关节腔内注射皮质类固醇激素和透明质酸治疗膝骨关节炎的Meta分析

Meta-analysis of Intra-articular Injection of Corticosteroids and Hyaluronic Acid in the Treatment of Knee Osteoarthritis

目的 通过Meta分析系统评价关节内注射皮质类固醇激素和透明质酸治疗膝骨关节炎的临床疗效。方法 检索PubMed、Embase、Medline、中国知网、维普、万方等数据库中以关节内注射皮质类固醇激素和透明质酸作为主要干预措施治疗膝骨关节炎的随机对照试验,检索年限限制为2000年1月至2021年9月。运用RevMan 5.3软件对文献中提取的数据资料进行Meta分析。结果 (1)最终纳入11篇文献,均为随机对照试验,共纳入1 582例膝骨关节炎患者,其中使用皮质类固醇激素治疗789例、透明质酸治疗793例,使用改良Jadad评分表进行文献质量评价,4分以上高质量文献8篇,3分低质量文献3篇,文献质量较好,数据的可靠性较高。(2)Meta分析结果显示,关节内注射透明质酸治疗后Lequesne评分在3个月(MD=2.01,95%CI:1.58,2.63,P=0.02)、6个月(MD=1.43,95%CI:1.06,1.81,P<0.00001),WOMAC评分在治疗6个月后(MD=4.66,95%CI:2.18,7.13,P=0.0002)优于注射皮质类固醇激素。皮质类固醇激素组VAS评分在治疗3个月(MD=1.95,95%CI:1.31,2.58,P<0.00001)及治疗6个月后(MD=0.99,95%CI:0.48,1.49,P=0.0001)均优于透明质酸组。两组在治疗后不良反应结果差异无统计学意义。

Objective To evaluate the clinical efficacy of intra-articular injection of corticosteroids and hyaluronic acid in the treatment of knee osteoarthritis through the Meta analysis system.Methods Through searching PubMed,Embase Medline,CNKI,Weipu,Wanfang and other databases,using intra-articular injection of corticosteroids and hyaluronic acid as the main intervention measures,randomized controlled trials for the treatment of knee osteoarthritis,the search period is limited to January 2000-September 2021.Use RevMan 5.3 software to conduct meta-analysis on the data extracted from the literature.Results(1)Finally,11 articles were included,all of which were randomized controlled trials.A total of 1582 patients with knee osteoarthritis were enrolled.Among them,789 were treated with corticosteroids and 793 were treated with hyaluronic acid.The quality of the literature was evaluated using the modified Jadad score sheet.8 high-quality documents with a score of 4 or more,3 low-quality documents with a score of 3,the quality of the documents is good,and the reliability of the data is high.(2)The results of Meta analysis showed that the Lequesne score was 3 months(MD=2.01,95%CI:1.58,2.63,P=0.02)after intra-articular injection of hyaluronic acid for 6 months(MD=1.43,95%CI:1.06,1.81,P<0.00001),WOMAC score after 6 months of treatment(MD=4.66,95%CI:2.18,7.13,P=0.0002)is better than the corticosteroid injection group.In the corticosteroid group,the VAS score in the treatment was 3 months after treatment(MD=1.95,95%CI:1.31,2.58,P<0.00001),And after 6 months of treatment(MD=0.99,95%CI:0.48,1.49,P=0.0001)were better than the hyaluronic acid group.There was no statistical difference between the two groups in adverse reactions and knee range of motion results after treatment.