关节腔内注射透明质酸钠治疗大骨节病疗效的Meta分析

Efficacy of Intra-articular Injection of Sodium Hyaluronate for Kashin-beck Disease: A Meta-analysis

目的系统评价关节腔内注射透明质酸钠治疗大骨节病的疗效。方法计算机检索Pub Med、EMbase、The Cochrane Library(2016年1期)、CBM、VIP、Wan Fang Data和CNKI数据库,搜集关节腔内注射透明质酸钠治疗大骨节病的相关随机对照试验(RCT),检索时限均为从建库至2016年1月。由2位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Rev Man 5.3软件进行Meta分析。结果共纳入6个RCT,1 276例患者。Meta分析结果显示:与对照组相比,透明质酸钠组的临床优良率[OR=5.89,95%CI(4.10,8.47),P<0.000 01]和Lequesne指数[SMD=–1.66,95%CI(–2.14,–1.13),P<0.000 01]明显优于对照组,差异均有统计学意义。结论现有证据表明,关节腔内注射透明质酸钠可以改善临床优良率以及Lequesne指数。受纳入研究数量和质量的限制,上述结论尚需开展更多高质量的研究进一步验证。

Objectives To systematically review the efficacy of intra-articular injection of sodium hyaluronate for kashin-beck disease. Methods Databases including PubMed, EMbase, The Cochrane Library （Issue 1, 2016）, CBM, VIP, WanFang Data, and CNKI were electronically searched from inception to January 2016 to collect randomized controlled trials （RCTs） about sodium hyaluronate in the treatment of kashin-beck disease. 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. Results A total of 6 RCTs involving 1 276 patients were included. The result of meta- analysis suggested that the sodium hyaluronate group was significantly superior to the control group in clinical effect （OR：5.89, 95%CI 4.10 to 8.47, P〈0.000 01） and the Lequesne index （SMD= -1.66, 95%CI -2.14 to -1.13, P〈0.000 01）. Conclusion Intra-articular injection of sodium hyaluronate is helpful in the improvement of kashin-beck disease in clinical effect and the Lequesne index. Due to the limited quality and quantity of the included studies, more high quality studies are need to verify the above conclusion.