摘要
背景大量临床研究显示,壮医药线点灸治疗痛风性关节炎具有治疗效果好、不良反应少等优点。但当前壮医药线点灸治疗该病缺乏多中心大样本的临床研究试验。目的应用荟萃分析法系统评价壮医药线点灸治疗痛风性关节炎临床疗效及安全性。方法计算机检索中国知网、万方数据知识服务平台、维普数据库、PubMed、EMBase及Cochrane Library,检索时间为建库至2019年9月,搜集有关壮医药线点灸治疗痛风性关节炎的临床随机对照试验(RCT),其中治疗组为壮医药线点灸,对照组为不同于壮医药线点灸的其他治疗方法。对文献进行数据资料提取和质量评价,采用RevMan 5.3软件进行Meta分析。结果共纳入10篇中文文献。Jadad评分量表结果显示,5篇文献为高质量研究,5篇文献为低质量研究。Meta分析结果显示,治疗组总体有效率、治愈率、血尿酸下降幅度、关节肿痛积分下降幅度均高于对照组〔OR=4.62,95%CI(2.69,7.94),P<0.000 01;OR=2.39,95%CI(1.37,4.16),P=0.002;SMD=-0.62,95%CI(-0.83,-0.40),P<0.000 01;MD=-2.51,95%CI(-3.38,-1.64),P<0.000 01〕,不良反应发生率低于对照组〔OR=0.18,95%CI(0.11,0.31),P<0.000 01〕。总体有效率、治愈率、治疗前后血尿酸差值、治疗前后关节肿痛积分差值及不良反应发生率的漏斗图均未完全对称,提示存在发表性偏倚的可能。翻转效应模型分析总体有效率、治愈率、治疗前后血尿酸差值、治疗前后关节肿痛积分差值及不良反应发生率,所有指标未被逆转,说明研究结果可信度较高。结论壮医药线点灸治疗痛风性关节炎的近期疗效确切,能够有效降低痛风性关节炎患者的血尿酸水平,可对关节肿痛发挥积极效应且不良反应少。由于本次纳入研究的样本量有限及可能存在偏倚等因素,今后仍需更多规范化的RCT研究来验证本研究的结论。
Background A large number of clinical studies have shown that moxibustion with ramie threads processed with the Zhuang medicine(MRTPZM)can achieve good efficacy with low risk of adverse reactions in gouty arthritis patients.However,the effect of this therapy lacks of supports from multi-center and large-sample clinical studies.Objective To perform a systematic meta-analysis of the clinical efficacy and safety of MRTPZM in gouty arthitis patients.Methods The databases of CNKI,Wanfang Data Knowledge Service Platform,VIP,PubMed,EMBase and Cochrane Library were searched from inception to September 2019 for randomized controlled trials(RCT)about gouty arthritis patients treated with MRTPZM(treatment group)versus those with other therapies(control group).Data extraction from and quality assessment of the included RCTs were performed.RevMan 5.3 as used to carry out meta-analysis.Results A total of 10 RCT in Chinese were included,and 5 of them were high-quality,other 5 were low-quality assessed by the Jadad Scale.Meta-analysis showed that the treatment group had higher overall response rate and cure rate,as well as greater decrease in serum uric acid and joint swelling and pain score〔OR=4.62,95%CI(2.69,7.94),P<0.00001;OR=2.39,95%CI(1.37,4.16),P=0.002;SMD=-0.62,95%CI(-0.83,-0.40),P<0.00001;MD=-2.51,95%CI(-3.38,-1.64),P<0.00001〕,and lower incidence of adverse reactions〔OR=0.18,95%CI(0.11,0.31),P<0.00001〕than the control group.Analysis of the overall response rate,cure rate,pre-and posttreatment differences in serum uric acid and joint swelling and pain score as well as the mild asymmetrical funnel plot of adverse reactions suggested that there was a possibility of publication bias.Reversal effect model-based analysis of the aforementioned 5 parameters revealed that these parameters were not reversed,which indicated that the results of the study are highly credible.Conclusion MRTPZM may effectively reduce the serum uric acid and relieve the level of joint swelling and pain to some extent with low risk of adverse reactions,indicating it has a good short-term efficacy in gouty arthritis patients.Due to limited sample size and possible bias in the included RCT,more standardized RCT are needed to verify the conclusion of this study.
作者
邓凯烽
陈日兰
李书振
朱圣旺
颜家兴
高倩倩
马颖露
朱英
DENG Kaifeng;CHEN Rilan;LI Shuzhen;ZHU Shengwang;YAN Jiaxing;GAO Qianqian;MA Yinglu;ZHU Ying(Guangxi University of Chinese Medicine,Nanning 530001,China;Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine,Nanning 530011,China)
出处
《中国全科医学》
CAS
北大核心
2020年第23期2956-2963,共8页
Chinese General Practice
基金
国家自然科学基金资助项目(81460763
81960908)
广西自然科学基金资助项目(2017JJA140564z)
广西壮族自治区卫计委广西医疗卫生适宜技术开发与推广应用项目(S2017057)。
关键词
痛风性关节炎
壮医药线点灸
尿酸
治疗结果
随机对照试验
META分析
Gouty arthritis
Thread-point moxibustion
Uric acid
Treatment outcome
Randomized controlled trial
Meta-analysis
