Chinese Journal of Tissue Engineering Research ›› 2020, Vol. 24 ›› Issue (21): 3438-3444.doi: 10.3969/j.issn.2095-4344.2605
Effect of electro-acupuncture on pain relief and joint function in patients with knee osteoarthritis: a meta-analysis
Chen Rilan1, Deng Kaifeng2, Wei Xingcheng2, Wang Hengsheng2, Feng Jiaoqun2, Yan Jiaxing2, Gao Qianqian2, Ma Yinglu2, Zhu Ying1
- 1Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine, Nanning 530011, Guangxi Zhuang Autonomous Region, China; 2Guangxi University of Chinese Medicine, Nanning 530001, Guangxi Zhuang Autonomous Region, China
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Received:2019-08-22Revised:2019-08-26Accepted:2019-10-09Online:2020-07-28Published:2020-04-20 -
Contact:Zhu Ying, Chief physician, Professor, Master’s supervisor, Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine, Nanning 530011, Guangxi Zhuang Autonomous Region, China -
About author:Chen Rilan, Chief physician, Professor, Master’s supervisor, Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine, Nanning 530011, Guangxi Zhuang Autonomous Region, China -
Supported by:the National Natural Science Foundation of China, No. 81960908; Guangxi Medical and Health Technology Development and Promotion Project of Guangxi Health and Family Planning Commission, No. S2017057; Graduate Education Innovation Program of Guangxi Zhuang Autonomous Region, No. YCSY20190095
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Chen Rilan, Deng Kaifeng, Wei Xingcheng, Wang Hengsheng, Feng Jiaoqun, Yan Jiaxing, Gao Qianqian, Ma Yinglu, Zhu Ying. Effect of electro-acupuncture on pain relief and joint function in patients with knee osteoarthritis: a meta-analysis[J]. Chinese Journal of Tissue Engineering Research, 2020, 24(21): 3438-3444.
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2.1 文献检索结果 共纳入1 059篇相关文献，软件去重后获得539篇文献，通过阅读摘要，排除综述、动物实验、会议记录、护理记录、个案或专家经验、非RCT等文献，共获得电针治疗膝关节骨性关节炎的文献248篇。根据研究限定的纳入及排除标准，最终纳入符合标准的文献共11篇，包括期刊论文8篇[12，15-21]，学位论文3篇[11，13-14]，均为中文文献。文献检索流程详见图1。 "
2.2 纳入文献的基本特征 此次荟萃分析共纳入11篇RCT研究，涉及患者727例，其中治疗组合计366例，对照组合计361例。此11项研究在临床疗效判定上主要以VAS评分[22]、WOMAC评分[23]、ISOA评分3种疗效指标为标准[24]，而此3项指标均涉及膝关节功能状况，故可认为纳入的各项独立研究疗效判断标准大体一致。临床疗效分级包括临床治愈、显效、有效和无效4级标准，总体有效率作为结局指标包括临床治愈率、显效率及有效率三者之和。详见表1。 "
2.3 纳入研究的质量评价 采用Jadad评分量表(≤2分判定为低质量，≥3分判定为高质量)对纳入的11项研究进行评估。结果显示有3项为高质量研究[13-14，20]，得分均为3分；其余8项均为低质量研究[11-12，15-19，21]，4项研究得分为2分[11，17-18，21]，4项研究得1分[12，15-16，19]。7项试验使用随机数字表法[11，13-14，17-18，20-21]，其余4项只提及了随机字样[12，15-16，19]。有3项试验提及随访时间[14，6，21]，所有的研究皆报告了两组之间基线相似性一致。但是，以上文献均未将原始数据进行呈现，只能通过研究者的总结报告进行评价，使分析存在信息偏倚的可能。由于电针疗法本身治疗方式特殊，难以对研究人员以及受试人员施盲，导致实施性偏倚风险评估均为high risk。详见表2，图2，3。 "
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2.4 干预措施比较 11项研究中，4项为电针与常规针刺的比较[11-14]，另7项为电针与药物(包括口服西药、中药及关节腔内注射)的比较[15-21]。 2.5 Meta分析结果 2.5.1 总体有效率 11项研究报告皆报道了总体有效率，异质性检验P=0.42，I2=3%，采用固定效应模型分析，结果显示治疗组对于提高总体有效率较之对照组效果更为显著[OR=3.22，95%CI(2.13，4.87)，Z=5.53，P < 0.000 01]。详见图4。 "
2.5.2 治愈率 11项研究报告皆报道了治愈率，异质性检验P=0.57，I2=0%，采用固定效应模型分析，结果显示治疗组的临床治愈率比对照组更高[OR=2.73，95%CI(1.80，4.15)，Z=4.72，P < 0.000 01]。详见图5。 "
2.5.3 治疗前后VAS评分差值 6项研究报告报道了VAS评分[11-14，16，19]。对其差值进行异质性检验P < 0.000 01，I2=91%，采用随机效应模型分析，结果显示治疗组在降低VAS评分、减轻膝关节疼痛方面比对照组更有优势[MD=-1.00，95%CI(-1.71，-0.30)，Z=2.80，P=0.005]。详见图6。 "
2.5.4 治疗前后WOMAC评分差值 5项研究报告报道了WOMAC评分[11，13-14，20-21]。对其差值进行异质性检验P=0.09，I2=50%，采用随机效应模型分析，结果显示电针在改善关节局部症状和功能方面明显优于对照组[MD=-7.69，95%CI(-10.31，-5.07)，Z=5.75，P < 0.000 01]。详见图7。 "
2.5.5 治疗前后ISOA评分差值 4项研究报告报道了ISOA评分[13，15，17-18]。由于其中1项研究未提供试验数据[14]，故未能纳入分析。对其余3项研究的ISOA评分差值进行异质性检验P=0.002，I2=84%，采用随机效应模型分析，结果显示治疗组在缓解疼痛及恢复关节功能方面比对照组效果更好[MD=-2.22，95%CI(-3.74，-0.70)，Z=2.86，P=0.004]。详见图8。 "
2.6 安全性分析 纳入的11项研究中，4项研究对不良反应事件进行了叙述[11，13-14，16]，电针组所涉及患者共计121例，均无不良反应发生。其余7项研究均未提及不良反应，这可能与电针本身安全性较高有关。 2.7 偏倚性分析 漏斗图分布并不完全对称，以漏斗图进行偏倚分析较为主观，再结合纳入研究样本量小且质量偏低等特点，提示存在发表性偏倚的可能。除此之外，所纳入研究的结局指标并未完全统一，大部分文献未涉及后期随访，这些因素同样是其潜在发表性偏倚的来源。详见图9。 "
2.8 敏感性分析 采用固定效应模型和随机效应模型分析纳入电针治疗膝关节骨性关节炎的总体有效率、治愈率、VAS评分、WOMAC评分及ISOA评分，估计其合并的OR值，结果较为接近，未被逆转，证明其敏感性低，说明研究结果可信度较高。详见表3。 "
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