灸法治疗膝骨性关节炎模型兔疗效的系统评价

Efficacy of moxibustion in the treatment of knee osteoarthritis in model rabbit:a systematic review

目的系统评价灸法治疗膝骨性关节炎(KOA)模型兔的疗效。方法计算机检索CNKI、WanFang Data、VIP、CBM、PubMed、EMbase和The Cochrane Library数据库,搜集灸法治疗KOA模型兔的动物实验,检索时限均为建库至2019年1月31日。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果最终纳入13个动物实验研究,包括226只模型兔。Meta分析结果显示:灸法能够降低KOA模型兔的Mankin评分[MD=-6.47,95%CI(-7.63,-5.32),P<0.00001]、软骨细胞凋亡阳性表达率[MD=-22.21,95%CI(-23.22,-21.21),P<0.00001]、关节液IL-1β水平[SMD=-8.40,95%CI(-15.09,-1.72),P=0.01]、关节液NO含量[SMD=-11.03,95%CI(-17.87,-4.19),P=0.002]、血清IL-1β水平[MD=-19.94,95%CI(-23.61,-16.27),P<0.05]和血清NO含量[MD=-22.69,95%CI(-28.77,-16.61),P<0.05]。结论当前动物模型证据表明,灸法能够改善模型兔关节软骨损伤,加强软骨细胞活性,抑制炎症反应,抑制软骨细胞凋亡。受纳入研究数量和质量的限制,上述结论尚待更多高质量研究予以验证。

Objective To systematically review the efficacy of moxibustion in the treatment of model rabbits with knee osteoarthritis(KOA).Methods CNKI,WanFang Data,VIP,CBM,PubMed,EMbase and The Cochrane Library databases were electronically searched to collect animal experiments on moxibustion in the treatment of model rabbits with KOA from inception to January 31 st,2019.Two reviewers independently screened literature,extracted data,and assessed the risk of bias of included studies.Meta-analysis was then performed by using RevMan 5.3 software.Results A total of 13 articles involving 226 model rabbits were included.The results of meta-analysis showed that moxibustion could reduce Mankin score(MD=-6.47,95%CI-7.63 to-5.32,P<0.00001),positive expression rate of chondrocyte apoptosis(MD=-22.21,95%CI-23.22 to-21.21,P<0.00001),level of IL-1βin joint fluid(SMD=-8.40,95%CI-15.09 to-1.72,P=0.01),NO content in joint fluid(SMD=-11.03,95%CI-17.87 to-4.19,P=0.002),the level of serum IL-1β(MD=-19.94,95%CI-23.61 to-16.27,P<0.05),and serum NO content(MD=-22.69,95%CI-28.77 to-16.61,P<0.05)of model rabbits with KOA.Conclusions Current evidence shows that moxibustion can improve articular cartilage injury,strengthen chondrocyte activity,inhibit the inflammatory response,and inhibit chondrocyte apoptosis of model rabbits with KOA.Due to the limited quality and quantity of the included studies,more high-quality studies are required to verify the above conclusions.