EMbase, CNKI, CBM, VIP and WanFang Data from inception to 14 June 2015, to collect randomized controlled trials （RCTs） about TCM therapies for KOA. Two reviewers independently screened literature, extracted data and assessed the methodological quality of included studies. Then network meta-analysis was performed using Stata 12.0 and WinBUGS 1.4.3 softwares. Results A total of 56 RCTs involving 7 256 patients were included, in which 19 different treatment strategies were investigated. All were short-term efficacy studies. Our work yielded 33 direct and 138 indirect comparisons, among which 76 were demonstrated statistically significant. The result of meta-analysis showed that, the TCM-hased therapy group had lower complication rates, compared with the NSAIDs group. TCM internal application ＋ acupuncture ＋ fumigation, internal application ＋ fumigation ＋ moxibustion, acupuncture ＋ massage, TCM extra-apply ＋ massage, massage ＋ fumigation ＋ moxibustion, and massage ＋ fumigation were the top six in terms of treatment effect. NSAIDs ranked 18th. Conclusion The safety and effectiveness of TCM therapies are generally better than NSAIDs except moxibustion, particularly more remarkable for the top six TCM therapies. TCM comprehensive therapies are superior over mono- modality therapies. Due to the limitation of the present studies, the long-term efficacy of TCM therapies needs further investigation, and our findings also need to be verified by large-scale and well-designed RCTs.