姜黄素治疗膝骨关节炎疗效及安全性的系统评价

Efficacy and safety of curcumin in the treatment of knee osteoarthritis:a systematic review

目的采用系统评价的方法对姜黄素治疗膝骨关节炎的疗效及安全性进行分析。方法检索收集2011年1月至2021年8月间发表的有关于姜黄素治疗膝骨关节炎随机对照研究的相关文献, 采用Revman 5.3软件对纳入研究文献进行偏倚风险评估, 采用Stata 16.0软件对疗效相关指标及不良反应事件发生率进行系统评价。疗效指标差异计算加权均数差(WMD), 安全性指标差异计算优势比(OR), 差异比较行t检验。结果①共纳入相关文献9篇, 全部为英文文献。②共纳入研究患者总量为724例, 其中383例口服姜黄素胶囊进行治疗, 341例口服安慰剂进行对照。③口服姜黄素治疗后患者3~4、6、8周的疼痛视觉模拟评分(VAS)均显著低于口服安慰剂患者相应的评分, 差异均有统计学意义[加权均数差(WMD)(95%CI)=-1.09(-1.44, -0.73), P<0.001;WMD(95%CI)=-1.52(-2.35, -0.69), P<0.001;WMD(95%CI)=-1.20(-1.71, -0.69), P<0.001]。④口服姜黄素治疗患者3~4、6~8周的西安大略和麦克斯特大学骨关节炎指数评分(WOMAC评分)均显著低于口服安慰剂患者相应的评分, 差异均有统计学意义[WMD(95%CI)=-7.96(-14.89, -1.04), P=0.020;WMD(95%CI)=-15.34(-20.51, -10.18), P<0.001]。具体表现为口服姜黄素治疗患者6~8周的WOMAC疼痛、僵硬评分均显著低于口服安慰剂患者相应的评分, 差异均有统计学意义[WMD(95%CI)=-2.16(-3.69, -0.63), P=0.010;WMD(95%CI)=-1.00(-1.54, -0.46), P<0.01];口服姜黄素的患者治疗3~4、6~8周的WOMAC关节功能评分均显著低于口服安慰剂患者相应的评分, 差异均有统计学意义[WMD(95%CI)=-3.21(-4.51, -1.92), P<0.001;WMD(95%CI)=-7.07 (-11.19, -2.94), P<0.001]。⑤不良反应事件发生率比较, 口服姜黄素的患者不良反应事件发生率与口服安慰剂患者的发生率相比, 差异无统计学意义[OR值(95%CI)=1.19(0.74, 1.90), P=0.478]。结论与安慰剂相比, 口服姜黄素具有明显缓解膝骨关节炎患者的疼痛, 改善僵硬及关节功能的疗效, 而且安全性方面与安慰剂相当。

Objective To analyze the efficacy and safety of curcumin in the treatment of knee osteoarthritis.Methods The randomized controlled trials of curcumin in the treatment of knee osteoarthritis published from January 2011 to August 2021 were retrieved.The bias risk of the included literatures was evaluated by Revman 5.3 software,and the efficacy related indexes and the incidence of adverse events were analyzed by Stata 16.0 software.The weighted mean difference(WMD)was calculated for the difference of efficacy indexes,the odds ratio(OR)was calculated for the difference of safety indexes,the difference was compared by t test.Results①A total of 9 relevant literatures were included,all of which were in English.②A total of 724 patients were included in the study,of which 383 were treated with curcumin capsules and 341 were treated with placebo.③The visual analogue scale/score(VAS)of patients treated with oral curcumin at 3-4,6 and 8 weeks were significantly lower than those of patients treated with oral placebo,the differences were statistically significant[weighted mean difference(WMD)=-1.09,95%CI(-1.44,-0.73),P<0.001;WMD=-1.52,95%CI(-2.35,-0.69),P<0.001;WMD=-1.20,95%CI(-1.71,-0.69),P<0.001].④The western Ontario and McMaster universities osteoarthritis index(WOMAC)scores of patients treated with oral curcumin for 3-4 and 6-8 weeks were significantly lower than those of patients treated with oral placebo,and the differences were statistically significant[WMD=-7.96,95%CI(-14.89,-1.04),P=0.020;WMD=-15.34,95%CI(-20.51,-10.18),P<0.001].Specifically,the WOMAC pain and stiffness scores of patients treated with oral curcumin for 6-8 weeks were significantly lower than those of patients treated with oral placebo,and the differences were statistically significant[WMD=-2.16,95%CI(-3.69,-0.63),P=0.010;WMD=-1.00,95%CI(-1.54,-0.46),P<0.001].The WOMAC joint function scores of patients treated with oral curcumin for 3-4 and 6-8 weeks were significantly lower than those of patients treated with oral placebo,the difference was statistically significant[WMD=-3.21,95%CI(-4.51,-1.92),P<0.001;WMD=-7.07,95%CI(-11.19,-2.94),P<0.001].⑤There was no significant difference in the incidence of adverse events between oral curcumin and placebo[OR=1.19,95%P(0.74,1.90),P=0.478].Conclusion Compared with placebo,oral curcumin can significantly alleviate the pain,stiffness and joint function of patients with knee osteoarthritis,and its safety is similar to placebo.