针刺治疗膝骨关节炎疗效及安全性的系统评价和Meta分析

Efficacy and safety of acupuncture for the treatment of knee osteoarthritis:a systematic review and meta-analysis

目的:评估针刺治疗膝骨性关节炎的有效性及安全性,并为其临床应用提供依据.方法:共检索8个数据库,检索时间从建库到2018年3月,纳入分析针刺对比假针刺或针刺对比无针刺治疗膝骨性关节炎的随机对照试验.两位评审员独立进行文献筛选、数据提取和质量评估.采用Cochrane风险评估工具评估纳入文献的偏倚风险.结果:纳入随机对照试验18个,涉及总人数3522.结果发现,针刺组在缓解关节疼痛及改善关节功能方面均优于假针刺组[SMD=-0.34;95%CI(-0.57,-0.11);I^2=85%;P=0.003],[SMD=-0.34,95%CI(-0.57,-0.11),I^2=85%,P=0.003].针刺组对比无针刺组,在缓解关节疼痛及改善关节功能方面同样显示显著优势[SMD=-0.79,95%CI(-1.15,-0.43),I^2=87%,P<0.0001),[SMD=-0.75,95%CI(-1.19,-0.31),I^2=91%,P=0.0008].敏感性分析提示结果稳固,Egger检验也未发现潜在的发表偏倚.结论:针刺组对比假针刺组或无针刺组在缓解膝骨性关节炎疼痛、提高关节功能方面具有优势.

Objective:To evaluate the efficacy and safety of acupuncture for the treatment of knee osteoarthritis and to provide evidence for its use in clinical practice.Methods:Eight databases were extensively searched up to March 2018.Randomized controlled trials(RCTs)comparing the efficacy of acupuncture with sham acupuncture or no acupuncture for knee osteoarthritis were included.Study selection,data extraction and quality assessment were independently conducted by two reviewers.The Cochrane Collaboration's tool was used for assessing the risk of bias.Results:A total of 18 RCTs were included,involving a total of 3522 participants.The results showed that acupuncture was superior to sham acupuncture in relieving pain(SMD=-0.34,95%CI:-0.57 to-0.11,I^2=85%,P=0.003)and improving physical function(SMD=-0.34,95%CI:-0.57 to-0.11,I^2=85%,P=0.003).In comparison to the no-acupuncture group,the acupuncture group also showed significant advantages in relieving pain(SMD=-0.79,95%CI:-1.15 to-0.43,I^2=87%,P<0.0001)and improving physical function(SMD=-0.75,95%CI:-1.19 to-0.31,I^2=91%,P=0.0008).Sensitivity analyses suggested that the results were robust,and Egger's test found no potential publication bias.Conclusion:In the treatment of knee osteoarthritis,the acupuncture group had significant advantages over sham acupuncture or no-acupuncture groups in relieving pain and improving physical function.