独活寄生汤联合针灸治疗膝骨关节炎的系统评价与Meta分析*

目的探讨临床中使用独活寄生汤联合针灸治疗膝骨关节炎（KOA）的临床疗效。方法 对临床中常用中、英文7个数据库（中国知网、中国生物医学文献数据库、万方数据库、维普数据库、Clinical trials.gov、PubMed，Cochrane Library）中收录的独活寄生汤联合针灸治疗膝骨关节炎的相关文献进行系统检索，文献发表选取区间为从建库起至2019年3月。将检索出的相关文献按照本次研究所设定的纳入标准及排除标准等进行筛选，得到最终纳入文献。由3名资深研究者对最终纳入文献进行质量评估，其评估标准参照Cochrane Handbook for Systematic Reviews of Interventions，同时运用Review Manager5.3软件对符合标准的文献进行Meta分析。结果 按照检索标准共检索出相关文献158篇，其中中文数据库检索出文献152篇，英文数据库英文文献6篇，按照要求最终纳入文献7篇。与对照组比较，临床疗效Meta分析结果示[OR=3.56，95%CI (2.22，5.71)，P<0.000 01]；关节疼痛改善情况Meta分析结果示[MD=-1.14，95%CI(-1.83，-0.46)，P=0.001]；WOMAC评分改善情况Meta分析结果示[MD=-19.26，95%CI (-21.45，-17.07)，P<0.000 01]；肿胀度改善情况Meta分析结果示[MD=-0.30，95%CI (-0.40， -0.21)，P=0.000 01]；不良反应发生情况Meta分析结果示[OR=0.09，95%CI (0.03，0.31)，P=0.000 1]。结论 独活寄生汤联合针灸治疗膝骨关节炎能够有效的提高临床有效率、缓解疼痛、提高关节功能、减轻关节肿胀度且不良反应较少，临床值得推广。但其临床效果是否优于单一运用独活寄生汤或针灸方面证据不足，需更多的高质量研究来证实其有效性及安全性。

Systematic Review and Meta-analysis of Duhuo Jisheng Decoctionin the Treatment of Knee Osteoarthritis

Objective To investigate the clinical efficacy of the treatment of knee osteoarthritis (KOA) with a combination of Duhuo Jisheng Decoction combined with acupuncture in the clinic. Methods A total of 7 commonly used Chinese and English databases(CNKI, China Biomedical Literature Database, Wanfang Database, VIP Database, Clinical trials.gov, PubMed, Cochrane Library) were searched,and the literature on osteoarthritis was systematically selected, with selection interval from the establishment of the library to March 2019. The relevant documents were selected according to the proposed inclusion criteria and exclusion criteria in this research, and finally included in the literature. The quality of the final literature was evaluated by three senior researchers. The evaluation criteria were based on the Cochrane Handbook for Systematic Reviews of Interventions, at the same time, Meta-analysis was performed on the standards-compliant literature using Review Manager 5.3 software. Results A total of 158 articles were retrieved, including 152 Chinese literatures and 6 foreign literatures. After screening, 7 papers were finally included. Compared with the control group, the results of the meta-analysis of clinical efficacy showed [OR=3.56, 95% CI(2.22, 5.71), P<0.000 01]; the results of meta-analysis of joint pain improvement showed [MD=-1.14, 95% CI(-1.83) , -0.46), P=0.001]; the results of the meta-analysis of WOMAC scores showed [MD=-19.26, 95% CI(-21.45,-17.07), P<0.000 01]; the results of the meta-analysis of swelling improvement showed [MD=-0.30, 95% CI(-0.40, -0.21), P=0.000 01]; the results of the meta-analysis of the adverse reaction showed [OR=0.09, 95% CI(0.03, 0.31), P=0.000 1]. Conclusion Duhuo Jisheng Decoction combined with acupuncture for knee osteoarthritis can effectively improve clinical efficiency, reduce pain, improve joint function, reduce joint swelling and have less adverse reactions, and it is worthy of promotion in clinical. However, whether the clinical effect is better than the single use of the living parasitic soup or acupuncture is insufficient evidence, more high-quality research is needed to confirm its effectiveness and safety.