5种针刺方法治疗类风湿关节炎的网状Meta分析

Network Meta-analysis on 5 Acupuncture Methods in Treatment of Rheumatoid Arthritis

目的运用网状Meta分析比较5种针刺方法治疗类风湿关节炎(rheumatoid arthritis,RA)的临床疗效。方法计算机检索PubMed、Embase、Cochrane Library、Web of science、中国知网(CNKI)、维普(VIP)、中国生物医学文献数据库(CBM)、万方数据库,检索时间从数据库建库时间至2018年9月9日,运用ADDIS 1.16.8进行网状Meta分析。结果共检索相关文献1886篇,纳入25项随机对照试验(randomized controlled trials,RCTs),包含5种针刺方法和1915例患者。火针在提高总有效率方面排序最高,且温针灸、火针在提高总有效率方面均优于毫针针刺,其差异均具有统计学意义[OR=4.14,95%CI(1.77,9.12)]、[OR=5.68,95%CI(2.00,16.47)];温针灸、火针在提高总有效率均优于西药,其差异均具有统计学意义[OR=2.89,95%CI(1.60,5.79)]、[OR=4.13,95%CI(1.55,11.16)]。在降低ESR方面,温针灸优于毫针针刺[OR=-16.04,95%CI(-27.63,-3.17)]。结论5种针刺方法中,火针在提高总有效率方面是最佳选择,但我们的发现仍需要更多高质量RCTs的证实。

Objective To comparethe clinical effects of 5 acupuncture methods for rheumatoid arthritis by network Meta-analysis. Methods Authors searched PubMed, Embase, Cochrane Library, Web of science, CNKI, VIP, CBM and Wanfang and the retrieval time was from the database of establishment to September 9 th, 2018. ADDIS 1.16.8 was for network Meta-analysis. Results A total of 1886 related literature were retrieved and 25 randomized controlled trials(RCTs) were included, including 5 acupuncture methods and 1915 patients. Fire-needles ranked the highest in clinical efficacy. Warm-acupuncture and fire-acupuncture were better than needle acupuncture in improving efficiency, and the differences were statistically significant[OR=4.14, 95%CI(1.77, 9.12)], [OR=5.68, 95%CI(2.00, 16.47)]. Warm-acupuncture and fire-needle were better than western medicine in efficacy, and the differences were statistically significant[OR=2.89, 95%CI(1.60, 5.79)], [OR=4.13, 95%CI(1.55, 11.16)]. Warm-acupuncture was superior to needle acupuncture in reducing ESR [OR=-16.04, 95%CI(-27.63,-3.17)]. Conclusions Among 5 types of acupuncture,fire-needles was optimal in enhancing clinical efficacy. However, our findings should be confirmed by more high-quality RCTs.