中医综合治疗膝骨性关节炎效果的Meta分析

Meta analysis of the effect of traditional Chinese medicine on knee osteoarthritis

目的运用循证医学的方法对中医综合治疗膝骨性关节炎(KOA)的临床效果进行系统评价。方法计算机检索CNKI、WanFang Data、VIP、PubMed数据库,搜集中医治疗KOA的随机对照试验(RCT),搜索时限为建库起至2018年12月。由3名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,使用RevMan 5.3软件进行分析。结果纳入31个RCT,共3140例。Meta分析显示:与西医综合治疗比较,中医综合治疗在总有效率上更佳[OR=4.47,95%CI(3.57,5.59),P<0.00001]。中医综合治疗对比4个亚组Meta分析结果显示,软骨保护剂内外治[OR=5.62,95%CI(2.52,12.52),P<0.0001]、口服软骨保护剂[OR=4.06,95%CI(2.17,7.61),P<0.0001]、口服非甾体类抗炎药(NSAIDs)[OR=4.46,95%CI(3.43,5.80),P<0.00001]、外用软骨保护剂内服NSAIDs[OR=4.04,95%CI(1.66,9.85),P=0.002]4个亚组在疗效上均以中医综合治疗效果为佳,差异有统计学意义。结论中医综合治疗KOA具有较好的效果,值得临床推广。

Objective To systematically evaluate the clinical efficacy of traditional Chinese medicine in the treatment of knee osteoarthritis(KOA)by evidence-based medicine.Methods CNKI,WanFang Data,VIP,PubMed databases were searched by computer,and the randomized controlled trials(RCT)on the treatment of knee osteoarthritis in tradi-tional Chinese medicine were collected.The search time was from the establishment of the database to December 2018.After 3 researchers independently screened the literature,extracted data and evaluated the risk of bias in the included studies,the RevMan 5.3 software was used for analysis.Results A total of 31 RCT were included,with a total of 3140 cases.Meta analysis showed:compared with the comprehensive treatment of Western medicine,the comprehensive treatment of traditional Chinese medicine had a better overall effective rate[OR=4.47,95%CI(3.57,5.59),P<0.00001].Meta analysis results of the comprehensive treatment of traditional Chinese medicine compared with the four subgroups showed that the internal and external treatment of cartilage protectant[OR=5.62,95%CI(2.52,12.52),P<0.0001],oral cartilage protectant[OR=4.06,95%CI(2.17,7.61),P<0.0001],oral NSAIDs[OR=4.46,95%CI(3.43,5.80),P<0.00001],externaluseofchondroprotective agents and NSAIDs[OR=4.04,95%CI(1.66,9.85),P=0.002].In the four subgroups,the effect of traditional Chinese medicine comprehensive treatment was the best,and the difference was statistically significant.Conclusion The comprehensive treatment of knee os-teoarthritis by traditional Chinese medicine has good curative effect,which is worthy of clinical promotion.