艾灸治疗膝骨关节炎的系统评价再评价  

Moxibustion for the Treatment of Knee Osteoarthritis:An Overview of Systematic Reviews

作　　者：王芝怡 费宇彤[2] 任书盟 吕乐奇 伦涵蔚 罗慜婧 高一城 夏如玉 WANG Zhiyi;FEI Yutong;REN Shumeng;LYU Leqi;LUN Hanwei;LUO Minjing;GAO Yicheng;XIA Ruyu(Qi-Huang Chinese Medicine School,Beijing University of Chinese Medicine,Beijing 100029,China;Centre for Evidence-based Chinese Medicine,Beijing University of Chinese Medicine,Beijing 100029,China;School of Acupuncture-Moxibustion and Tuina,Beijing University of Chinese Medicine,Beijing 100029,China)

机构地区：[1]北京中医药大学岐黄学院,北京100029 [2]北京中医药大学循证医学中心,北京100029 [3]北京中医药大学针灸推拿学院,北京100029

出　　处：《中国中医药信息杂志》2024年第3期56-63,共8页Chinese Journal of Information on Traditional Chinese Medicine

基　　金：新疆维吾尔自治区重点研发计划(2021B03006-4)。

摘　　要：目的评价艾灸治疗膝骨关节炎的疗效和安全性,以及已发表的相关系统评价的方法学质量。方法计算机检索中国知识资源总库(CNKI)、维普资讯中文期刊服务平台、万方数据知识服务平台、中国生物医学文献服务系统、PubMed、Cochrane Library、Embase、Web of Science建库至2022年2月10日收录的艾灸治疗膝骨关节炎的系统评价,采用AMSTAR2量表进行方法学质量评价。汇总并根据纳排标准筛选收集的系统评价中纳入的随机对照试验(RCT),使用RevMan5.4软件进行Meta分析,采用GRADE工具评价证据质量。结果共纳入系统评价15篇,AMSTAR2量表评分显示低质量1篇,极低质量14篇。共涉及RCT 36项,Meta分析结果显示,艾灸相较于非甾体抗炎药改善西安大略麦马斯特大学骨性关节炎指数评分[MD=-5.95,95%CI(-9.25,-2.65),低质量]、减轻疼痛[MD=-1.26,95%CI(-2.19,-0.32),极低质量]、提高总有效率[RR=1.16,95%CI(1.11,1.22),低质量]效果更佳。纳入试验报告了艾灸组不良事件(水泡),多于3 d内痊愈。结论艾灸相较于常用西医疗法,在改善患者疼痛、提高总有效率方面呈现一定优势,仍需设计严谨的高质量RCT进一步验证。Objective To evaluate the effectiveness and safety of moxibustion for knee osteoarthritis and the methodological quality of systematic reviews(SRs).Methods SRs of moxibustion for knee osteoarthritis were retrieved from CNKI,VIP,Wanfang Data,SinoMed,PubMed,Cochrane Library,Embase and Web of Science was conducted from the establishment of the databases to February 10,2022.AMSTAR 2 was used to assess the methodological quality of SRs.The randomized controlled trials(RCTs)included in these SRs were screened and summarized according to inclusion standard.RevMan 5.4 software was used for Meta-analysis,and GRADE approach was used to assess the certainty of evidence.Results A total of 15 SRs were included.The evaluation results of the AMSTAR 2 showed that the methodological quality was very low for 14 SRs,and low for other 1 SR.A total of 36 RCTs were included.Meta-analysis results showed that compared with the non-steroidal anti-inflammatory drugs(NSAIDs),the moxibustion group had better effects on improvement of WOMAC scores[mean difference(MD)=-5.95;95%confidence interval(CI):-9.25 to-2.65;low quality],relieving pain[MD=-1.26;95%CI:-2.19 to-0.32;very low quality],and improving effective rate[risk ratio(RR)=1.16;95%CI:1.11 to 1.22;low quality].In the moxibustion group,some patients experienced blisters,and most healed in 3 days.Conclusion Moxibustion has advantages in pain reduction and improving effective rate compared with routine Western therapy for knee osteoarthritis.However,well-designed high-quality RCTs are needed for further verification.

关 键 词：艾灸 膝骨关节炎 系统评价再评价 AMSTAR2 META分析 

分 类 号：R274.94[医药卫生—中西医结合] R2-05[医药卫生—中医骨伤科学]