针灸治疗膝关节滑膜炎疗效的系统评价

Effect of Acupuncture on gonarthromeningitis: A systematic review

目的系统评价和比较针灸治疗膝关节滑膜炎的疗效。方法计算机检索中国知网(CNKI)、维普期刊数据库(VIP)、万方数据库(Wanfang Data)、PubMed、Cochrane Library、Embase,所有数据库检索时间从建库到2018年7月15日。收集所有以西药为对照的针灸治疗膝关节滑膜炎的临床随机对照试验,由2名评价者根据事先制定的纳入和排除标准筛选文献,独立提取资料并进行文献质量评价,评价纳入研究的偏倚风险后,采用定量综合或定性分析的方法对针灸治疗膝关节滑膜炎的疗效进行评价。共纳入5个随机对照研究的671名患者,由于纳入研究的临床异质性较大,未进行Meta分析,仅作描述性分析。结果5个研究报告了总有效率,大多研究提示针灸治疗膝关节滑膜炎的总有效率明显高于西药。3个研究报道了疼痛和功能评分,多数研究提示针灸在缓解疼痛和改善功能方面优于西药组。2个研究报道了滑膜指标改善,提示针灸在减轻滑膜肿胀,促进滑膜积液吸收方面优于对照组,但在促进炎症细胞因子吸收方面和西药疗效相当。针灸较少出现不良反应,仅有2个研究报告了不良反应事件。结论目前有限的证据显示,针灸治疗膝关节滑膜炎的疗效优于西药,安全性相对较好。但本次分析纳入的研究质量不高,异质性较大,建议今后开展更多高质量的设计严谨的随机对照实验,纳入同质性更好的研究对象,以进一步验证针灸治疗膝关节滑膜炎的疗效。

Objective To systematically review the curative effect of acupuncture on gonarthromeningitis.Methods Databases of CNKI,VIP,Wanfang Data,PubMed,The Cochrane Library,Embase were searched from the inception to July 15 th,2018.All the Randomized Controlled Trials(RCTs)on gonarthromeningitis treated by western medicine with electroacupuncture were collected.These RCTs were selected independently by two reviewers according to the pre-designed inclusion and exclusion criteria.The effect was evaluated by using quantitative or descriptive analysis.Results The total effective rate was reported in 7 studies,which showed that the total effective rate of acupuncture for gonarthromeningitis is significantly higher than that of western medicine.3 studies reported pain and function score,indicating that acupuncture could relieve pain and improve the function compared to the control group.2 studies reported improvement in synovial index,suggesting that acupuncture was superior to the control group in reducing synovial swelling and promoting synovial fluid absorption,but it is equivalent to western medicine in promoting the absorption of inflammatory cytokines.2 studies reported adverse events,and acupuncture had fewer adverse effects.Conclusion Limited evidence suggests that acupuncture has better effect and less adverse reactions compared with western medicine in treating gonarthromeningitis.However,due to the poor quality and large heterogeneity of the included studies,it is recommended that more high-quality and well-designed RCTs be conducted in the future,also studies with better homogeneity should be included to further validate the efficacy of acupuncture in the treatment of gonarthromeningitis.