苗医弩药针治疗膝骨关节炎临床疗效及安全性的Meta分析  

Meta-analysis of Clinical Efficacy and Safety of Traditional Miao Technique of Crossbow Needle Therapy in the Treatment of Knee Osteoarthritis

作　　者：赵金龙[1,2,3] 潘建科 李嘉晖[1] 梁桂洪 曾令烽 罗明辉[2] 杨伟毅 徐南俊[1] 刘军[3,4,5] Zhao Jinlong;Pan Jianke;Li Jiahui;Liang Guihong;Zeng Lingfeng;Luo Minghui;Yang Weiyi;Xu Nanjun;Liu Jun(The Second Clinical Medical College of Guangzhou University of Chinese Medicine,Guagnzhou 510405,China;The Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine/Guangdong Province Hospital of Traditional Chinese Medicine,Guangzhou 510120,China;Guangdong Provincial Academy of Chinese Medical Sciences,Guangzhou 510120,China;Guangdong Second Traditional Chinese Medicine Hospital/Guangdong Province Enginering Technology Research Institute of Traditional Chinese Medicine,Guangzhou 510095,China;The Fifth Clinical Medical College of Guangzhou University of Chinese Medicine,Guangzhou 510405,China)

机构地区：[1]广州中医药大学第二临床医学院,广州510405 [2]广州中医药大学第二附属医院/广东省中医院,广州510120 [3]广东省中医药科学院,广州510120 [4]广东省第二中医院/广东省中医药工程技术研究院,广州510095 [5]广州中医药大学第五临床医学院,广州510405

出　　处：《世界科学技术-中医药现代化》2022年第12期4777-4786,共10页Modernization of Traditional Chinese Medicine and Materia Medica-World Science and Technology

基　　金：国家自然科学基金青年项目(82004386):补肾活血方通过Hippo-YAP信号通路调控TBK1抑制软骨细胞“炎性衰老”干预骨性关节炎的机制研究,负责人:潘建科;广东省中医院中医药科学技术研究专项(YN2019ML08):基于岭南瘀湿合治理论探讨膝骨关节炎临床诊治及慢病管理研究,负责人:刘军;广东省财政厅专项(粤财社[2018]8号):中医骨伤科传统特色疗法传承创新研究,负责人:刘军。

摘　　要：目的 探讨弩药针治疗膝骨关节炎临床疗效和安全性,为临床应用提供循证依据。方法 检索中国知网、万方、维普、PubMed、EMBASE以及Cochrane Library数据库查找有关弩药针治疗膝骨关节炎的临床随机对照试验。检索时间限定为各数据库建立至2021年12月。采用Review Manager 5.3进行Meta分析计算相关结局指标的比值比(OR)或加权均数差(WMD)。采用Stata 15.1对相关结局指标进行发表偏倚的定量分析。结果 共纳入证据等级为1级的临床随机对照试验8篇。共纳入病例935例,其中试验组494例,普通针刺组441例。Meta分析结果提示与普通针刺相比,在末次随访中弩药针更能降低VAS评分(WMD=-0.35,95%CI=-0.69 to-0.02, P=0.04)以及WOMAC评分(WMD=-2.75, 95%CI=-4.27 to-1.23),差异均具有统计学意义(P<0.05)。弩药针比普通针刺更能增加KOA患者JOA评分(WMD=4.17, 95%CI=2.33 to 6.01)。与普通针刺相比,弩药针治疗KOA患者后可明显增加关节液中HA含量(WMD=4.34, 95%CI=3.20 to 5.49)以及减少NO含量(WMD=-3.95, 95%CI=-5.00 to-2.90),差异具有统计学意义(P<0.00001)。两种干预措施在安全性方面无明显差异(OR=0.32, 95%CI=0.13 to 0.81)。结论 与普通针刺相比,弩药针在改善膝关节疼痛以及功能方面可能存在潜在的治疗优势。受限于纳入文献数量以及相关机理机制研究较少,未来可开展更多更高质量的临床及实验研究加以证实。Objective The purpose of this study is to explore the clinical efficacy and safety of crossbow needle therapy in the treatment of KOA,and to provide evidence-based basis for clinical application.Methods CNKI,Wanfang,VIP,Pub Med,EMBASE and Cochrane Library were searched for randomized controlled trials(RCTs) on the treatment of knee osteoarthritis with crossbow needle therapy.The retrieval time is limited to December 2021.Meta-analysis was performed with Review Manager 5.3 to calculate the odds ratio(OR) or weighted mean difference(WMD) of related outcome indicators.Stata 15.1 was used for quantitative analysis of publication bias.Results A total of 8 RCTs with evidence level 1 were included.A total of 935 cases were included,including 494 cases in the crossbow needle group and 441 cases in the acupuncture group.Compared with the acupuncture,the crossbow needle can lower VAS score(WMD=-0.35,95% CI=-0.69 to-0.02,P=0.04) and WOMAC score(WMD=-2.75,95% CI=-4.27 to-1.23),and the difference was statistically significant(P<0.05).The JOA score of KOA patients was increased more by using the crossbow needle than that of acupuncture(WMD=4.17,95% CI=2.33 to 6.01).Compared with acupuncture,the HA content in synovial fluid of KOA patients was significantly increased(WMD=4.34,95% CI=3.20 to 5.49) and the content of NO decreased(WMD=-3.95,95% CI=-5.00 to-2.90).There was no significant difference in safety between the two interventions(OR=0.32,95% CI=0.13 to 0.81).Conclusion Compared with the acupuncture,the crossbow needle therapy may have more advantages in improvement of knee joint pain and function.Limited by the number of included literatures and the lack of relevant mechanism research,more and higher quality clinical and experimental studies can be carried out in the future.

关 键 词：弩药针 疗效 安全性 膝骨关节炎 META分析 

分 类 号：R684.3[医药卫生—骨科学]