针刺联合中药口服治疗膝骨关节炎临床疗效及安全性的Meta分析

Meta-analysis of Efficacy and Safety of Acupuncture Combined with Oral Use of Chinese Herbal Medicine in Treatment of Knee Osteoarthritis

【目的】系统评价针刺联合中药口服治疗膝骨关节炎(KOA)的临床疗效和安全性。【方法】计算机检索中国知网(CNKI)、万方(Wanfang)、维普(VIP)、PubMed、Cochrane Library数据库中有关针刺联合中药口服治疗膝骨关节炎的文献,检索时间为2015年1月1日至2020年10月1日;采用Review Manager 5.3软件对纳入的文献进行Meta分析。【结果】研究共纳入8篇文献,累计样本量762例,其中治疗组385例,对照组377例。Meta分析结果显示:针灸联合中药口服治疗膝骨关节炎总有效率高于西药组(OR=4.57,95%CI[2.26,9.26],P<0.01);针灸联合中药口服在改善视觉模拟量表(VAS)评分上优于西药组(SMD=-3.64;95%CI[-5.04,-2.24],P<0.01);在改善WOMAC评分上,针灸联合中药口服组优于西药组(SMD=-11.56;95%CI[-17.09,-6.03],P<0.01);在提高Lysholm膝关节功能评分上,针灸联合中药口服组优于西药组(SMD=16.43;95%CI[9.01,23.85],P<0.01);针灸联合中药口服组治疗上发生不良反应的比例低于西药口服组(OR=0.30,95%CI[0.13,0.68],P<0.01)。【结论】针灸联合中药口服治疗膝骨关节炎在有效性和症状功能改善方面优于西药治疗,不良反应少,安全性好。鉴于纳入研究的数量少,质量较低,上述结论有待更多高质量研究予以验证。

Objective To systematically evaluate the clinical efficacy and safety of acupuncture combined with oral use of Chinese herbal medicine in treating knee osteoarthritis(KOA). Methods The literatures on acupuncture combined with oral treatment of Chinese herbal medicine in treating KOA were retrieved from the CNKI,Wanfang,VIP,PubMed and Cochrane Library from January 1,2015 to October 1,2020. Review Manager 5.3 software was used for Meta-analysis of the included literatures. Results A total of 8 literatures were included in this study,with a total sample size of 762 cases,including 385 cases in the treatment group and 377 cases in the control group. The results of Meta-analysis showed that the total effective rate of acupuncture combined with oral use of Chinese herbal medicine was higher than that of the western medicine group(OR=4.57, 95% CI[2.26,9.26],P < 0.01). The VAS score of the acupuncture combined with oral treatment of Chinese herbal medicine group was superior to that of the western medicine group(SMD=-3.64;95% CI[-5.04,-2.24],P<0.01). The improvement of WOMAC score in the acupuncture combined with oral use of Chinese herbal medicine group was superior to the western medicine group(SMD=-11.56;95% CI[-17.09,-6.03], P<0.01);In improving Lysholm score of knee function,the acupuncture combined with oral use of Chinese herbal medicine group was superior to the western medicine group(SMD=16.43;95% CI[9.01, 23.85], P<0.01);The proportion of adverse reaction in the acupuncture combined with oral use of Chinese herbal medicine group was lower than that in the oral use of western medicine group(OR=0.30, 95% CI[0.13, 0.68], P < 0.01). Conclusion Acupuncture combined with oral use of Chinese herbal medicine in the treatment of KOA is superior to the western medicine in the effectiveness and improvement of symptoms and functions, with fewer adverse reactions and higher safety index. Considering the small number and low quality of the included studies,the above conclusions need to be verified by more high-quality studies.