小针刀与透明质酸治疗膝骨性关节炎的有效性:网状Meta分析

The Effectiveness of Small-needle-scalpel and Hyaluronic Acid for Knee Osteoarthritis: a Network Meta-Analysis

目的:运用网状Meta分析的方法,以透明质酸(HA)为共同参照,评价小针刀及其综合疗法治疗KOA的有效性。方法:检索Pub Med、The Cochrane Library(2015年第10期)、EMbase、CNKI、CBM、VIP及Wan Fang数据库中有关小针刀、小针刀综合疗法、HA之间比较治疗KOA有效性的临床随机对照试验(RCT)。以治疗有效率、VAS疼痛评分、Lysholm功能评分为结局指标,运用Stata12.0和Gemtc0.14.3软件进行统计分析。结果:纳入29个RCT,合计KOA患者3 417例,涉及HA、小针刀等6种治疗措施。Meta分析结果显示:⑴在治疗有效率方面,小针刀与HA相比差异无统计学意义,4种综合疗法之间比较差异均无统计学意义,综合疗法与两种单一疗法比较差异有统计学意义;⑵在降低VAS疼痛评分方面,3种中医疗法与HA相比差异均有统计学意义,中医疗法之间比较差异均无统计学意义;⑶在增加Lysholm功能评分方面,仅小针刀+HA与HA相比差异有统计学意义。结论:现有的研究证据显示,小针刀综合疗法优于单一疗法和HA,小针刀综合疗法间疗效无明显差异。基于现有研究局限,本研究结论仍需开展大量高质量RCT予以证实。

Objective To systematically evaluate the therapeutic effects of small-needle-scalpel and synthetic therapies by using network recta- analysis and taking the hyaluronic acid （HA） as a common reference. Methods We systematically searched the PubMed, Cochrane Library （ Issue 10,2015 ）, EMbase, CNKI, CBM, VIP and WanFang databases for relevant clinical randomized controlled trials（RCT） .Treated effect, visual analogue scale （VAS） and Lysholm function scores were used as the clinical outcome indexes.The odds ratio for dichotomous data and mean difference for continuous variables were calculated.The data were analyzed by using Statal2.0 and Gemtc0.14.3 software. Results Finally, 29 RCTs, containing 6 different treatments,with 3 417 KOA patients were included in our study.The results of network meta-analysis showed that there was no significant differences in treated effects between small-needle-scalpel and HA,but 4 synthetic therapies com- pared with 2 monotherapies had statistical significance.Three traditional Chinese medicine treatment which involving small- needle-scalpel compared with HA alone had difference in decreasing VAS, however, there was no significant difference a- mong 3 traditional Chinese medicine treatments.In Lysholm function scores,only small-needle-scalpel combining with HA compared with HA alone had statistical difference.Conclusion Current evidences suggested that Chinese medical synthetic therapies were advantage over the monotherapies and HA.There were no significant difference of efficacy among different synthetic therapies.Due to the limitation of the present studies, Our findings also need further verification with more largescale and well-designed RCTs.