温针灸治疗膝关节骨性关节炎Meta分析  

A Meta Analysis of Warming Needle Acupuncture in the Treatment of Knee Osteoarthritis

作　　者：李小贾 雷梦南 蒋志明 赵丽娜 胡玲[1,2] 吴子建 LI Xiao-jia;LEI Meng-nan;JIANG Zhi-ming;ZHAO Li-na;HU Ling;WU Zi-jian(Anhui University of Chinese Medicine,Hefei,Anhui,China,230038;Institute of Acupuncture and Meridian of Anhui Academy of Traditional Chinese Medicine,Hefei,Anhui,China,230038)

机构地区：[1]安徽中医药大学,安徽合肥230038 [2]安徽省中医药科学院针灸经络研究所,安徽合肥230038

出　　处：《河南中医》2021年第2期250-260,共11页Henan Traditional Chinese Medicine

基　　金：国家重点基础研究发展计划“973”项目(2015CB554504);安徽高校科研创新平台建设项目(2015TD033)。

摘　　要：目的:运用循证医学方法对温针灸(needle warming moxibustion,NWM)治疗膝关节骨性关节炎(knee osteoarthritis,KOA)的临床疗效进行系统回顾和Meta分析。方法:检索国内外主要数据库查找相关文献并筛选治疗组为NWM治疗,对照组为传统针刺(traditional acupuncture,TA)或电针(electroacupuncture,EA)治疗的相关临床随机对照试验。根据Cochrane偏倚风险评估标准对所纳入文献的质量进行评估,并使用Review Manager 5.3软件对文献数据进行统计分析。结果:共纳入17篇文献,共计1 515例。与EA治疗比较,NWM治疗KOA有效率[OR:0.91,95%CI(0.58,1.43),Z=0.41],WOMAC总评分[WMD:0.98,95%CI(-1.76,3.71),Z=0.70],WOMAC功能活动评分[WMD:2.22,95%CI(-3.94,8.38),Z=0.71],其差异均无统计学意义(P>0.05)。在改善疼痛评分方面[WMD:1.05,95%CI(0.31,1.79),Z=2.77],EA治疗效果优于NWM,两组差异具有统计学意义(P<0.01);在改善僵硬评分方面[WMD:-1.28,95%CI(-2.11,-0.45),Z=3.02],NWM治疗效果优于EA,两组差异具有统计学意义(P<0.01)。与TA治疗比较,NWM治疗KOA有效率[OR:3.44,95%CI(2.25,5.27),Z=5.70],疼痛评分[WMD:-1.61,95%CI(-1.96,-1.27),Z=9.19],Lysholm膝功能评分[WMD:17.36,95%CI(13.40,21.32),Z=8.60],WOMAC总评分[WMD:-10.13,95%CI(-16.19,-4.07),Z=3.28],僵硬评分[WMD:-8.01,95%CI(-13.39,-2.63),Z=2.92],功能活动评分[WMD:-1.14,95%CI(-1.67,-0.61),Z=4.18],ISOA指数[WMD:-2.98,95%CI(-3.78,-2.18),Z=7.26],差异均有统计学意义(P<0.01)。结论:NWM治疗KOA僵硬效果优于EA,治疗KOA有效率、改善WOMAC总评分及改善WOMAC功能活动评分效果与EA相当。NWM治疗KOA有效率、改善WOMAC总评分、疼痛评分、僵硬评分、功能活动评分、Lysholm膝功能评分、ISOA指数效果优于TA。但由于纳入研究在选择性、测量、双盲等其他来源偏倚的存在,可能会在一定程度上影响结果,因此本研究还需要大样本量、高质量的RCTs进行验证。Objective:To systematically review and carry out a Meta analysis of the clinical efficacy of warming needle moxibustion(WNM) in the treatment of knee osteoarthritis(KOA) by evidence-based medicine.Methods:The main databases at home and abroad were searched for relevant literatures,and the treatment group was selected as WNM treatment,while the control group was selected as traditional acupuncture(TA) or electroacupuncture(EA) treatment related clinical randomized controlled trials.The quality of the included pieces of literature was evaluated according to the Cochrane bias risk assessment standard,and the literature data were statistically analyzed by using the Review Manager 5.3 software.Results:A total of 17 articles including 1515 cases were included.Compared with EA,there were no significant differences in the effective rate [OR:0.91,95%CI(0.58,1.43),Z=0.41],WOMAC total score [WMD:0.98,95%CI(-1.76,3.71),Z=0.70],WOMAC functional activity score [WMD:2.22,95%CI(-3.94,8.38),Z=0.71] between WNM and EA(P>0.05).In the improvement of pain score [WMD:1.05,95%CI(0.31,1.79),Z=2.77],EA was better than WNM,and the difference was statistically significant(P<0.01).In the improvement of stiffness score [WMD:-1.28,95%CI(-2.11,-0.45),Z=3.02],WNM was better than EA,and the difference was statistically significant(P<0.01).Compared with TA,WNM was more effective in the treatment of KOA [OR:3.44,95% CI(2.25,5.27),Z=5.70],pain score [WMD:-1.61,95%CI(-1.96,-1.27),Z=9.19],Lysholm knee function score [WMD:17.36,95%CI(13.40,21.32),Z=8.60],WOMAC total score [WMD:-10.13,95%CI(-16.19,-4.07),Z=3.28],stiffness score [WMD:-8.01,95%CI(-13.39,-2.63),Z=2.92],functional activity score [WMD:-1.14,95%CI(-1.67,-0.61),ZA=4.18],ISOA index [WMD:-2.98,95%CI(-3.78,-2.18),Z=7.26],and all the differences were statistically significant(P<0.01).Conclusion:WNM is superior to EA in the treatment of KOA stiffness,and its effective rate,total WOMAC score and functional activity score are similar to those of EA.The effect of WNM on KOA,WOMAC total score,pain sco

关 键 词：温针灸 膝关节骨性关节炎 系统回顾 META分析 

分 类 号：R274.984.3[医药卫生—中西医结合]