健脾利湿通络法改善骨关节炎湿热证免疫炎症指标的系统评价和Meta分析

Systematic Evaluation and Meta-analysis of Improving Immune Inflammatory Indexes of Osteoarthritis with Damp Heat Syndrome by Strengthening Spleen,Removing Dampness and Dredging Collaterals

目的:系统评价健脾利湿通络法改善骨关节炎湿热证患者免疫炎症指标的情况及安全性。方法:计算机检索中文数据库中国知网、万方、维普和英文数据库PubMed、EMbase、Web of Science,收集关于健脾利湿通络法治疗骨关节炎湿热证的期刊文献,文献类型限于临床随机对照试验(RCT)。检索时间为数据库建立至2021年2月10日。治疗组为健脾利湿通络法治疗,排除合并西药治疗,对照组为常规西药口服治疗,非药物治疗和手术治疗不纳入研究。2名系统评价员按照纳入、排除标准独立进行文献筛选、资料提取和质量评价,采用Cochrane Handbook偏倚风险评估工具,RevMan 5.3软件进行Meta分析。结果:共纳入20篇RCT文献。Meta分析显示,治疗组总有效率高于对照组,在改善患者西安大略和麦克马斯特大学骨关节炎指数(WOMAC评分)、视觉模拟评分法(VAS)评分、骨关节炎严重程度指数(Lequesne MG评分)方面均优于对照组;且能明显降低炎症指标红细胞沉降率(ESR)和超敏C反应蛋白(hs-CRP)水平(P<0.05);不良反应发生率低于对照组(P<0.05)。结论:健脾利湿通络法治疗骨关节炎湿热证在总有效率,改善WOMAC评分、VAS评分和Lequesne MG评分,降低炎症指标ESR和hs-CRP方面均优于常规西药治疗;且不良反应少,安全性较高。

Objective:To systematically evaluate the efficacy and safety of the method of strengthening spleen,removing dampness and dredging collaterals in improving immune inflammatory indexes in patients of osteoarthritis(OA)with damp heat syndrome.Methods:Chinese databases such as CNKI,Wanfang,VIP and English databases sucha as PubMed,EMbase and Web of Science were searched by computer to collect the literature on the treatment of OA with damp heat syndrome by strengthening the spleen,removing dampness and dredging collaterals.The literature type was limited to clinical randomized controlled trial(RCT).The retrieval time is from the establishment of the database to February 10,2021.The treatment group was treated by strengthening the spleen,removing dampness and dredging collaterals,excluding the treatment with western medicine,and the intervention measure of the control group was oral administration of conventional western medicine.Non drug treatment and surgical treatment were not included in the study.Two system evaluators independently conducted literature screening,data extraction and quality evaluation according to the Naxi standard,and Meta-analysis was conducted with Cochrane Handbook bias risk assessment tool and software RevMan 5.3.Results:A total of 20 RCTs were included.Meta-analysis showed that the total effective rate of the treatment group was higher than that of the control group,and it was better than the control group in improving the WOMAC score,VAS score and Lequesne MG score.It could significantly reduce the levels of ESR and hs-CRP(P<0.05).The incidence of adverse reactions was lower than that in the control group(P<0.05).Conclusion:The method of strengthening the spleen,removing dampness and dredging collaterals is superior to conventional western medicine in the total effective rate,improving the scores of WOMAC,VAS and Lequesne MG,and reducing the inflammatory indexes ESR and hs-CRP,with less adverse reactions and high safety.