光疗法联合透明质酸钠治疗膝骨关节炎疗效及安全性的Meta分析

文题释义：光疗法：是指利用自然光或人工光线用以防治疾病、促进机体功能恢复的一种理疗方法。光疗法最主要的作用是热效应，即通过光照射使局部组织温度升高，扩张周围血管，加速血液循环，抑制神经兴奋性，放松肌肉，其能纠正病变部位微循环障碍，利于炎症的消退，是一种安全且有效的治疗方法。膝骨关节炎：是一种发病率较高的以关节软骨丧失为主要特征的进行性、关节退化性疾病，临床表现包括膝关节疼痛及功能受损，晚期可致残，严重影响患者身心健康。目前尚没有有效的治疗方法来逆转关节内进行性损害过程，现阶段主要围绕着疼痛减轻和功能改善两大治疗目标。背景：目前已有大量研究证实光疗法联合透明质酸钠对膝骨关节炎疗效显著，且安全性较高，但仍缺乏循证依据。目的：对光疗法联合透明质酸钠治疗膝骨关节炎进行Meta分析。方法：使用计算机对英文数据库(PubMed，OVID，EMBASE)及中文数据库(中国知网、万方、维普、中国生物医学文献数据库)进行检索，查找各数据库建库至2019-07-01发表的光疗法联合透明质酸钠治疗膝骨关节炎的随机对照中英文文献。评价纳入研究的质量并提取文献中相关临床数据，采用专业软件(RevMan5.3)对结果行Meta分析。结果与结论：共纳入16篇文献，1 505例患者。实验组采用光疗法联合透明质酸钠治疗，对照组采用透明质酸钠治疗。Meta分析结果显示：实验组临床总有效率优于对照组(OR=4.20，95% CI(2.75，6.39)，P < 0.000 01)；实验组痊愈率高于对照组[OR=2.62，95%CI(1.78，3.86)，P < 0.000 01]；实验组治疗膝骨关节炎较对照组目测类比评分降低更为明显[MD=-1.51，95%CI(-2.15，-0.87)，P < 0.000 01]；实验组治疗膝骨关节炎较对照组Lysholm评分改善更为明显[MD=13.30，95%CI(6.82，19.78)，P < 0.000 01]；实验组在不良反应发生率方面与对照组无明显差别[OR=0.64，95%CI(0.25，1.63)，P=0.35]。结果显示，光疗法联合透明质酸钠治疗膝骨关节炎较单一关节腔注射透明质酸钠具有更大优势，疗效显著，安全性亦较高，但仍需进行更多研究质量高、样本数量大的随机对照研究加以验证。ORCID: 0000-0003-4306-287X(邓薇)中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程

Meta-analysis of efficacy and safety of light therapy combined with sodium hyaluronate in the treatment of knee osteoarthritis

BACKGROUND:A large number of studies have confirmed that light therapy combined with sodium hyaluronate has a significant effect on knee osteoarthritis.The combination use is highly safe,but there is still lack of evidence-based evidence.OBJECTIVE:To perform a meta-analysis of light therapy combined with sodium hyaluronate for knee osteoarthritis.METHODS:English databases(PubMed,OVID,EMBASE)and Chinese databases(CNKI,WanFang,VIP,China Biomedical Literature Database)were retrieved by computer for relevant articles regarding randomized controlled trials of light therapy combined with sodium hyaluronate in the treatment of knee osteoarthritis.The search time was from the inception to July 1,2019.The quality of the included studies was evaluated and relevant clinical data in the literature were extracted.The results were analyzed by RevMan 5.3.RESULTS AND CONCLUSION:A total of 16 articles were included,involving 1505 patients.The experimental group was treated with light therapy combined with sodium hyaluronate,and the control group was treated with sodium hyaluronate.The meta-analysis results showed that compared with the control group,the experimental group showed higher total clinical effective rate(odds ratio(OR)=4.20,95%confidence interval(CI)[2.75,6.39],P<0.00001),higher cure rate(OR=2.62,95%CI[1.78,3.86],P<0.00001),lower visual analogue scale score(mean difference(MD)=-1.51,95%CI[-2.15,-0.87],P<0.00001),and better Lysholm score(MD=13.30,95%CI[6.82,19.78],P<0.00001).There was no significant difference in the incidence of adverse reactions between the experimental and control groups(OR=0.64,95%CI[0.25,1.63],P=0.35).Light therapy combined with sodium hyaluronate for knee osteoarthritis has greater advantages than intraarticular injection of sodium hyaluronate alone,with high efficacy and safety.However,further investigations with high-quality and large sample size randomized controlled studies are still warranted.