不同药物关节内注射治疗膝骨关节炎疗效的网状Meta分析  

Clinical efficacy of knee intra-articular injection of different drugs for treatment of knee osteoarthritis:a net-work meta-analysis

作　　者：王煜东 汪利合[1] 孙明帅 李艺鸣 高瑞永 WANG Yudong;WANG Lihe;SUN Mingshuai;LI Yiming;GAO Ruiyong(The First Affiliated Hospital of Henan University of CM,Zhengzhou 450000,Henan,China)

机构地区：[1]河南中医药大学第一附属医院,河南郑州450000

出　　处：《中医正骨》2022年第9期24-32,共9页The Journal of Traditional Chinese Orthopedics and Traumatology

基　　金：河南省中医药科学研究专项课题(2017ZY2044,2019ZYBJ06)。

摘　　要：目的:评价不同药物关节内注射治疗膝骨关节炎(knee osteoarthritis,KOA)的疗效。方法:应用计算机检索中国知网、万方数据库、维普网、PubMed、Cochrane Library,搜集关于关节内注射治疗KOA的随机对照试验文献,检索时间范围均为2016年1月至2021年1月。经过文献筛选、数据提取及偏倚风险评价后,采用Stata14软件绘制网状关系图和比较-校正漏斗图,采用ADDIS1.16.6软件对治疗有效率、膝关节疼痛视觉模拟量表(visual analogue scale,VAS)评分、西安大略和麦克马斯特大学骨关节炎指数(Western Ontario and McMaster Universities osteoarthritis index,WOMAC)评分进行网状Meta分析,并按照每个干预措施成为最佳干预措施的概率(Rank1概率)进行疗效排序。结果:共检索到3123篇文献,经过逐层筛选,最终纳入40项随机对照试验,涉及糖皮质激素(glucocorticoid,GC)、臭氧(ozone,O_(3))、玻璃酸钠(sodium hyaluronate,SH)、富血小板血浆(platelet rich plasma,PRP)、间充质干细胞(mesenchymal stem cell,MSC)、PRP+SH、O_(3)+SH、SH+GC、酮咯酸氨丁三醇(ketorolac tromethamine,KT)+SH、MSC+PRP共10种关节内注射药物和药物组合,以及作为安慰剂的生理盐水(normal saline,NS)。在治疗有效率方面,各种关节内注射药物的疗效排序为PRP+SH(Rank1概率=0.38)>O_(3)+SH(Rank1概率=0.34)>SH+GC(Rank1概率=0.18)>MSC+PRP(Rank1概率=0.05)>KT+SH(Rank1概率=0.03)>PRP(Rank1概率=0.02)>SH(Rank1概率=0.00)=O_(3)(Rank1概率=0.00)=GC(Rank1概率=0.00);在改善膝关节疼痛VAS评分方面,各种关节内注射药物的疗效排序为PRP+SH(Rank1概率=0.43)>O_(3)+SH(Rank1概率=0.25)>O_(3)(Rank1概率=0.12)>KT+SH(Rank1概率=0.07)>MSC(Rank1概率=0.06)>MSC+PRP(Rank1概率=0.04)>SH+GC(Rank1概率=0.02)>GC(Rank1概率=0.01)>PRP(Rank1概率=0.00)=SH(Rank1概率=0.00);在改善WOMAC评分方面,各种关节内注射药物的疗效排序为PRP+SH(Rank1概率=0.42)>O_(3)+SH(Rank1概率=0.20)>MSC+PRP(Rank1概率=0.18)>MSC(Rank1概率=0.1Objective:To evaluate the clinical efficacy of knee intra-articular injection of different drugs for treatment of knee osteoarthritis(KOA).Methods:All the randomized controlled trial(RCT) articles about knee intra-articular injection of different drugs for treatment of KOA included from January 2016 to January 2021 were retrieved from the China National Knowledge Internet,Wanfang Database,Vip Database,Pub Med and Cochrane Library through computer.The articles were screened and the information was extracted according to the inclusion and exclusion criteria,and the bias risk of the research in the articles was evaluated using Cochrane bias risk assessment tools independently by two researchers.If any disagreement was found between them,they would ask for another researcher for making a final decision.The network relationship diagrams and comparison-correction funnel plots were drawn by using Stata14.0 software,and then a network meta-analysis on clinical effective rate,knee pain visual analogue scale(VAS) score and Western Ontario and McMaster Universities osteoarthritis index(WOMAC) score was conducted by using ADDIS1.16.6 software,furthermore,the efficacies of the interventions were ranked in accordance with the probability of being the best intervention (Rank1 probability).Results:Three thousand one hundred and twenty-three articles were searched out.After screening,40 articles were included in the final analysis,involving glucocorticoid(GC),ozone(O),sodium hyaluronate(SH),platelet rich plasma(PRP),mesenchymal stem cell(MSC),PRP+SH,O+SH,SH+GC,ketorolac tromethamine(KT)+SH,MSC+PRP and normal saline(NS) that used as placebo.The clinical effective rate was reported in 22 researches,involving 9 interventions.Their efficacies for treatment of KOA were ranked from best to worst in accordance with the clinical effective rate,and the results of ranking revealed that the PRP+SH(Rank1 probability=0.38) behaved best in treatment of KOA,followed by O+SH(Rank1 probability=0.34),SH+GC(Rank1 probability=0.18),MSC+PRP(Rank1 pro

关 键 词：骨关节炎 膝 注射 关节内 网状Meta分析 

分 类 号：R684.3[医药卫生—骨科学]