基于GRADE评级对活血利水类中药复方治疗全膝关节置换术后膝关节肿痛的Meta分析

Meta-analysis of Traditional Chinese Medicine Compound for Huoxue Lishui Chinese Herbal Compound in the Treatment of Knee Joint Swelling and Pain After Total Knee Arthroplasty Based on GRADE Rating

目的通过Meta分析的方法归纳合并结局指标,系统评价口服活血利水类中药复方对全膝关节置换(TKA)术后膝关节肿胀、疼痛的临床疗效,并对相关证据进行质量等级评价,旨在为临床提供更有力的循证依据。方法检索建库至2021年12月数据库(中国知网、万方、维普、中国生物医学文献数据库、PubMed、EMbase、Cochrane Library、Web of Science)中活血利水类中药复方治疗TKA术后膝关节肿胀、疼痛的随机对照试验(RCTs),提取筛选出的文献数据,采用Cochrane偏倚风险评估工具对文献进行质量评价,采用ReviewManager5.4软件对膝关节肿胀度进行Meta分析,对结局指标以漏斗图表示发表偏倚,按照GRADE标准对结局指标进行证据质量评价。结果共纳入病例632例,其中治疗组共纳入324例,对照组共纳入308例。Meta分析结果显示,与对照组比较,治疗组在降低VAS评分[SMD=-1.13,95%CI(-1.60,-0.67),P<0.00001]、降低膝关节肿胀度[SMD=-0.62,95%CI(-1.05,-0.20),P=0.004]方面具有优势。上述2项结局指标发表偏倚结果提示,VAS评分和膝关节肿胀度的纳入文献可能存在潜在的发表偏倚。结论口服活血利水类中药复方治疗TKA术后肿胀、疼痛有明显临床疗效。

Objective To systematically evaluate the clinical efficacy of Chinese medicine compound for huoxue lishui chinese herbal compound in the treatment of knee joint swelling and pain after total knee arthroplasty(TKA)by summarizing the combined outcome indicators through Meta-analysis,and to evaluate the quality grade of relevant evidence,aiming to provide a more powerful evidence-based basis for clinical practice.Methods The randomized controlled trials(RCTs)on the treatment of knee joint swelling and pain after TKA by traditional Chinese medicine compounds for promoting blood circulation and diuresis in the database(China National Knowledge Infrastructure,Wanfang,VIP,China Biomedical Literature Database,PubMed,EMbase,Cochrane Library,Web of Science)from the establishment of the database to December 2021 were retrieved.The selected literature data were extracted and the quality of the literature was evaluated by Cochrane bias risk assessment tool.Meta-analysis of knee joint swelling was performed using ReviewManager 5.4 software.Funnel plot was used to represent publication bias.The quality of evidence was evaluated according to GRADE criteria.Results A total of 632 cases were included,including 324 cases in the treatment group and 308 cases in the control group.The results of Meta-analysis showed that compared with the control group,the treatment group had advantages in reducing VAS score[SMD=-1.13,95%CI(-1.60,-0.67),P<0.00001]and reducing knee joint swelling[SMD=-0.62,95%CI(-1.05,-0.20),P=0.004].The publication bias results of the above two outcome indicators suggest that there may be potential publication bias in the included literature of VAS score and knee swelling.Conclusion Oral Huoxue Lishui Chinese medicine compound has obvious clinical effect in the treatment of swelling and pain after TKA.