氨基葡萄糖联合硫酸软骨素治疗膝骨关节炎的系统评价

Glucosamine combined with chondroitin sulfate for knee osteoarthritis:a systematic review

摘要目的评价氨基葡萄糖(GS)联合硫酸软骨素(CS)治疗膝OA的疗效及安全性。方法检索数据库CENTRAL(2016年第1期)、Pubmed(1946年至2016年1月20日)、EMBASE(1947年至2016年1月20日)、中国生物医学文献服务系统(1978年至2016年1月20日)、中国知网(1994年至2016年1月20日)、万方数据库(1980年至2016年1月20日)和维普数据库(1989年至2016年1月20日),查找GS联合CS治疗膝OA的随机对照试验(RCT)。由2名评价员独立确定纳入试验,评价其方法学质量并提取数据,采用ReviewManager5.3软件进行分析。结果共纳入4个RCT,其中联合组与单用GS比较纳入1145例患者,联合组与单用CS比较纳入1067例患者。结果①联合与单用GS比较的4个研究中有3个报告西安大略和麦克马斯特大学骨关节炎指数量表(WOMAC)评分,3个试验汇总结果显示联合与单用GS差异无统计学意义(P均>0.05)。疼痛、僵硬和功能WOMAC评分MD分别为-6.60[95%CI(-18.79,5.59)、-15.90(-43.09,11.29)和-6.44(-16.46,3.59)]。②联合与单用CS比较:2个长期(≥6个月)研究(937例)将联合与单用CS比较,显示联合治疗与单用CS对比差异无统计学意义(P均>0.05),汇总的疼痛和功能WOMAC评分MD分别为-0.80(-4.96,3.36)和-1.76(-4.46,0.94)。③有1个RCT进行分组分析显示:联合组与单用CS比较(142例)WOMAC评分(疼痛、僵硬和功能),差异有统计学意义(P均<0.05),MD分别为-10.46(-17.98,-2.94)、-9.70(-18.48,-0.92)和-9.39(-17.33,-1.45)。结论尚无证据表明GS联合CS较使用单药治疗膝OA能显著改善WOMAC评分;但在中重度膝关节疼痛的膝OA患者,联合治疗可能优于单用GS或CS。

To evaluate the efficacy and safety of glucosamine (GS) combined with chondroitin sulfate (CS) for knee osteoarthritis (OA).Methods We searched the CENTRAL (Issue 1,2016),PUBMED (1946 to 2016.1.20),EMBASE (1947 to 2016.1.20),CBM (1978 to 2016.1.20),CNKI (1994 to 2016.1.20),WanFang Data (1980 to 2016.1.20) and VIP (1989 to 2016.1.20) and we searched randomized controlled trials (RCT) of GS combined with CS for knee OA.Two reviewers independently identified the included trials,evaluated the quality of methodology and extracted data.The Review manager 5.3 software was used for data analysis.Results Four RCTs were included in this systematic review.The combination group compared with GS group,a total number of 1 145 patients,and the combination group compared with CS group,a total number of 1 067 patients.The outcomes showed:① Among those 4 RCTs that comparing the combination with GS,three RCTs reported western ontario and mcmaster universities osteoarthritis index (WOMAC) score.Summarized results of these 3 RCTs showed no significant difference between combination group and GS group (all P values >0.05).MDs of WOMAC score in pain,stiffnessand function were-6.60 [95%CI(-18.79,5.59),-15.90(-43.09,11.29) and-6.44 (-16.46,3.59)].② Two long-term (≥6 months) study (n=937) compared the combination with CS group and showed no significant difference (all P values >0.05).Pooled MD of WOMAC score in pain and function were-0.80(-4.96,3.36) and-1.76(-4.46,0.94) respec-tively.③ Subgroup analysis in 1 RCT showed that in moderate-to-severe knee pain group(n=142) combination obviously improve the WOMAC score in pain,stiffnessand function compared with CS groupand the differences werestatistically significant (all P values <0.05).MDs were-10.46(-17.98,-2.94),-9.70(-18.48,0.92) and 9.39(-17.33,-1.45).Conclusion There is no evidence to support that the combination of GS and CS for knee OA cansignificantlyimprovethe WOMAC score compared with either GS or CS.For patients with-moderate-to-severe knee pain,combination might be superior toeither GS or CS.