火针对比西药治疗痛风性关节炎血尿酸及关节功能影响Meta分析及试验序贯分析

Objective:To conduct the meta-analysis and trial sequential analysis(TSA) on clinical trials of fire needling therapy in treatment of gouty arthritis and review systematically the clinical therapeutic effect of fire needling therapy on gouty arthritis so as to provide the medical evidences of the extensive application of this therapy in treatment of gouty arthritis.Methods:The relevant clinical trials of fire needling therapy for treatment of gouty arthritis were searched from China National knowledge Infrastructure,Wanfang Data Knowledge Service Platform,Chinese Science and Technology Journal Database,American Medical Online,Dutch Medical Literature Database and International Evidence-Based Medical library.Using Review Manager 5.3 software,the quality of the included trials was assessed and meta-analysis was performed.With TSA v0.9 software,the trial sequential analysis was conduced on the appropriate outcomes.Results:A total of 10 trials were included with 775 patients involved.The analysis results showed that compared with the western medication,the total effective rate(RR=1.14’95%CI [1.09,1.20]),the curative rate(RR=1.59’95%CI [1.33,1.89]),the reduced VAS score(MD=-1.44’ 95%CI [-1.93,-0.951]) and the reduced incidence of adverse reaction(RR=0.27’ 95% CI [0.09,0.76]) of the fire needling therapy were different significantly(all P <0.05).Regarding the reduction of blood uric acid(MD=-40.47’ 95%CI [-80.21,-0.72]) and the score of symptoms and physical signs(MD=-1.38’95% CI [-3.71,0.95]),the effect of fire needling therapy was similar to that of western medication group(both P≥0.05).The trial sequential analysis suggested that the result was reliable,in which,the total effective rate of fire needling therapy was much higher than the western medication.But,it was potentially a false-positive finding,in which,fire needling therapy was much more advantageous at reducing blood uric acid as compared with the western medication.Conclusion:Based on the analytic results,it can be determined that fire needling therapy,as an effective approach to the treatment of gouty arthritis,has a certain advantage as compared with western medication.Given the low overall quality of trials,it still needs high-quality clinical trial to verify the findings of this study results.     

中药治疗痛风的作用机制研究进展

痛风是我国第二大代谢类疾病，会引起关节组织损伤及多种慢性疾病，严重影响人类生活健康。嘌呤代谢紊乱或尿酸排泄异常引发的尿酸升高是其发病的生化基础，西医治疗主要采用控制炎症类药物如秋水仙碱、非甾体抗炎药，降尿酸类药物非布司他、苯溴马隆等，其效果明显，但存在停药后易复发及不良反应较多等问题。中药治疗痛风历史悠久，具有多途径、多靶点、多层次对症治疗的优势，通过降尿酸、抗炎、抗氧化、保护肾脏等发挥治疗作用，其疗效明显且不良反应率低。近年来，有关中药对痛风动物模型的作用机制研究较多，笔者在回顾近年来相关文献的基础上，对痛风发病机制、中药作用机制及其相关实验设计等进行了系统的梳理，从调节炎性因子水平、抑制氧化反应、降尿酸、调节信号通路等方面对中药治疗痛风的作用机制研究进行总结与分析，以期为痛风治疗药物的研发提供参考。     

电针联合雷火灸治疗寒湿型膝骨性关节炎:随机对照试验

ObjectiveTo observe the clinical effect differences of knee osteoarthritis (KOA) with cold-damp type between electroacupuncture (EA) combined with thunder-fire moxibustion and medication.MethodsA total of 72 cases of KOA patients with cold-damp type were randomly divided into a combined treatment group of EA and thunder-fire moxibustion (combined treatment group) and a medication group, 36 cases in each group. In the combined treatment group, the acupoints for EA were Dúbí (犊鼻 ST35), Nèixīyăn (内膝眼 EX-LE4), Zúsānlĭ (足三里 ST36), Yánglíngquán (阳陵泉 GB34), Yīnlíngquán(阴陵泉 SP9), Xuèhăi (血海 SP10), Liángqiū (梁丘 ST34) and Hèdĭng (鹤顶 EX-LE2). During the period of EA, the suspending thunder-fire moxibustion was applied to Shénquè (神阙 CV8) and Guānyuán (关元 CV4). In the medication group, diclofenac sodium double release intestine-sol capsule and Fugui gutong capsules were prescribed for oral administration. The treatment for 14 days was taken as one course and the consecutive 2 courses of treatment were required in each group. Before and after treatment, as well as in the follow-up visit, the pain score (visual analogue scale, VAS), the knee function score(Western Ontario and McMaster University, WOMAC, the expressions of interleukin 6 (IL-6) and transforming growth factor β1 (TGF-β1) in the joint fluid as well as the difference in the clinical therapeutic effect were observed in the two groups separately.Results(1) The pain score: compared with those before treatment, the VAS scores were all reduced after treatment and in the follow-up in the two groups (all P < 0.05). After treatment and in the follow-up, VAS scores in the combined treatment group were lower than those in the medication group (both P < 0.05). (2) The knee function score: WOMAC score of each item, i.e. pain, stiffness and function, as well as the total score after treatment and the follow-up were all lower than those before treatment in the patients of the two groups (all P < 0.05). The score of each item, i.e. pain and function, as well as the total score in the combined treatment group were all lower than those in the medication group after treatment and the follow-up respectively (all P < 0.05). (3)The expressions of IL-6 and TGF-β1: the level of IL-6 in the joint fluid was reduced after treatment as compared with that before treatment in either group and the level of TGF-β1 was increased, indicating the statistical differences (all P < 0.05). After treatment, the level of IL-6 in the combined treatment group was lower than that in the medication group and the level of TGF-β1 was higher than that of the medicating group, indicating the statistical significance (both P < 0.05). (4)The total effective rate in the combined treatment group was 97.1%, higher than 78.8% in the medication group, indicating the statistical significance (P < 0.05).ConclusionThe clinical effect of the combined treatment of electroacupuncture and the thunder-fire moxibustion is remarkable on knee osteoarthritis of cold-damp type. The combined treatment presents a more advantageous at the sustainability of the therapeutic effect as compared with medication.     

滞针法对膝骨关节炎关节功能及关节液中相关炎性标志物的影响:随机对照试验

ObjectiveTo observe the differences of clinical effect and influence on joint function and inflammatory markers in joint fluid between stuck-needle technique and regular acupuncture in patients with knee osteoarthritis.MethodsSeventy-two patients with knee osteoarthritis were randomly divided into a stuck-needle technique group and a regular acupuncture group, with 36 cases in each one. The selection of acupoints, retaining time of needles, and treatment course were all the same in both groups. The visual analog scale (VAS) score, Lequesne index score, and the content of related inflammatory indexes in joint fluid before and after treatment were observed, and the therapeutic effect were evaluated.ResultsAfter treatment, the VAS scores, Lequesne index scores, interleukin-1 beta (IL-1β), and the tumor necrosis factor α (TNF-α) of the two groups were all lower than those before treatment (all P<0.05). After treatment, the VAS scores, Lequesne index scores, IL-1β, and TNF-α of the stuck-needle technique group were all lower than those of the regular acupuncture group (all P<0.05). The total effective rate of the stuck-needle technique group was 96.97% (32/33), higher than 93.75% (30/32) of the regular acupuncture group (P<0.05).ConclusionStuck-needle technique can effectively relieve the pain and improve the joint functions, being more effective than regular acupuncture for the treatment of knee osteoarthritis.     

壮医药线点灸对痛风性关节炎患者血尿酸及关节功能影响的Meta分析

背景　大量临床研究显示,壮医药线点灸治疗痛风性关节炎具有治疗效果好、不良反应少等优点。但当前壮医药线点灸治疗该病缺乏多中心大样本的临床研究试验。目的　应用荟萃分析法系统评价壮医药线点灸治疗痛风性关节炎临床疗效及安全性。方法　计算机检索中国知网、万方数据知识服务平台、维普数据库、PubMed、EMBase及Cochrane Library,检索时间为建库至2019年9月,搜集有关壮医药线点灸治疗痛风性关节炎的临床随机对照试验（RCT）,其中治疗组为壮医药线点灸,对照组为不同于壮医药线点灸的其他治疗方法。对文献进行数据资料提取和质量评价,采用RevMan 5.3软件进行Meta分析。结果　共纳入10篇中文文献。Jadad评分量表结果显示,5篇文献为高质量研究,5篇文献为低质量研究。Meta分析结果显示,治疗组总体有效率、治愈率、血尿酸下降幅度、关节肿痛积分下降幅度均高于对照组〔OR=4.62,95%CI（2.69,7.94）,P<0.000 01;OR=2.39,95%CI（1.37,4.16）,P=0.002;SMD=-0.62,95%CI（-0.83,-0.40）,P<0.000 01;MD=-2.51,95%CI（-3.38,-1.64）,P<0.000 01〕,不良反应发生率低于对照组〔OR=0.18,95%CI（0.11,0.31）,P<0.000 01〕。总体有效率、治愈率、治疗前后血尿酸差值、治疗前后关节肿痛积分差值及不良反应发生率的漏斗图均未完全对称,提示存在发表性偏倚的可能。翻转效应模型分析总体有效率、治愈率、治疗前后血尿酸差值、治疗前后关节肿痛积分差值及不良反应发生率,所有指标未被逆转,说明研究结果可信度较高。结论　壮医药线点灸治疗痛风性关节炎的近期疗效确切,能够有效降低痛风性关节炎患者的血尿酸水平,可对关节肿痛发挥积极效应且不良反应少。由于本次纳入研究的样本量有限及可能存在偏倚等因素,今后仍需更多规范化的RCT研究来验证本研究的结论。