中药外敷干预骨性关节炎的临床疗效Meta分析及组方用药规律研究

Meta-analysis of Clinical Efficacy of External Application of Chinese Medicine in the Intervention of Osteoarthritis and Medication Rules

目的采用Meta分析与数据挖掘技术,探索中药外敷治疗骨性关节炎(Osteoarthritis OA)的临床疗效分析及用药规律。方法检索PubMed、中国知网、万方、维普等数据库,纳入符合中药外敷治疗OA标准相关文献研究,进行质量评价、Meta分析,且对中药外敷组方药物进行数据整理分析。结果共纳入21篇研究,Meta分析结果:①总体有效率:“中药外敷VS非中药外敷”[RR=1.25,95%CI(1.20,1.30),P<0.00001);②总体有效率亚组:“中药外敷VS西药口服”[RR=1.20,95%CI(1.14,1.27),P<0.00001],“中药外敷VS西药外用”[RR=1.29,95%CI(1.21,1.39),P<0.00001],“中药外敷VS西药口服+关节腔注射”[RR=1.30,95%CI(1.00,1.68),P=0.05],“中药外敷VS针灸”[RR=1.26,95%CI(1.03,1.55),P=0.03];③不同结局指标分析结果:Lequesne指数:“中药外敷VS非中药外敷”[RR=-1.59,95%CI(-2.17,-1.01),P<0.00001];WOMAC评分:“中药外敷VS非中药外敷”[RR=-9.84,95%CI(-14.56,-5.12),P<0.0001];VAS评分:“中药外敷VS非中药外敷”[RR=-0.89,95%CI(-1.08,-0.71),P<0.00001];差异均有统计学意义;用药规律分析:共涉及100味中药,累计频次290次,≥7次的中药有10味,累计频次83次,关联规则分析:乳香、没药、威灵仙、白芷、当归、牛膝、川乌、独活、伸筋草是核心中药。结论中药外敷明显改善OA的疼痛、肿胀,有助于关节功能恢复,尤其适用于早中期患者,其组方的核心药物以逐瘀通络功效药物为主,辅以温阳散寒、祛风除湿药物,适于临床广泛应用。

Objective To explore the clinical efficacy of external application of Chinese medicine in the treatment of osteoarthritis(OA)and medication rules by Meta-analysis and data mining.Methods PubMed,China National Knowledge Infrastructure(CNKI),Wanfang,VIP Chinese Technology Periodical Database,and other databases were retrieved to collect randomized controlled trials(RCTs)on the treatment of OA with external application of Chinese medicine that met the inclusion criteria.The quality evaluation and Meta-analysis were performed on the included RCTs,and the data of external application of Chinese medicine were sorted out and analyzed.Results Twenty-one RCTs were included.The results of the Meta-analysis showed that the total effective rate of external application of Chinese medicine was higher than that of external application of non-Chinese medicine[RR=1.25,95%CI(1.20,1.30),P<0.00001].The results of subgroup analysis showed that the total effective rate of external application of Chinese medicine was higher than that of oral administration of western medicine[RR=1.20,95%CI(1.14,1.27),P<0.00001],higher than that of external application of western medicine[RR=1.29,95%CI(1.21,1.39),P<0.00001],higher than that of oral administration of western medicine+articular cavity injection[RR=1.30,95%CI(1.00,1.68),P=0.05],and higher than that of acupuncture[RR=1.26,95%CI(1.03,1.55),P=0.03].The results of different outcome indicators showed that the Lequesne index of external application of Chinese medicine was higher than external application of non-Chinese medicine[RR=-1.59,95%CI(-2.17,-1.01),P<0.00001],the Western Ontario and McMaster Universities OsteoarthritisIndex(WOMAC)score of external application of Chinese medicine was higher than external application of non-Chinese medicine[RR=-9.84,95%CI(-14.56,-5.12),P<0.0001],and the visual analogue scale(VAS)score of external application of Chinese medicine was higher than external application of non-Chinese medicine[RR=-0.89,95%CI(-1.08,-0.71),P<0.00001].The analysis of medication rules found that a total of 100 Chinese medicines were involved in the studies,with a cumulative frequency of 290 times,and 10 Chinese medicines≥7 times were involved,with a cumulative frequency of 83 times.Analysis of association rules showed that Olibanum,Myrrha,Clematidis Radix et Rhizoma,Angelicae Dahuricae Radix,Angelicae Sinensis Radix,Achyranthis Bidentatae Radix,Aconiti Radix,Angelicae Pubescentis Radix,and Lycopodii Herbawere the core Chinese medicines.Conclusion The external application of Chinese medicine significantly reduces the pain and swelling of OA and helps the recovery of joint function,which is especially suitable for patients with OA at an early or middle stage.The core medicines in the prescription are mainly to remove blood stasis and clear collateral channels,with adjuvant medicines to warm yang,dissipate cold,dispel wind,and remove dampness,which is suitable for wide clinical application.