壮医药线点灸治疗痛风性关节炎有效性和安全性的荟萃分析及试验序贯分析

Efficacy and Safety of Thread-point Moxibustion in The Treatment of Gouty Arthritis:A Meta Analysis and Trial Sequential Analysis

目的:对壮医药线点灸治疗痛风性关节炎的随机对照试验进行荟萃分析与试验序贯分析,评价其治疗痛风性关节炎的有效性及安全性。方法:检索CNKI、WF、VIP、Pubmed、Embase及Cochrance Library中关于壮医药线点灸治疗痛风性关节炎的随机对照试验,使用Review Manager 5.3软件及TSA v0.9软件对纳入研究进行荟萃分析,并对主要结局指标进行试验序贯分析。结果:最终5篇文献被纳入,共计受试者276例。与西药比较,壮医药线点灸对于总体有效率、治愈率,血尿酸、关节肿痛积分以及不良反应发生率5个方面均有显著差异[RR=1.20’95%CI(1.07,1.36)][RR=2.07’95%CI(1.11,3.87)][MD=-47.66’95%CI(-66.44,-28.88)][MD=-2.20’95%CI(-3.45,-0.96)][RR=0.37’95%CI(0.17,0.82)]。试验序贯分析提示总体有效率、血尿酸结果可靠,不良反应发生率可能存在假阳性结论。结论:基于本次分析结果可以认为,壮医药线点灸对比西药治疗痛风性关节炎疗效更优,血尿酸水平下降更显著,而壮医药线点灸是否比西药安全性更高仍需开展更多研究加以证实。

Objective:To systematically evaluate the clinical efficacy and safety of Thread-Point Moxibustion in the treatment of gouty arthritis by Meta Analysis and Trial Sequential Analysis.Methods:Retrieved the clinical randomized controlled trial literature on thread-point moxibustion in the treatment of gouty arthritis in CNKI,WF,VIP,PubMed,EMBase,Cochrane Library.Review Manager 5.3 software and TSA v0.9 software were used to evaluate the quality of the literature and meta analysis,and the appropriate outcome index was analyzed sequentially.Results:Finally,5 articles were included in the study,and a total of 276 patients were included.Compared with the drug,Thread-Point Moxibustion had significant differences in improving the overall effective rate,cure rate,reducing blood uric acid,joint swelling and pain score and the incidence of adverse reactions,[RR=1.20’95%CI(1.07,1.36)],[RR=2.07’95%CI(1.11,3.87)],[MD=-47.66’95%CI(-66.44,-28.88)],[MD=-2.20’95%CI(-3.45,-0.96)],[RR=0.37’95%CI(0.17,0.82)].The sequential analysis of the experiment suggested that the overall effective rate and the results of serum uric acid were reliable,and the incidence of adverse reactions might have false positive conclusions.Conclusion:Based on the results of this analysis,it can be concluded that the curative effect of thread-point moxibustion was better than that of western medicine in the treatment of gouty arthritis,and the level of serum uric acid was decreased more significantly.However,more studies should be carried out to confirm whether the moxibustion was more safe than western medicine.