中国组织工程研究

中国组织工程研究 ›› 2016, Vol. 20 ›› Issue (20): 3000-3011.doi: 10.3969/j.issn.2095-4344.2016.20.016

• 组织构建循证医学 evidence-based medicine in tissue construction • 上一篇    下一篇

中医疗法与透明质酸治疗膝骨性关节炎有效性的网状Meta分析

刘  羽1，艾金伟1，2，刘  盈2，李德胜1，裴  斌1，2   

  1. 湖北医药学院附属襄阳医院，1整形外科，2循证医学中心，湖北省襄阳市  441000
  • 收稿日期:2016-02-19 出版日期:2016-05-13 发布日期:2016-05-13
  • 通讯作者: 裴斌，硕士，主任医师，教授，硕士生导师，湖北医药学院附属襄阳医院，整形外科，循证医学中心，湖北省襄阳市 441000
  • 作者简介:刘羽，女，1969年生，湖北省襄阳市人，汉族，副主任医师，主要从事自体脂肪组织移植研究。 并列第一作者简介：艾金伟，男，1984年生，湖北省十堰市人，汉族，硕士，医师，主要从事循证医学、骨关节病防治研究。
  • 基金资助:

    湖北省卫生计生西医类2015-2016年度一般项目(WJ2015MB187)

Efficacy of traditional Chinese medicine therapy and hyaluronic acid for knee osteoarthritis: a network Meta-analysis

Liu Yu1, Ai Jin-wei1, 2, Liu Ying2, Li De-sheng1, Pei Bin1, 2   

  1. 1Department of Plastic Surgery; 2Evidence-Based Medicine Center, Xiangyang Hospital, Hubei University of Medicine, Xiangyang 441000, Hubei Province, China
  • Received:2016-02-19 Online:2016-05-13 Published:2016-05-13
  • Contact: Pei Bin, Master, Professor, Chief physician, Master’s supervisor, Department of Plastic Surgery, Xiangyang Hospital, Hubei University of Medicine, Xiangyang 441000, Hubei Province, China; Evidence-Based Medicine Center, Xiangyang Hospital, Hubei University of Medicine, Xiangyang 441000, Hubei Province, China
  • About author:Liu Yu, Associate chief physician, Department of Plastic Surgery, Xiangyang Hospital, Hubei University of Medicine, Xiangyang 441000, Hubei Province, China Ai Jin-wei, Master, Department of Plastic Surgery; Evidence-Based Medicine Center, Xiangyang Hospital, Hubei University of Medicine, Xiangyang 441000, Hubei Province, China Liu Yu and Ai Jin-wei equally contributed to this work.
  • Supported by:

    2015-2016 Research Project of Hubei Provincial Health and Family Planning Commission, No. WJ2015MB187

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553

被引次数

6

摘要：

文章快速阅读：

文题释义：
网状Meta分析：是传统Meta分析的扩展，可以同时比较3个或者3个以上的干预措施的疗效。但是目前对网状Meta分析的定义相对混乱，按照“国际药物经济学和结果研究协会”的报告，网状Meta分析包括调整间接比较和混合治疗分析。混合治疗分析是在直接比较的基础上合并间接比较的证据，从而提高分析结果的精确性，但是这种方法主要是应用于干预措施可以形成具有闭合环路(loop)时。网状Meta分析的最大优势就是可以对治疗同类疾病的不同干预措施进行量化比较，并按照某一结果指标效果好坏进行排序，进而选择最优治疗方案。
透明质酸：D-葡萄糖醛酸及N-乙酰葡糖胺组成的双糖单位玻尿酸，又称糖醛酸、透明质酸，基本结构是由两个双糖单位D-葡萄糖醛酸及N-乙酰葡糖胺组成的大型多糖类。与其他黏多糖不同，它不含硫。它的透明质分子能携带500倍以上的水分，为当今所公认的最佳保湿成分，广泛应用在保养品和化妆品中。
摘要
背景：中医疗法之间及它们与标准西医疗法之间比较治疗膝骨性关节有效性的研究结论存在争议，现有的原始研究和Meta分析多为中医疗法与西医疗法间的比较，缺乏中医疗法间的直接比较，使人们难以对中医疗效有较清晰、全面的认识。
目的：采用网状Meta分析的方法，以关节腔内注射透明质酸为共同参照，全面比较各中医疗法、透明质酸治疗膝骨性关节炎的有效性。
方法：检索PubMed、The Cochrane Library(2015年第10期)、EMbase、CNKI、CBM、VIP、Wan-Fang数据库中有关中医疗法与透明质酸比较治疗膝骨性关节炎有效性的随机对照试验，检索时限为各数据库建库至2015年10月20日。由2名研究者根据纳入排除标准独立筛选文献、提取数据，并行文献质量评价。运用Stata12.0和WinBUGS1.4.3软件进行统计分析，以比值比及95%可信区间为效应指标，比较各治疗措施疗效差异 ，并进行疗效排疗。
结果与结论：纳入59个RCT，合计6 155例膝骨性关节炎患者，涉及12种治疗措施。Meta分析结果显示中医综合疗法均优于单一疗法和透明质酸，单一疗法中小针刀优于透明质酸。在所纳入的治疗措施中，小针刀+针刺疗效最佳。对Kellgren-Lawrence Ⅱ-Ⅲ级患者可优先选择中医综合疗法。基于现有研究的缺陷，研究结论尚需大量高质量RCT予以证实。

中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程
ORCID: 0000-0002-4380-4266(刘羽)

关键词: 组织构建, 骨组织工程, 骨性关节炎, 关节, 中医疗法, 中医, 透明质酸, 玻璃酸纳, 疗效, 循证医学, 网状Meta分析

Abstract:

BACKGROUND: Comparative study results between the efficacies of traditional Chinese medicine (TCM) therapy with Western medicine therapy in the treatment of knee osteoarthritis remain controversial. Currently, meta-analysis studies mainly focus on comparison of the efficacy between TCM and Western medicine, but lack investigations among TCM therapies. It makes us difficult to fully understand the efficacy of TCM therapy for knee osteoarthritis.
OBJECTIVE: To compare the efficacies of TCM therapy with intra-articular injection of hyaluronic acid for knee osteoarthritis using a network Meta-analysis method.
METHODS: PubMed, The Cochrane Library (tissue 10, 2015), EMbase, CNKI, CBM, VIP, Wangfang databases were searched up to October 20, 2015 for relevant randomized controlled trials addressing the efficacies of TCM therapy versus intra-articular injection of hyaluronic acid for knee osteoarthritis. Two reviewers independently selected the studies, extracted information, and assessed the quality of included trials. Data extraction from eligible studies was pooled and meta-analyzed using Stata12.0 and WinBUGS1.4.3 softwares. Odd ratios with their 95% confidence interval were estimated as effect size between treatments.
RESULTS AND CONCLUSION: A total of 59 randomized controlled trials involving 6 155 patients with knee osteoarthritis and 12 treatment strategies were included. The results of network meta-analysis showed that TCM comprehensive therapy was superior to the TCM monotherapy and intra-articular injection of hyaluronic acid. Among these therapies, the efficacy of needle scalpel combined with acupuncture is optimal. TCM comprehensive therapies may be the best choice to treat patients with knee osteoarthritis of Kellgren-Lawrence II-III. More large-scale and well-designed randomized controlled trials are still warranted due to the limitation of the present study.

中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程

Key words: Osteoarthritis, Knee, Medicine, Chinese Traditional, Hyaluronic Acid, Tissue Engineering

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