针灸联合独活寄生汤治疗类风湿性关节炎的Meta分析

目的:类风湿关节炎是一种主要影响滑膜关节的免疫介导的多系统炎症性疾病,发病率高,病程长。文章系统评价了针灸联合独活寄生汤治疗类风湿性关节炎的临床疗效。方法:计算机检索PubMed、EMbase、中国知网、中国生物医学文献数据库(Sinomed)、万方及维普数据库,主要检索针灸联合独活寄生汤治疗类风湿性关节炎的临床随机对照试验,检索时间为建库至2020年8月。由2名研究员独立进行文献检索、筛选及数据提取,采用Cochrane协作网所提供的RCT偏倚风险工具对所有纳入文献进行偏倚风险评价,并用RevMan 5.3软件对数据进行Meta分析。结果:①共纳入16个随机对照试验,根据改良Jadad量表得分4分文献1篇,3分文献4篇,2分文献8篇,1分文献3篇,总体文献质量较低;②总共纳入1551例患者,其中试验组采用针灸联合独活寄生汤治疗共777例,对照组采用西药治疗共774例;③Meta分析结果显示:针灸联合独活寄生汤组总有效率高于对照组(RR=1.20,95%CI:1.15-1.25,P<0.00001);晨僵时间(WMD=-0.86,95%CI:-1.13至-0.58,P<0.00001)、20 m步行时间(WMD=-4.64,95%CI:-5.24至-4.04,P<0.00001)、关节肿胀指数亚组年龄小于49岁(WMD=-2.42,95%CI:-2.58至-2.26,P<0.00001)、红细胞沉降率(ESR)(WMD=-1.56,95%CI:-1.73至-1.40,P<0.00001)、C-反应蛋白(WMD=-1.18,95%CI:-1.34至-1.02,P<0.00001)、类风湿因子(WMD=-2.26,95%CI:-2.55至-1.97,P<0.00001)、肿瘤坏死因子α(WMD=-42.28,95%CI:-47.47至-37.09,P<0.00001)和改善不良反应发生率(RR=0.36,95%CI:0.17-0.80,P=0.01)方面均优于对照组。结论:针灸联合独活寄生汤与西药相比,治疗类风湿性关节炎总有效率更高,患者临床症状改善情况更好,不良反应发生率较低,安全性高,但由于纳入研究的质量限制及发表性偏倚,未来需进一步开展高质量、多中心、大样本的随机对照试验来验证。

Meta-analysis of acupuncture and moxibustion combined with Duhuo Jisheng Decoction in treating rheumatoid arthritis

OBJECTIVE: Rheumatoid arthritis is an immune-mediated multi-system inflammatory disease that mainly involves synovium and joints. It has a high incidenceand a long course of disease. This paper evaluates the clinical effect of acupuncture and moxibustion combined with Duhuo Jisheng Decoction in treatingrheumatoid arthritis through a systematic evaluation.METHODS: PubMed, Embase, CNKI, Sinomed, WanFang, and VIP were searched for randomized controlled trials (RCTs) regarding acupuncture and moxibustioncombined with Duhuo Jisheng Decoction for treating rheumatoid arthritis. The retrieval time was from the inception of the databases to August 2020. Tworesearchers independently conducted literature search, screening and data extraction. According to RCT risk of bias tool provided by Cochrane collaborationnetwork, a bias risk assessment of all included literatures was conducted followed by Meta-analysis using RevMan 5.3 software.RESULTS: A total of 16 RCTs were included, and scored according to the modified Jadad scale, including 1 article with 4 points, 4 articles with 3 points, 8 articles with 2points, and 3 articles with 1 point. The overall quality of the included RCTs was low. A total of 1 551 cases were involved in these 16 RCTs, including 777 cases in the trialgroup (Duhuo Jisheng Decoction) and 774 cases in the control group (western medicine). The results of meta-analysis showed acupuncture and moxibustion combinedwith Duhuo Jisheng Decoction were all better than the control group in terms of overall response rate (relative risk (RR)=1.20, 95% confidence interval (CI): 1.15 to 1.25,P < 0.000 01), morning stiffness time (weighted mean difference (WMD)=-0.86, 95% CI: -1.13 to -0.58, P < 0.000 01), 20-meter walk time (WMD=-4.64, 95% CI: -5.24to -4.04, P < 0.000 01), joint swelling index (< 49 years old) (WMD=-2.42, 95% CI: -2.58 to -2.26, P < 0.000 01), erythrocyte sedimentation rate (WMD=-1.56, 95% CI:-1.73 to -1.40, P < 0.000 01), C-reactive protein (WMD=-1.18, 95% CI: -1.34 to -1.02, P < 0.000 01), rheumatoid factor (WMD=-2.26, 95% CI: -2.55 to -1.97, P < 0.000 01),tumor necrosis factor-α (WMD=-42.28, 95% CI: -47.47 to -37.09, P < 0.000 01) and adverse reaction incidence (RR=0.36, 95% CI: 0.17 to 0.80, P=0.01).CONCLUSION: Compared with western medicine, acupuncture and moxibustion combined with Duhuo Jisheng Decoction for treating rheumatoid arthritis hasadvantages in the overall response rate, improvement of clinical symptoms, incidence of adverse reactions, and safety, but due to the limitations of literaturequality and publication bias, high-quality, multicenter, large-sample RCTs are required to further assess the efficacy and safety.