穴位贴敷疗法治疗类风湿性关节炎疗效及安全性Meta分析

A Meta-Analysis of Efficacy and Safety of Acupoint Application in Treating RA

目的:评价穴位贴敷疗法治疗类风湿性关节炎的临床疗效及安全性。方法:检索中国期刊全文数据库(CNKI),万方数据库,维普中文期刊全文数据库,中国生物医学文献数据库(CBM),Pubmed,Cochrane图书馆,EMbase,Medline8个国内外数据库,筛选出符合预先设定的纳入标准的临床随机对照实验,采用偏倚风险评估工具进行质量评价提取数据,并采用RevMan 5.3软件进行Meta分析。结果:单纯穴位贴敷在有效率方面与西药相当(OR=1.82,95%Cl[0.84,3.92],Z=1.52(P=0.13)),单纯穴位贴敷在有效率方面与中成药相当(U=0.9361,P>0.05);穴位贴敷联合西药在有效率方优于西药(OR=3.21,95%Cl[2.18,4.74],Z=5.89(P<0.01)),而联合其它中医疗法或联合其他中医疗法及对照组西药时在有效率方面均优于西药(OR=5.41,95%Cl[2.36,12.41],Z=3.99(P<0.01),(OR=7.88,95%Cl[3.82,16.25],Z=5.59(P<0.01));HAQ量表评分两组间比较无统计学意义(MD=-0.23,95%CI[-0.67,0.21],Z=1.02,P=0.31),穴位贴敷组对比西药组两组相当;DAS28评分两组间比较无统计学意义(MD=-0.23,95%CI[-0.67,0.21],Z=1.02,P=0.31),穴位贴敷组对比西药组,两组相当;VAS评分观察组及对照组均较治疗前下降,观察组低于对照组,差异均具统计学意义(P<0.05);安全性评价方面西药安全性评价优于穴位贴敷。结论:穴位贴敷疗法对类风湿性关节炎的临床治疗确具有疗效,但单纯穴位贴敷疗法与西药相比疗效相当,无明显优势,也有研究表明单纯穴位贴敷有效率优于对照组,此现象的发生可能与用药、选穴的差异及病程的差异有关,穴位贴敷存在一定不良反应但比较轻微,由于纳入文献质量问题及存在的局限性,该研究结论还需要更多高质量的临床RCT进一步的验证。

Objective:To evaluate the efficacy and safety of acupoint application in the treatment of rheumatoid arthritis(RA).Methods:Relative clinical RCTs of acupoint application in treating RA,which met the inclusion criteria,were searched from Chinese Journal Full-text Database(CNKI),Wanfang Database,Weipu Chinese Journal Full-text Database,China Biomedical Literature Database(CBM),Pubmed,Cochrane Library,EMbase and Medline these 8 domestic and foreign databases.Bias risk assessment tools were used for quality evaluation,and RevMan 5.3 software were applied to extract clinical data for meta-analysis.Results:A total of 1801 patients in 17 RCT studies were included,meta-analysis results showed that the therapy of simple acupoint application was equivalent to western medication in terms of efficiency(OR=1.82,95%Cl[0.84,3.92],Z=1.52,P=0.13).In terms of efficacy,single acupoint application was equivalent to Chinese patent medicine(U=0.9361,P>0.05);the combination of acupoint application and western medication was superior to western medicaton(OR=3.21,95%CI[2.18,4.74],Z=5.89,P<0.01);acupoint application combined with Chinese medication or other Chinese medical therapies,as well as western medication as in the control group,was also superior to western medication alone(OR=5.41,95%CI[2.36,12.41],Z=3.99,P<0.01),(OR=7.88,95%CI[3.82,16.25],Z=5.59,P<0.01).In terms of HAQ scale scores,there were no statistical difference between the acupoint application group and the western medication group(MD=-0.23,95%CI[-0.67,0.21],Z=1.02,P=0.31).In terms of the DAS28 scores,there were also no statistical differnce between the acupoint application group and the western medication group(MD=-0.23,95%CI[-0.67,0.21],Z=1.02,P=0.31).In terms of the VAS scores,they were lower both in the observation group and the control group after the treatment compared to those before the treatment;of which the observation group was significantly lower than the control group(P<0.05).In terms of the safety evaluation,it was better in the western medication group than that in the acupoint application group.Conclusion:The therapy of acupoint application does have curative effect for RA.The acupoint application is equivalent to western medication,which did not show obivous advantages.However,some studies had shown that the acupoint application was more effective than the treatment in the control group,which may be related to the medication,points selection and course duration.Acupoint application has some adverse reactions but relatively mild.Due to the quality of the literatures included,the conclusion of the study needs further verification with more high-quality RCTs.