针灸联合康复疗法治疗膝骨性关节炎有效性的网状meta分析

Effectiveness of therapies of acupuncture combined with rehabilitation on knee osteoarthritis:a network meta-analysis

目的采用网状meta分析方法评价不同针灸结合康复疗法治疗膝骨性关节炎(KOA)的有效性。方法计算机检索中国期刊全文数据库(CNKI)、中国生物医学文献数据库(ChinaBiology Medicinedisc,CBM)、万方数据库(WanFangData)、重庆维普中文科技数据库(VIP)、PubMed、Embase、TheCochraneLibrary中公开发表的针灸与康复疗法联合治疗KOA的随机对照试验,时间限定为从建库至2021年1月1日,经筛选文献、提取资料并评价纳入研究的偏倚风险后,采用STATA 14.2软件进行网状meta分析。结果共纳入23个随机对照试验,包括KOA患者2062例,干预措施共15种。网状meta分析结果显示:有效率方面,电针+理疗、温针灸+理疗、温针灸+康复、针刺+理疗、针刺+康复+理疗、针刺+康复优于西药[电针+理疗比西药,OR=20.09,95%CI(2.32,174.34);温针灸+理疗比西药,OR=16.41,95%CI(1.64,163.81);温针灸+康复比西药,OR=8.58,95%CI(3.29,22.36);针刺+理疗比西药,OR=8.86,95%CI(1.64,48.00);针刺+康复+理疗比西药,OR=4.67,95%CI(1.88,11.62);针刺+康复比西药,OR=4.72,95%CI(1.58,14.09)]。电针+理疗、温针灸+理疗、温针灸+康复、针刺+理疗、针刺+康复+理疗、针刺+康复有效率优于针刺[电针+理疗比针刺:OR=15.46,95%CI(1.91,125.27);温针灸+理疗比针刺:OR=12.63,95%CI(1.35,118.22);温针灸+康复比针刺:OR=6.60,95%CI(2.17,20.05);针刺+理疗比针刺:OR=6.82,95%CI(1.38,33.81);针刺+康复+理疗比针刺:OR=3.59,95%CI(1.07,12.06);针刺+康复比针刺:OR=3.63,95%CI(1.53,8.61)]。电针+理疗和温针灸+康复有效率优于康复[电针+理疗比康复:OR=13.99,95%CI(1.29,151.08);温针灸+康复比康复:OR=5.97,95%CI(1.80,19.76)]。电针+理疗、温针灸+康复、针刺+康复+理疗有效率优于康复+理疗[电针+理疗比康复+理疗:OR=12.45,95%CI(1.14,136.15);温针灸+康复比康复+理疗:OR=5.32,95%CI(1.90,14.86);针刺+康复+理疗比康复+理疗:OR=2.89,95%CI(1.12,7.51)]。电针+理疗和温针灸+理疗有效率优于电针[电针+理疗比电针:OR=8.97,95%CI(1.02,79.22);温针灸+理疗比电针:OR=7.33,95%CI(2.05,26.21)]。曲线下面积概率值(SUCRA)排序结果:电针+理疗>温针灸+理疗>温针灸+康复>针刺+理疗>电针+康复>理疗>针刺+康复+理疗>针刺+康复>温针灸>针刀+康复>电针>康复+理疗>康复>针刺>西药。结论针灸与康复疗法联合治疗的有效率高于西药、单一针灸疗法、单纯康复疗法,并且治疗KOA有效率最高的疗法为电针+理疗,可作为KOA的较优治疗方式。

Objective To evaluate the effectiveness of different therapies of acupuncture combined with rehabilitation in the treatment of knee osteoarthritis by using a network meta-analysis.Methods The randomized controlled trials(RCT)of therapies of acupuncture combined with rehabilitation in the treatment of KOA published in CNKI,CBM,WanFang Data,VIP,PubMed,Embase,and The Cochrane Library were searched from their establishment to January 1,2021.After screening the literatures,extracting the data,and evaluating the risk of bias in the included studies,the STATA 14.2 software was adopted for network meta-analysis.Results A total of 23 RCT and 2062 patients with KOA and 15 intervention measures were included.The network meta-analysis results showed that electroacupuncture(EA)+physiotherapy(PT),warm acupuncture(WA)+PT,WA+rehabilitation therapy(RT),manual acupuncture(MA)+PT,MA+RT+PT,and MA+RT were better than western medicine(WM)in effectiveness[EA+PT vs.WM:OR=20.09,95%CI(2.32,174.34);WA+PT vs.WM:OR=16.41,95%CI(1.64,163.81);WA+RT vs.WM:OR=8.58,95%CI(3.29,22.36);MA+PT vs.WM:OR=8.86,95%CI(1.64,48.00);MA+RT+PT vs.WM:OR=4.67,95%CI(1.88,11.62);MA+RT vs.WM:OR=4.72,95%CI(1.58,14.09)].EA+PT,WA+PT,WA+RT,MA+PT,MA+RT+PT,and MA+RT were better than MA in effectiveness[EA+PT vs.MA:OR=15.46,95%CI(1.91,125.27);WA+PT vs.MA:OR=12.63,95%CI(1.35,118.22);WA+RT vs.MA:OR=6.60,95%CI(2.17,20.05);MA+PT vs.MA:OR=6.82,95%CI(1.38,33.81);MA+RT+PT vs.MA:OR=3.59,95%CI(1.07,12.06);MA+RT vs.MA:OR=3.63,95%CI(1.53,8.61)].EA+PT and WA+RT were better than RT in effectiveness[EA+PT vs.RT:OR=13.99,95%CI(1.29,151.08);WA+RT vs.RT:OR=5.97,95%CI(1.80,19.76)].EA+PT,WA+RT,and MA+RT+PT were better than RT+PT in effectiveness[EA+PT vs.RT+PT:OR=12.45,95%CI(1.14,136.15);WA+RT vs.RT+PT:OR=5.32,95%CI(1.90,14.86);MA+RT+PT vs.RT+PT:OR=2.89,95%CI(1.12,7.51)].EA+PT and WA+PT were better than EA in effectiveness[EA+PT vs.EA:OR=8.97,95%CI(1.02,79.22);WA+PT vs.EA:OR=7.33,95%CI(2.05,26.21)].The SUCRA results showed that EA+PT>WA+PT>WA+RT>MA+PT>EA+RT>PT>MA+RT+PT>MA+RT>WA>needle knife(NK)+RT>EA>RT+PT>RT>MA>WM.Conclusion The effectiveness of therapy of acupuncture combined with rehabilitation is higher than those of WM,single acupuncture therapy,and RT alone,and the most effective therapy for KOA is EA+PT,which can be used as a better therapy for KOA.