针灸疗法治疗膝骨性关节炎的Meta分析/系统评价再评价

Meta-analysis/systematic review of acupuncture therapy for knee osteoarthritis

目的:对针灸治疗膝骨性关节炎的Meta分析/系统评价进行再评价,为临床治疗膝骨性关节炎提供更加可靠的依据。方法:计算机检索中国知网、维普、万方、The Cochrane Library、Embase、CBM、PubMed数据库以及手工检索图书馆,收集已经公开发表的针灸治疗膝骨性关节炎的Meta分析或者系统评价。检索时限为建库开始至2020年2月,由两名研究人员独立筛选及提取文献资料后,使用PRISMA工具、AMSTAR2量表和GRADE工具分别对纳入的研究进行报告质量、方法学质量和证据质量评价。结果:纳入的12篇Meta分析/系统评价评分在12.5~21.5分,其中除了1篇中文文献外,英文文献评分均比中文文献稍高。而AMSTAR2量表结果显示,纳入的12篇Meta分析/系统评价均被评为极低质量文献。在GRADE证据质量评价结果中,只有3个结局指标被评价为中等质量,其余均评价为低或极低,其中有8篇文献将总有效率作为评价结局疗效的指标,并进行了合并分析,有9篇文章对安大略湖与麦克马斯特的骨性关节炎评分标准(The Western Ontario and McMaste Universities Osteoarthritis Index,WOMAC)评分进行了合并分析。结论:目前针灸治疗膝骨性关节炎的相关Meta分析/系统评价的方法学质量及证据质量均较低,针灸治疗膝骨性关节炎疗效尚存疑问,亟待未来开展更多高质量的随机对照试验证实。

Objective:To re-evaluate the Meta-analysis/systematic evaluation of acupuncture and moxibustion in the treatment of knee osteoarthritis in order to provide a more reliable basis for clinical treatment of knee osteoarthritis.Methods:Meta-analyses or systematic reviews of acupuncture in the treatment of knee osteoarthritis were collected by computer retrieval from CNKI,VIP,Wanfang,the Cochrane Library,Embase,CBM,PubMed and manual retrieval Library.The retrieval period was from the beginning of database construction to February 2020.After literature was independently screened and extracted by two researchers,PRISMA tool,AMSTAR2 scale and GRADE tool were used to evaluate the quality of reports,methodological quality and evidence quality of the included studies respectively.Results:The meta-analysis/systematic evaluation scores of the 12 included papers ranged from 12.5 to 21.5 points.Except for one Chinese paper,the scores of English literature were slightly higher than Chinese literature.The results of AMSTAR2 scale showed that all the 12 included meta-analysis/systematic evaluation papers were rated as extremely low quality.Among the GRADE evidence quality evaluation results,only 3 outcome indicators were evaluated as medium quality,and the rest were all evaluated as low or very low.Among them,8 literatures used total response rate as an indicator to evaluate outcome efficacy and conducted a combined analysis,and 9 literatures conducted a combined analysis on WOMAC score.Conclusion:At present,the methodological quality and evidence quality of Metaanalysis/systematic evaluation of acupuncture and moxibustion in the treatment of knee osteoarthritis are low.The efficacy of acupuncture in the treatment of knee osteoarthritis is still in doubt,which needs to be confirmed by more high-quality randomized controlled trials in the future.