中医疗法与透明质酸治疗膝骨性关节炎有效性的网状Meta分析  

Efficacy of traditional Chinese medicine therapy and hyaluronic acid for knee osteoarthritis: a network Meta-analysis

作　　者：刘羽[1] 艾金伟 刘盈[2] 李德胜[1] 裴斌[1,2] 

机构地区：[1]湖北医药学院附属襄阳医院整形外科,湖北省襄阳市441000 [2]湖北医药学院附属襄阳医院循证医学中心,湖北省襄阳市441000

出　　处：《中国组织工程研究》2016年第20期3000-3011,共12页Chinese Journal of Tissue Engineering Research

基　　金：湖北省卫生计生西医类2015-2016年度一般项目(WJ2015MB187)~~

摘　　要：背景:中医疗法之间及它们与标准西医疗法之间比较治疗膝骨性关节有效性的研究结论存在争议,现有的原始研究和Meta分析多为中医疗法与西医疗法间的比较,缺乏中医疗法间的直接比较,使人们难以对中医疗效有较清晰、全面的认识。目的:采用网状Meta分析的方法,以关节腔内注射透明质酸为共同参照,全面比较各中医疗法、透明质酸治疗膝骨性关节炎的有效性。方法:检索PubMed、The Cochrane Library(2015年第10期)、EMbase、CNKI、CBM、VIP、Wan-Fang数据库中有关中医疗法与透明质酸比较治疗膝骨性关节炎有效性的随机对照试验,检索时限为各数据库建库至2015年10月20日。由2名研究者根据纳入排除标准独立筛选文献、提取数据,并行文献质量评价。运用Stata12.0和WinBUGS1.4.3软件进行统计分析,以比值比及95%可信区间为效应指标,比较各治疗措施疗效差异,并进行疗效排疗。结果与结论:纳入59个RCT,合计6 155例膝骨性关节炎患者,涉及12种治疗措施。Meta分析结果显示中医综合疗法均优于单一疗法和透明质酸,单一疗法中小针刀优于透明质酸。在所纳入的治疗措施中,小针刀+针刺疗效最佳。对Kellgren-LawrenceⅡ-Ⅲ级患者可优先选择中医综合疗法。基于现有研究的缺陷,研究结论尚需大量高质量RCT予以证实。BACKGROUND： Comparative study results between the efficacies of traditional Chinese medicine（TCM） therapy with Western medicine therapy in the treatment of knee osteoarthritis remain controversial. Currently, meta-analysis studies mainly focus on comparison of the efficacy between TCM and Western medicine, but lack investigations among TCM therapies. It makes us difficult to fully understand the efficacy of TCM therapy for knee osteoarthritis. OBJECTIVE： To compare the efficacies of TCM therapy with intra-articular injection of hyaluronic acid for knee osteoarthritis using a network Meta-analysis method. METHODS： Pub Med, The Cochrane Library（tissue 10, 2015）, EMbase, CNKI, CBM, VIP, Wangfang databases were searched up to October 20, 2015 for relevant randomized controlled trials addressing the efficacies of TCM therapy versus intra-articular injection of hyaluronic acid for knee osteoarthritis. Two reviewers independently selected the studies, extracted information, and assessed the quality of included trials. Data extraction from eligible studies was pooled and meta-analyzed using Stata 12.0 and WinB UGS1.4.3 softwares. Odd ratios with their 95% confidence interval were estimated as effect size between treatments. RESULTS AND CONCLUSION： A total of 59 randomized controlled trials involving 6 155 patients with knee osteoarthritis and 12 treatment strategies were included. The results of network meta-analysis showed that TCM comprehensive therapy was superior to the TCM monotherapy and intra-articular injection of hyaluronic acid. Among these therapies, the efficacy of needle scalpel combined with acupuncture is optimal. TCM comprehensive therapies may be the best choice to treat patients with knee osteoarthritis of Kellgren-Lawrence II-III. More large-scale and well-designed randomized controlled trials are still warranted due to the limitation of the present study.

关 键 词：骨关节炎 膝 中医疗法 透明质酸 组织工程 组织构建 骨组织工程 骨性关节炎 关节 中医 玻璃酸纳 疗效 循证医学 网状Meta分析 

分 类 号：R318[医药卫生—生物医学工程]