艾灸对类风湿关节炎动物模型促炎性细胞因子影响的文献分析

A Meta-analysis of Effects of Moxibustion on Pro-inflammatory Cytokines in Animal Model with Rheumatoid Arthritis

目的:系统评价艾灸对实验性类风湿关节炎(RA)动物模型体内促炎性细胞因子表达的影响,为艾灸治疗RA的临床应用及相关基础研究提供参考。方法:检索中国知网(CNKI)、中国生物医学文献数据库(CBM)、维普(VIP)、万方4个中文数据库和PubMed、EMBASE及Web of Science 3个英文数据库,检索时间从建库至2020年1月。两名研究人员独立筛选和提取相关数据,采用SYRCLE偏倚风险评估工具进行研究质量评价,使用Revman 5.3软件对纳入文献的结局指标进行Meta分析。结果:共检索到648篇文献,最终纳入15篇动物实验研究。Meta分析结果显示:①与模型组比较,艾灸能降低RA大鼠外周血肿瘤坏死因子-α(TNF-α)(SMD=-3.46,95%CI[-4.89,-2.03],P<0.001)、白介素-1β(IL-1β)(SMD=-3.81,95%CI[-5.82,-1.81],P=0.0002)、白介素-6(IL-6)(SMD=-2.24,95%CI[-2.72,-1.75],P<0.001)的表达;②艾灸治疗后,家兔滑膜液中TNF-α(SMD=-3.98,95%CI[-7.54,-0.42],P=0.003)、IL-6(MD=-42.69,95%CI[-76.47,-8.91],P=0.01)表达下降,而IL-1β(MD=-3.62,95%CI[-7.41,0.17],P=0.06)的表达与模型组比较差异无统计学意义;③与模型组比较,艾灸组小鼠脾脏IL-1β(MD=-15.44,95%CI[-25.73,-5.15],P=0.003)、IL-6(MD=-37.5,95%CI[-62.41,-12.59],P=0.003)的表达下降,差异有统计学意义。结论:当前证据表明,艾灸能降低实验性RA动物模型体内促炎性细胞因子TNF-α、IL-1β、IL-6的表达,减轻炎症反应,但今后的研究有必要在炎症因子的选择、造模方式、艾灸形式等方面进一步规范。

Objective:This study aims to systematically evaluate the effects of moxibustion on the expression of pro-inflammatory cytokines in experimental rheumatoid arthritis(RA)model and to provide basis for the clinical application of moxibustion in the treatment of RA and related researches.Methods:Four Chinese databases(CNKI,CBM,VIP,WANFANG)and three English databases(PubMed,EMBASE and Web of Science)were retrieved.The retrieval time was from the establishment of the database to January 2020.Two researchers independently read the selected literature and extracted relevant data.The risk assessment tool SYRCLE was used to evaluate the study quality and the Revman 5.3 was used to conduct meta-analysis on the outcome indicators of the included literature.Results:A total of 648 articles were retrieved and 15 animal researches were included.The results of meta-analysis indicated that①Compared with the model group,moxibustion reduced the level of TNF-α(SMD=-3.46,95%CI[-4.89,-2.03],P<0.001),IL-1β(SMD=-3.81,95%CI[-5.82,-1.81],P=0.0002)and IL-6(SMD=-3.81,95%CI[-5.82,-1.81],P=0.0002)in serum of the rat model;②After moxibustion treatment,the levels of TNF-α(SMD=-1.19,95%CI[-1.99,-0.39],P=0.003)and IL-6(MD=-42.69,95%CI[-76.47,-8.91],P=0.01)in synovial fluid of the rabbit model decreased,while the expression of IL-1β(MD=-3.62,95%CI[-7.41,0.17],P=0.06)was not significantly different from that of the model group;③Compared with the model group,the expressions of IL-1β(MD=-15.44,95%CI[-25.73,-5.15],P=0.003)and IL-6(MD=-37.5,95%CI[-62.41,-12.59],P=0.003)in the spleen of mice in the moxibustion group were significantly decreased.Conclusion:The current evidence shows that moxibustion can reduce the level of pro-inflammatory cytokines such as TNF-α,IL-1βand IL-6 in experimental RA animal models and reduce the inflammatory response,but future researches need to further standardize the selection of inflammatory cytokines,modeling methods,and moxibustion forms.