刺络放血结合针灸治疗膝骨性关节炎的Meta分析
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摘要
目的:系统评价刺络放血结合针灸治疗膝骨性关节炎(KAO)的疗效。方法:计算机检索中国知网(CNKI)、万方数据库、维普数据库(VIP)、Pubmed及中国生物医学文献数据库(CBM)中有关刺络放血疗法治疗KAO的临床随机对照试验文献,按拟定的纳入标准和排除标准对原始文献进行筛选,对纳入研究进行文献质量评价和Meta分析。运用Review Manager 5.3软件进行异质性检验并计算各指标的OR值和95%可信区间。结果:10篇文献纳入研究,共764例患者,其中3项为高质量研究,7项为低质量研究。刺络放血组与常规治疗组比较,总有效率及治愈率的Meta分析结果显示:[OR=4.38,95%CI(2.63,7.28),P<0.000,01]、[OR=2.40,95%CI (1.54,3.74),P=0.0001];其中7篇以VAS评分为疼痛指标的样本量为577例,治疗前后VAS差值的均差(MD)合并效应量为[MD=-1.81,95%CI(-2.33,-1.28),P<0.000,01],以上差异均有统计学意义(P<0.05),表明刺络放血配合针灸治疗KOA的疗效优于常规针刺或单纯西药治疗。结论:刺络放血结合针灸在KOA的治疗上较常规针刺或单纯西药治疗更有优势,由于纳入研究的质量普遍不高、样本量小及可能存在的偏倚等因素,尚需更多高质量及方法学规范化的随机对照研究验证。
Objective: To systematic review of the efficacy of pricking blood therapy combined with acupuncture in the treatment of knee osteoarthritis(KAO). Methods: The literatures on clinical randomized controlled trials of pricking blood therapy for KAO in CNKI, Wanfang database, VIP database, Pubmed database and CBM were searched by computer. The original literatures were screened according to the proposed inclusion and exclusion criteria, and the quality of the literatures was evaluated and Meta-analyzed. Review Manager 5.3 software was used to test the heterogeneity and calculate the OR value and 95% confidence interval of each index. Results: 10 articles were included in the study, 3 of them were high quality research and 7 were low quality research. The cure rate and the total effective rate of OR and 95% CI were: the total effective rate was[OR=4.38, 95%CI(2.63,7.28), P<0.00001], the cure rate was [OR=2.40, 95%CI(1.54, 3.74), P=0.0001]. Among them,there were 577 samples with VAS score as pain index, and the combined effect of mean deviation(MD) of VAS difference before and after treatment was [MD =-1.81, 95% CI(-2.33,-1.28), P <0.000,01], which indicated that pricking blood therapy combined with acupuncture treatment of KOA is better than conventional acupuncture or simple western medicine treatment. Conclusion: Pricking blood therapy combined with acupuncture has more advantages in the treatment of KOA than conventional acupuncture or western medicine alone. Due to the low quality, small sample size and possible bias of the included studies, more randomized controlled studies with high quality and standardized methodology are needed.
Objective: To systematic review of the efficacy of pricking blood therapy combined with acupuncture in the treatment of knee osteoarthritis(KAO). Methods: The literatures on clinical randomized controlled trials of pricking blood therapy for KAO in CNKI, Wanfang database, VIP database, Pubmed database and CBM were searched by computer. The original literatures were screened according to the proposed inclusion and exclusion criteria, and the quality of the literatures was evaluated and Meta-analyzed. Review Manager 5.3 software was used to test the heterogeneity and calculate the OR value and 95% confidence interval of each index. Results: 10 articles were included in the study, 3 of them were high quality research and 7 were low quality research. The cure rate and the total effective rate of OR and 95% CI were: the total effective rate was[OR=4.38, 95%CI(2.63,7.28), P<0.00001], the cure rate was [OR=2.40, 95%CI(1.54, 3.74), P=0.0001]. Among them,there were 577 samples with VAS score as pain index, and the combined effect of mean deviation(MD) of VAS difference before and after treatment was [MD =-1.81, 95% CI(-2.33,-1.28), P <0.000,01], which indicated that pricking blood therapy combined with acupuncture treatment of KOA is better than conventional acupuncture or simple western medicine treatment. Conclusion: Pricking blood therapy combined with acupuncture has more advantages in the treatment of KOA than conventional acupuncture or western medicine alone. Due to the low quality, small sample size and possible bias of the included studies, more randomized controlled studies with high quality and standardized methodology are needed.
引文
[1]周洪保,张曦,吕正祥.膝关节骨性关节炎治疗进展[J].中医药导报,2012,18(2):87-89.
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[4]金立昆,谢利民.针灸治疗膝关节骨性关节炎研究现状及机理探讨[J].中国中医药信息杂志,2008,15(s1):79-81.
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[6]布文才.刺络放血疗法联合针刺治疗膝关节骨性关节炎32例临床观察[J].中国民族民间医药,2015,24(3):63.
[7]薛金,薛丽莉.刺络放血联合温针灸治疗膝骨性关节炎39例疗效观察[J].云南中医中药杂志,2017,38(5):70-71.
[8]罗燕君.刺络放血配合温针灸治疗退行性膝关节骨性关节炎的临床疗效[J].深圳中西医结合杂志,2017,27(5):67-68.
[9]凌耀权,曾祥毅,关铭坤,等.火针配合刺络放血治疗膝关节骨性关节炎的疗效研究[J].世界中医药,2017,12(5):1134-1137.
[10]何佳,李志峰,杨丽艳,等.雷火灸联合刺络放血疗法治疗膝关节炎的疗效观察[J].成都中医药大学学报,2017,40(2):64-66.
[11]王曙辉,许明珠,崔韶阳,等.针刺结合刺络放血疗法治疗膝关节骨性关节炎的临床随机对照研究[J].针刺研究,2010,35(2):129-133.
[12]易正珩.温针灸结合刺络放血治疗膝骨性关节炎的临床疗效观察[D].广州:广州中医药大学,2014.
[13]毛雪文.温针灸结合刺络放血治疗膝骨性关节炎的临床研究[D].北京:中国中医科学院,2015.
[14]黄健国,傅志辉.温针灸结合刺络拔罐治疗膝骨性关节炎48例[J].内蒙古中医药,2014,33(24):54-55.
[15]王建国.针刺联合刺络放血疗法治疗膝关节骨性关节炎临床分析[J].医药卫生:文摘版,2006(1):117.
[16] Stratford P W,Kennedy D M. Does parallel item content on Womac,S pain and function subscales limit its ability to detect in functional status[J].BMC Musculoskelet disord,2004,5(1):17.
[17]张弛,周章玲.刺络放血疗法探源—析《内经》刺血络法[J].中国中医基础医学杂志,2003,9(4):5-6.
[18]张瑜,吴勋仓.《黄帝内经》剌络放血疗法探析[J].陕西中医,2005,26(7):703-704.
[19]郝秀兰,李风兰,徐金风,等.刺络放血治疗高粘滞血症对血液流变性的影响[J].针灸临床杂志,2000,16(2):51-52.
[20]梁杜,陈志冲,黄世良.膝骨性关节炎中医证型与炎症因子的关联性探讨[J].中医药导报,2017,23(12):69-71.
[21]丁明晖,张宏,李燕.温针灸治疗膝关节骨性关节炎:随机对照研究[J].中国针灸,2009,29(8):603-607.
[22]武永利,张艳玲,唐朝.温针灸对膝骨性关节炎患者血清中IL-17、IL-18表达影响的研究[J].辽宁中医杂志,2013,40(5):864-866.
[23]卓廉佳,张子强.温针灸结合中药熏洗对膝关节骨性关节炎患者IL-1、TNF-α、MMP-3的影响[J].中医药导报,2015,21(15):64-65.
[24] Liu J P,Xia Y. Quality appraisal of systematic reviews or meta-analysis on traditional Chinese medicine published in Chinese journals[J].Chinese Journal of Integrated Traditional&Western Medicine,2007,27(4):306.
[2] Bijlsma J W,Berenbaum F,Lafeber F P. Osteoarthritis:an update with relevance for clinical practice[J].Lancet,2011,377(9783):2115.
[3]李丽,李宁,吴滨.针灸治疗膝关节骨性关节炎的文献计量学分析[J].中国针灸,2007,27(11):862-864.
[4]金立昆,谢利民.针灸治疗膝关节骨性关节炎研究现状及机理探讨[J].中国中医药信息杂志,2008,15(s1):79-81.
[5] Jadad A R,Moore R A,Carroll D,et al. Assessing the quality of reports of randomized clinical trials:is blinding necessary?[J].Control Clin Trials,1996,17(1):1-12.
[6]布文才.刺络放血疗法联合针刺治疗膝关节骨性关节炎32例临床观察[J].中国民族民间医药,2015,24(3):63.
[7]薛金,薛丽莉.刺络放血联合温针灸治疗膝骨性关节炎39例疗效观察[J].云南中医中药杂志,2017,38(5):70-71.
[8]罗燕君.刺络放血配合温针灸治疗退行性膝关节骨性关节炎的临床疗效[J].深圳中西医结合杂志,2017,27(5):67-68.
[9]凌耀权,曾祥毅,关铭坤,等.火针配合刺络放血治疗膝关节骨性关节炎的疗效研究[J].世界中医药,2017,12(5):1134-1137.
[10]何佳,李志峰,杨丽艳,等.雷火灸联合刺络放血疗法治疗膝关节炎的疗效观察[J].成都中医药大学学报,2017,40(2):64-66.
[11]王曙辉,许明珠,崔韶阳,等.针刺结合刺络放血疗法治疗膝关节骨性关节炎的临床随机对照研究[J].针刺研究,2010,35(2):129-133.
[12]易正珩.温针灸结合刺络放血治疗膝骨性关节炎的临床疗效观察[D].广州:广州中医药大学,2014.
[13]毛雪文.温针灸结合刺络放血治疗膝骨性关节炎的临床研究[D].北京:中国中医科学院,2015.
[14]黄健国,傅志辉.温针灸结合刺络拔罐治疗膝骨性关节炎48例[J].内蒙古中医药,2014,33(24):54-55.
[15]王建国.针刺联合刺络放血疗法治疗膝关节骨性关节炎临床分析[J].医药卫生:文摘版,2006(1):117.
[16] Stratford P W,Kennedy D M. Does parallel item content on Womac,S pain and function subscales limit its ability to detect in functional status[J].BMC Musculoskelet disord,2004,5(1):17.
[17]张弛,周章玲.刺络放血疗法探源—析《内经》刺血络法[J].中国中医基础医学杂志,2003,9(4):5-6.
[18]张瑜,吴勋仓.《黄帝内经》剌络放血疗法探析[J].陕西中医,2005,26(7):703-704.
[19]郝秀兰,李风兰,徐金风,等.刺络放血治疗高粘滞血症对血液流变性的影响[J].针灸临床杂志,2000,16(2):51-52.
[20]梁杜,陈志冲,黄世良.膝骨性关节炎中医证型与炎症因子的关联性探讨[J].中医药导报,2017,23(12):69-71.
[21]丁明晖,张宏,李燕.温针灸治疗膝关节骨性关节炎:随机对照研究[J].中国针灸,2009,29(8):603-607.
[22]武永利,张艳玲,唐朝.温针灸对膝骨性关节炎患者血清中IL-17、IL-18表达影响的研究[J].辽宁中医杂志,2013,40(5):864-866.
[23]卓廉佳,张子强.温针灸结合中药熏洗对膝关节骨性关节炎患者IL-1、TNF-α、MMP-3的影响[J].中医药导报,2015,21(15):64-65.
[24] Liu J P,Xia Y. Quality appraisal of systematic reviews or meta-analysis on traditional Chinese medicine published in Chinese journals[J].Chinese Journal of Integrated Traditional&Western Medicine,2007,27(4):306.