中国组织工程研究

中国组织工程研究 ›› 2021, Vol. 25 ›› Issue (32): 5232-5239.doi: 10.12307/2021.230

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

针灸联合独活寄生汤治疗类风湿性关节炎的Meta分析

李虹竹1，2，袁  思1，2，赵家莹1，2，陆丽明1，2，许能贵1，2   

  1. 广州中医药大学，1针灸康复临床医学院，2华南针灸研究中心，广东省广州市   510006

  • 收稿日期:2020-09-07 修回日期:2020-09-08 接受日期:2020-10-26 出版日期:2021-11-18 发布日期:2021-07-26
  • 通讯作者: 许能贵，博士，教授，副校长，广州中医药大学针灸康复临床医学院，华南针灸研究中心，广东省广州市 510006
  • 作者简介:李虹竹，女，广东省珠海市人，汉族，广州中医药大学在读博士。
  • 基金资助:
    国家自然科学基金青年基金项目(81704168)，项目负责人：赵家莹

Meta-analysis of acupuncture and moxibustion combined with Duhuo Jisheng Decoction in treating rheumatoid arthritis

Li Hongzhu1, 2, Yuan Si1, 2, Zhao Jiaying1, 2, Lu Liming1, 2, Xu Nenggui1, 2   

  1. 1Medical College of Acupuncture and Rehabilitation, 2South China Research Center for Acupuncture and Moxibustion, Guangzhou University of Chinese Medicine, Guangzhou 510006, Guangdong Province, China
  • Received:2020-09-07 Revised:2020-09-08 Accepted:2020-10-26 Online:2021-11-18 Published:2021-07-26
  • Contact: Xu Nenggui, MD, Professor, Medical College of Acupuncture and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou 510006, Guangdong Province, China; South China Research Center for Acupuncture and Moxibustion, Guangzhou University of Chinese Medicine, Guangzhou 510006, Guangdong Province, China
  • About author:Li Hongzhu, MD candidate, Medical College of Acupuncture and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou 510006, Guangdong Province, China; South China Research Center for Acupuncture and Moxibustion, Guangzhou University of Chinese Medicine, Guangzhou 510006, Guangdong Province, China
  • Supported by:
    the National Natural Science Foundation of China (Youth Program), No. 81704168 (to ZJY)

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摘要：

文题释义：
类风湿关节炎：是一种主要影响滑膜关节的免疫介导的多系统炎症性疾病。
独活寄生汤：出自《备急千金要方》，具有祛风湿、止痹痛之功效，适用于痹症日久、肝肾亏虚之证。
目的：类风湿关节炎是一种主要影响滑膜关节的免疫介导的多系统炎症性疾病，发病率高，病程长。文章系统评价了针灸联合独活寄生汤治疗类风湿性关节炎的临床疗效。
方法：计算机检索PubMed、EMbase、中国知网、中国生物医学文献数据库(Sinomed)、万方及维普数据库，主要检索针灸联合独活寄生汤治疗类风湿性关节炎的临床随机对照试验，检索时间为建库至2020年8月。由2名研究员独立进行文献检索、筛选及数据提取，采用Cochrane协作网所提供的RCT偏倚风险工具对所有纳入文献进行偏倚风险评价，并用RevMan 5.3软件对数据进行Meta分析。
结果：①共纳入16个随机对照试验，根据改良Jadad量表得分4分文献1篇，3分文献4篇，2分文献8篇，1分文献3篇，总体文献质量较低；②总共纳入1 551例患者，其中试验组采用针灸联合独活寄生汤治疗共777例，对照组采用西药治疗共774例；③Meta分析结果显示：针灸联合独活寄生汤组总有效率高于对照组(RR=1.20，95%CI：1.15-1.25，P < 0.000 01)；晨僵时间(WMD=-0.86，95%CI：-1.13至-0.58，P < 0.000 01)、20 m步行时间(WMD=-4.64，95%CI：-5.24至-4.04，P < 0.000 01)、关节肿胀指数亚组年龄小于49岁(WMD=-2.42，95%CI：-2.58至-2.26，P < 0.000 01)、红细胞沉降率(ESR)(WMD=-1.56，95%CI：-1.73至-1.40，P < 0.000 01)、C-反应蛋白(WMD=-1.18，95%CI：-1.34至-1.02，P < 0.000 01)、类风湿因子(WMD=-2.26，95%CI：-2.55至-1.97，P < 0.000 01)、肿瘤坏死因子α(WMD=-42.28，95%CI：-47.47至-37.09，P < 0.000 01)和改善不良反应发生率(RR=0.36，95%CI：0.17-0.80，P=0.01)方面均优于对照组。
结论：针灸联合独活寄生汤与西药相比，治疗类风湿性关节炎总有效率更高，患者临床症状改善情况更好，不良反应发生率较低，安全性高，但由于纳入研究的质量限制及发表性偏倚，未来需进一步开展高质量、多中心、大样本的随机对照试验来验证。


https://orcid.org/0000-0002-8002-2204 (许能贵) 

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

关键词: 关节, 针灸, 中医药, 类风湿性关节炎, 总有效率, 盲法, 随机对照试验, Meta分析

Abstract: OBJECTIVE: Rheumatoid arthritis is an immune-mediated multi-system inflammatory disease that mainly involves synovium and joints. It has a high incidence and a long course of disease. This paper evaluates the clinical effect of acupuncture and moxibustion combined with Duhuo Jisheng Decoction in treating rheumatoid arthritis through a systematic evaluation.
METHODS: PubMed, Embase, CNKI, Sinomed, WanFang, and VIP were searched for randomized controlled trials (RCTs) regarding acupuncture and moxibustion combined with Duhuo Jisheng Decoction for treating rheumatoid arthritis. The retrieval time was from the inception of the databases to August 2020. Two researchers independently conducted literature search, screening and data extraction. According to RCT risk of bias tool provided by Cochrane collaboration network, a bias risk assessment of all included literatures was conducted followed by Meta-analysis using RevMan 5.3 software.
RESULTS: A total of 16 RCTs were included, and scored according to the modified Jadad scale, including 1 article with 4 points, 4 articles with 3 points, 8 articles with 2 points, and 3 articles with 1 point. The overall quality of the included RCTs was low. A total of 1 551 cases were involved in these 16 RCTs, including 777 cases in the trial group (Duhuo Jisheng Decoction) and 774 cases in the control group (western medicine). The results of meta-analysis showed acupuncture and moxibustion combined with Duhuo Jisheng Decoction were all better than the control group in terms of overall response rate (relative risk (RR)=1.20, 95% confidence interval (CI): 1.15 to 1.25,                         P < 0.000 01), morning stiffness time (weighted mean difference (WMD)=-0.86, 95% CI: -1.13 to -0.58, P < 0.000 01), 20-meter walk time (WMD=-4.64, 95% CI: -5.24 to -4.04, P < 0.000 01), joint swelling index (< 49 years old) (WMD=-2.42, 95% CI: -2.58 to -2.26, P < 0.000 01), erythrocyte sedimentation rate (WMD=-1.56, 95% CI: -1.73 to -1.40, P < 0.000 01), C-reactive protein (WMD=-1.18, 95% CI: -1.34 to -1.02, P < 0.000 01), rheumatoid factor (WMD=-2.26, 95% CI: -2.55 to -1.97, P < 0.000 01), tumor necrosis factor-α (WMD=-42.28, 95% CI: -47.47 to -37.09, P < 0.000 01) and adverse reaction incidence (RR=0.36, 95% CI: 0.17 to 0.80, P=0.01). 
CONCLUSION: Compared with western medicine, acupuncture and moxibustion combined with Duhuo Jisheng Decoction for treating rheumatoid arthritis has advantages in the overall response rate, improvement of clinical symptoms, incidence of adverse reactions, and safety, but due to the limitations of literature quality and publication bias, high-quality, multicenter, large-sample RCTs are required to further assess the efficacy and safety.


Key words: joint, acupuncture and moxibustion, Duhuo Jisheng Decoction, rheumatoid arthritis, overall response rate, blindness, randomized control trial, Meta-analysis 

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