火针、温针及电针疗法治疗膝骨关节炎有效性的网状Meta分析

文题释义：网状Meta分析：基于间接比较或合并间接比较与直接比较而同时分析 2 个以上干预措施的Meta分析。包括如下2种情况：①间接比较Meta分析：当不存在直接比较情况下，基于共同对照对多个干预措施进行比较的Meta分析；②混合治疗效应Meta分析：当同时存在直接比较和间接比较的情况下，基于间接结果与直接结果的合并结果来同时分析多个干预措施的Meta分析。 温针灸：针刺与艾灸相结合的一种方法，又称针柄灸。即在留针过程中，将艾绒搓团捻裹于针柄上点燃，通过针体将热力传入穴位。 背景：针灸的方法主要包括温针灸、火针、电针，但这些疗法在治疗膝骨关节炎的有效性和安全性平衡仍不清楚。 目的：运用网状Meta分析，比较温针灸、火针、电针3种针灸疗法干预膝骨关节炎的有效性。 方法：检索Embase、Cochrane Library、PubMed及中国期刊全文数据库(CNKI)、万方数据库(Wangfang)、维普数据库(VIP)及中国生物医学文献数据库(CBMdisc)，检索时间为2019-09-20之前，搜集温针灸、火针、电针治疗膝骨关节炎的临床随机对照试验。采用 RevMan 5.3和Stata 14.0软件行数据分析。 结果与结论：最终纳入34个随机对照试验，共2 871例膝骨关节炎患者。网Meta分析结果示：①在临床总有效率方面，火针(OR=1.08，95%CI：1.00-1.17，P < 0.05)、温针(OR=1.08, 95%CI：1.02-1.14，P < 0.05)总有效率均优于电针，3种针灸疗法总有效率均优于西药，火针最佳；②在改善目测类比评分方面，火针(MD=-2.12，95%CI：-3.52至-0.71，P < 0.05)、温针灸(MD=-1.31，95%CI：-2.33至-0.29，P < 0.05)，电针(MD=-1.17，95%CI：-2.19至-0.16)，P < 0.05)的均优于西药，火针最佳；③在降低WOMAC总分方面，火针(MD=-15.38，95%CI：-27.88至-2.87，P < 0.05)、温针灸(MD=-11.48，95%CI：-16.45至-6.51)，P < 0.05)及电针(MD=-7.29，95%CI：-11.86至-2.72，P < 0.05)均优于西药，火针最佳；④结果证实，综合比较3种针灸疗法的相关结果排序后，在治疗膝骨关节炎中，优先推荐火针治疗。但仍需更多高质量随机对照研究来进一步证实。 ORCID: 0000-0002-8634-0633(张金焕) 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Network meta-analysis on effectiveness of fire needle,warm acupuncture,and electroacupuncture in the treatment of knee osteoarthritis

BACKGROUND:Acupuncture has different forms as a kind of therapy,mainly warm acupuncture,fire needle and electroacupuncture,but the balance of effectiveness and safety between these measures remains unclear.OBJECTIVE:To compare the effectiveness of warm acupuncture,fire needle and electroacupuncture in the intervention of knee osteoarthritis by network meta-analysis.METHODS:The Embase,Cochrane Library,PubMed,CNKI,Wanfang,VIP and CBMdisc databases were searched for the clinical randomized controlled trials of warm acupuncture,fire needle and electroacupuncture in the treatment of knee osteoarthritis published before September 20,2019.RevMan 5.3 and Stata 14.0 were used for data analysis.RESULTS AND CONCLUSION:A total of 2871 patients with knee osteoarthritis were included in 34 randomized controlled trials.The results of meta-analysis showed that(1)the total clinical effective rate in the fire needle group(OR=1.08,95%CI:1.00-1.17,P<0.05)and warm acupuncture group(OR=1.08,95%CI:1.02-1.14,P<0.05)was better than that in the electroacupuncture,and the total effective rate of the three acupuncture treatments was better than that of western medicine,especially fire needle.(2)In the aspect of improving the Visual Analogue Scale scores,the fire needle(MD=-2.12,95%CI:-3.52 to-0.71,P<0.05),warm acupuncture(MD=-1.31,95%CI:-2.33 to-0.29,P<0.05),and electroacupuncture(MD=-1.17,95%CI:-2.19 to-0.16),P<0.05)were superior to western medicine,especially fire needle.(3)In terms of reducing WOMAC scores,fire needle(MD=-15.38,95%CI:-27.88 to-2.87,P<0.05),warm acupuncture(MD=-11.48,95%CI:-16.45 to-6.51,P<0.05),and electroacupuncture(MD=-7.29,95%CI:-11.86 to-2.72,P<0.05)were superior to western medicine,especially fire needle.(4)In summary,comprehensive comparison of three kinds of acupuncture,in the treatment of knee osteoarthritis,fire needle is the first choice.However,it still needs to be confirmed by more high-quality randomized controlled trials.