摘要
目的采用Meta分析系统评价独活寄生汤治疗骨关节炎的临床疗效。方法通过检索中外数据库独活寄生汤治疗骨关节炎的随机对照试验文献（RCT）,经文献质量评价后,运用Rev Man5.2软件进行Meta分析。结果最终纳入文献数为9篇,合计病例数1116例,分为治疗组559例与对照组557例。治疗组采用独活寄生汤治疗为主。对照组治疗方法有关节腔内注射、非甾体类抗炎药、软骨保护剂。疗效评价主要包括VAS（视觉模拟评分法）评分、KSS（膝关节协会评分）评分、Lequesne的骨关节炎疼痛功能指数（Lequene-Mery KOA评分系统）、膝关节WOMAC评分、临床症状体征等。纳入文献中,Jadad评分仅1篇达到4分,仅有1篇文献采用随机数字表法,1篇文献按随机抽签法,1篇按先后就诊顺序进行随机分组;未采用随机双盲安慰剂对照方法;没有文献提及随机分配方案的隐藏,仅2篇文献报告了病例脱落情况。9篇文献均给出组间均衡性统计分析;6篇文献提及治疗过程中不良反应情况。治疗组总例数559,有效523例,有效率93.56%;对照组共557例,有效410例,有效率73.61%。进一步以不同对照药物分析发现,不同西医治法组（对照）有效率在60.99%~87.96%之间。异质性检验（χ~2=11.58,P=0.17〉0.1,I2=31%≤50%）,数据具有同质性,以固定效应模式进行分析。独活寄生治疗组和西药对照组合并后效应量OR=5.44,95%CI[3.68,8.03];合并后效应量的检验Z=8.52（P〈0.00001）,差异均具有统计学意义。置信区间落在无效线的右侧,表明独活寄生汤组的效应量大于西医对照组。倒漏斗图散点分布有一定的不对称性,说明存在一定的发表偏倚。结论独活寄生汤疗效优于西医治疗,这可能与采用中西结合治疗有关,但目前研究存在诸多试验设计问题,影响了独活寄生汤的特色优势发挥。
Objective： To assess the effectiveness of Duhuo Jisheng Decoction on the treatment of osteoarthritis （OA）. Methods： The randomized controlled trials about the Duhuo Jisbeng Decoction in the therapy of OA were searched in the databases in China and abroad, and meta-analyzed with RevMan5.2 statistical software after eval- uating the literature by Jadad quality score. Results： There were 9 randomized controlled trials about the Duhuo Jisheng Decoction in the treatment of OA,including 1116 cases： 559 cases in the treatment group,557 cases in the control group. The treatment group was treated with Duhuojisheng Decoction Treatment. The control group was treated with intra articular injection,non steroidal anti-inflammatory drugs,and cartilage protective agent. Efficacy evaluation mainly includes VAS score,KSS score,Lequene-Mery KOAscore,WOMAC score, and clinical signs and symptoms. Among the literature,there was only one getting the Jadadscore of 4, only one with random number table method, only one with random lottery, and only one randomly grouped according to the order of sequence. There was no Randomized double blind placebo control method and no reference to random allocation conceal- ment. Only 2 reported shedding case. All the 9 gave the statistical analysis of the equilibrium of groups, and 6 re- ferred to the adverse reactions in the treatment process. The total number of cases in the treatment group was 559,523 cases effective,the effective rate 93.56%, and the control group included 557 cases,410 cases effective, the effective rate 73.61%. Further analysis showed that in different control drugs,western medicine treatment groups had different efficiency between 60.99% to 87.96%. Heterogeneity test was （X2= 11.58 ,P= 0. 17〉0.1, I2=31% 〈 50% ）, and the data was homogeneous and the fixed effect model was analyzed. The total of odd ratio was 5.44,95% CI [3.68,8.03] ,the test value for overall effect was 8.52 （P〈0.00001）. Differences were statistically significant. The confidence interval
出处
《中国中医急症》
2015年第12期2099-2102,共4页
Journal of Emergency in Traditional Chinese Medicine
基金
重庆市科委项目(NO.cstc2013jcyj A10006
cstc2013jcsf10012)
重庆市卫计委项目(2012-01-06
2012-01-16)
北京中医药大学东直门医院管理集团项目(2013YLJT20)
关键词
骨关节炎
独活寄生汤
临床研究
META分析
Osteoarthritis （OA）
Clinical study
Meta-analysis
Duhuo Jisheng Decoction
