Chinese Journal of Tissue Engineering Research ›› 2021, Vol. 25 ›› Issue (32): 5232-5239.doi: 10.12307/2021.230
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Li Hongzhu1, 2, Yuan Si1, 2, Zhao Jiaying1, 2, Lu Liming1, 2, Xu Nenggui1, 2
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:
CLC Number:
Li Hongzhu, Yuan Si, Zhao Jiaying, Lu Liming, Xu Nenggui. Meta-analysis of acupuncture and moxibustion combined with Duhuo Jisheng Decoction in treating rheumatoid arthritis[J]. Chinese Journal of Tissue Engineering Research, 2021, 25(32): 5232-5239.
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2.2 纳入文献质量评价结果 纳入文献均为中文文献;有8篇文献提及具体随机方法[12-13,19-21,24-27],剩余8篇仅提及采用随机分组[14-18,20,22-23],未描述具体随机方法;有1篇文献提及采用双盲法[24],剩余15篇未表明采用盲法;16篇文献均未提及分配隐藏方法。改良Jadad量表得分:4分文献1 篇[24],3分文献4篇[12,21,25,26],2分文献8篇[15-18,20,22-23,27],1分文献3篇[13-14,19],总体质量较低。根据线性加权Weighted Kappa系数分析显示,2位评价者评价结果的Weighted Kappa系数为0.797(P < 0.001),说明两人的评价结果一致性较强。具体偏倚风险评估结果见表2,图3。 "
2.3 Meta分析结果 2.3.1 各组总有效率差异 有16篇文献采用总有效率为主要结局指标[12-27],异质性检验:P=0.50,I2=0%,提示各项研究之间无异质性,采用固定效应模型分析,见图4。Meta分析结果显示,试验组总有效率高于对照组(RR=1.20,95%CI:1.15-1.25,P < 0.000 01)。由于总有效率的计算方式有差异,通过亚组分析结果显示,总有效率=[(显效+有效)/总病例数]×100%的研究,Meta分析结果显示:试验组总有效率高于对照组(RR=1.26,95%CI:1.18-1.36,P < 0.000 01)。总有效率=[(痊愈+显 效+有效)/总人数]×100%的研究,Meta分析结果显示:试验组总有效率高于对照组(RR=1.16,95%CI:1.10-1.21, P < 0.000 01)。 "
2.3.2 各组晨僵时间差异 有9篇文献报道了晨僵时间[13,15,18, 20-24,26],异质性检验:P < 0.000 01,I2=97%,提示各研究之间存在较高异质性,分析其异质性,考虑到诊断标准及患者年龄差异对数据的影响,故排除大异质性文献6篇[13,15,18,21, 23,26],针灸联合独活寄生汤对比西药组仅纳入3篇文献[20,22,24],共纳入224例患者,试验组112例,对照组112例,异质性检验:P=0.20,I2=38%,提示各研究之间无明显异质性,故应用固定效应模型合并数据。Meta分析结果显示,试验组在改善晨僵时间方面优于对照组(WMD=-0.86,95%CI:-1.13至-0.58,P < 0.000 01),见图5。 "
2.3.4 各组关节肿胀指数差异 有6篇文献报道了关节肿胀指数[15,21-24,26],异质性检验:P < 0.000 01,I2=100%,提示各研究之间存在较高异质性,分析其异质性,考虑到纳入患者年龄的差异,进行亚组分析,亚组为年龄小于49岁,纳入文献4篇[15,22-24],异质性检验:P=0.34,I2=12%,提示各研究之间无明显异质性,故应用固定效应模型合并数据。Meta分析结果显示,试验组在改善关节肿胀指数方面(WMD=-2.42,95%CI:-2.58至-2.26,P < 0.000 01)优于对照组,亚组年龄大于49岁,异质性检验:P < 0.000 01,I2=100%,分析其异质性,进行敏感性分析,排除大异质性文献1篇[26],考虑不同治疗方式及对照对数据分析的影响,仅1篇文献[21],故不予纳入,仅评价年龄小于49岁组,见图7。 "
2.3.4 各组关节肿胀指数差异 有6篇文献报道了关节肿胀指数[15,21-24,26],异质性检验:P < 0.000 01,I2=100%,提示各研究之间存在较高异质性,分析其异质性,考虑到纳入患者年龄的差异,进行亚组分析,亚组为年龄小于49岁,纳入文献4篇[15,22-24],异质性检验:P=0.34,I2=12%,提示各研究之间无明显异质性,故应用固定效应模型合并数据。Meta分析结果显示,试验组在改善关节肿胀指数方面(WMD=-2.42,95%CI:-2.58至-2.26,P < 0.000 01)优于对照组,亚组年龄大于49岁,异质性检验:P < 0.000 01,I2=100%,分析其异质性,进行敏感性分析,排除大异质性文献1篇[26],考虑不同治疗方式及对照对数据分析的影响,仅1篇文献[21],故不予纳入,仅评价年龄小于49岁组,见图7。 "
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