口服中成药治疗膝骨关节炎的网状Meta分析

Network Meta-analysis of oral Chinese patent medicine in treatment of knee osteoarthritis

采用网状Meta分析评价中成药治疗膝骨关节炎(KOA)的疗效以及安全性,为临床提供循证依据。计算机检索PubMed,Cochrane Library,EMbase,CNKI,Wanfang,VIP,CBM等数据库,检索有关中成药治疗膝骨关节炎的临床随机对照研究,检索时限为各数据库建库至2020年3月。采用Cochrane推荐的偏倚风险评估工具对纳入的RCT进行质量评价。应用Stata 14.0进行网状Meta分析。最终纳入58篇RCTs,5 788例患者,涉及9种中成药。网状Meta分析结果显示,总有效率方面最优的前3种干预措施为金乌骨通胶囊+氨基酸葡萄糖(氨糖)、仙灵骨葆+氨糖以及痹祺胶囊;降低VAS评分最优的前3种干预措施为盘龙七片>仙灵骨葆+氨糖>仙灵骨葆+NSAIDs;降低WOMAC总评分最优的前3种干预措施为金天格胶囊+非甾体抗炎药(NSAIDs)>金乌骨通胶囊+氨糖>痹祺胶囊+NSAIDs;降低Lequesnse指数疗效较好的3种干预措施为仙灵骨葆+NSAIDs>痹祺胶囊+NSAIDs>金天格胶囊+NSAIDs;降低TNF-α水平最优的前3种干预措施为仙灵骨葆+氨糖>金天格胶囊>金天格胶囊+氨糖=金乌骨通胶囊+氨糖;安全性方面,用药方案不良反应最少的前5种干预措施为痹祺胶囊>金乌骨通胶囊>痹祺胶囊+NSAIDs>仙灵骨葆+NSAIDs>金天格胶囊。结果表明,中成药与NSAIDs或氨糖的联合应用,可以改善KOA患者的临床治疗效果以及减少不良反应。

To evaluate the efficacy and safety of Chinese patent medicine in the treatment of knee osteoarthritis(KOA) with network Meta-analysis, and provide evidence-based medicine evidences for clinical practice. PubMed, Cochrane Library, EMbase, CNKI, Wanfang, VIP and CBM were used to search for clinical randomized controlled trials(RCTs) on Chinese patent medicines for treatment of knee osteoarthritis, with a time limit from the establishment of each database to March 2020. The bias risk assessment tool recommended by Cochrane was used to evaluate the quality of the included RCTs. The network Meta-analysis was performed by Stata 14.0 software. A total of 5 788 patients in 58 RCTs were included, involving 9 kinds of Chinese patent medicines. The results of the network Meta-analysis indicated that in terms of total effective rate, the top three optimal medication regimens were Jinwu Gutong Capsules + Amino Acid Glucose(AAG), Xianling Gubao + AAG and Biqi Capsules;the top three interventions to reduce the VAS score were Panlongqi Tablets > Xianling Gubao + AAG > Xianling Gubao + non steroidal anti-inflammatory drugs(NSAIDs);the top three interventions to reduce the total score of WOMAC were Jintiange Capsules+NSAIDs> Jinwu Gutong Capsules + AAG > Biqi Capsules + NSAIDs;the top three medication schemes with better curative effect to reduce Lequesnse index were Xianling Gubao + NSAIDs > Biqi Capsules + NSAIDs > Jintiange Capsules + NSAIDs;the top three interventions to reduce TNF-α level Xianling Gubao + AAG > Jintiange Capsules > Jintiange Capsules + AAG=Jinwu Gutong Capsules + AAG. In terms of safety, the top five interventions with the least adverse reactions were Biqi Capsules > Jinwu Gutong Capsules > Biqi Capsules + NSAIDs > Xianling Gubao + NSAIDs > Jintiange Capsules. The combined application of Chinese patent medicine and NSADIs or AAG can improve the clinical treatment effect and reduce adverse reactions in KOA patients.