肉毒杆菌素治疗膝骨性关节炎有效性的荟萃分析  

Efficacy of botulinum toxin in the treatment of knee osteoarthritis: a meta-analysis

作　　者：张小辉 李睿[1,2] 滕飞 姜金 滕元君[1,2] 汉华 吴萌[1,2] 夏亚一 ZHANG Xiao-hui;LI Rui;TENG Fei;JIANG Jin;TENG Yuan-jun;HAN Hua;WU Meng;XIA YA-yi(Orthopedics Key Laboratory of Gansu Province,Orthopedic Department,The Second Hospital,Lanzhou University,Lanzhou730000,China)

机构地区：[1]兰州大学第二医院骨科,兰州730000 [2]甘肃省骨关节疾病重点实验室,兰州730000

出　　处：《中国矫形外科杂志》2019年第15期1390-1394,共5页Orthopedic Journal of China

基　　金：国家自然科学基金项目(编号:81874017和81672207);甘肃省中医药管理局科研项目(编号:GZK-2017-51);兰州市科技计划项目(编号:2017-4-88和2018-3-52);“中央高校基本科研业务费专项资金”重点研究基地创新项目(编号:lzujbky-2018-kb16);兰州大学第二医院“萃英科技创新”计划项目(编号:CY2017-QN11、CY2017-ZD02和CY2017-QN12)

摘　　要：[目的]荟萃分析A型肉毒杆菌素治疗膝骨性关节炎(KOA)的有效性和安全性。[方法]检索PubMed、Embase、The Cochrane Library、Web of Science、CBM、万方数据库和CNKI数据库,搜集A型肉毒杆菌素治疗膝骨性关节炎的研究。经由2名评价员独立筛选文献、提取资料并评价偏倚风险后,采用Stata14.0软件进行荟萃分析。[结果]经过初检、筛选和精读全文后共纳入7个RCT,包括535例患者。荟萃分析结果显示:与对照组相比,A型肉毒杆菌素可显著降低KOA 4周WOMAC疼痛评分[WMD=-9.83,95%CI(-11.79,-7.88),P<0.001]、4周WOMAC僵硬程度评分[WMD=-5.44,95%CI(-7.10,-3.78),P<0.001]、4周WOMAC功能障碍评分[WMD=-4.43,95%CI(-6.00,-2.87),P<0.001],8周WOMAC疼痛评分[WMD=-14.29,95%CI(-25.04,-3.54),P=0.009]、8周WOMAC僵硬程度评分[WMD=-5.33,95%CI(-8.54,-2.12),P<0.001]和8周WOMAC功能障碍评分[WMD=-7.99,95%CI(-12.71,-3.27),P<0.001],差异均有统计学意义。[结论]当前证据表明A型肉毒杆菌素可减轻膝关节疼痛,有效治疗膝骨性关节炎,受纳入研究质量的限制,上述结论尚需更多临床随机对照试验予以验证。[Objective]To evaluate the efficacy and safety of botulinum toxin type A in the treatment of knee osteoarthritis.[Methods]Databases,including PubMed,Embase,Cochrane Library,Web of Science,CBM,Wanfang database and CNKI database were searched to collect randomized controlled trials(RCTs)about the botulinum toxin type A for the treatment of knee osteoarthritis.Meta-analysis was performed using Stata14.0 software after two independent reviewers screened the literature,extracted the data,and evaluated the risk of bias in the included studies.[Results]A total of 7 RCTs were included,including 535 patients.Meta-analysis showed that compared with the control group,botulinum toxin type A can significantly reduce the 4-week WOMAC pain score[WMD=-9.83,95%CI(-11.79,-7.88),P<0.01],4-week WOMAC stiffness score[WMD=-5.44,95%CI(-7.10,-3.78),P<0.01],4-week WOMAC dysfunction score[WMD=-4.43,95%CI(-6.00,-2.87),P<0.01],8-week WOMAC pain score[WMD=-14.29,95%CI(-25.04,-3.54),P=0.009],8-week WOMAC stiffness score[WMD=-5.33,95%CI(-8.54,-2.12),P=0.001]and 8-week WOMAC dysfunction score[WMD=-7.99,95%CI(-12.71,-3.27),P=0.001],the differences were statistically significant.[Conclusions]The current evidence showed that botulinum toxin type A can effectively alleviate knee pain in knee osteoarthritis.Due to the limited quality of included studies,the above conclusions need to be verified by more RCTs.

关 键 词：肉毒杆菌素 肉毒毒素 骨性关节炎 荟萃分析 

分 类 号：R682.3[医药卫生—骨科学]