[1]唐萌芽,翁祝承,邵利芳.中药治疗膝骨关节炎临床疗效和安全性的系统评价[J].中医正骨,2014,26(01):43-48.
　Tang Mengya*,Weng Zhucheng,Shao Lifang..Systematic review on the clinical curative effects and safety of traditional chinese medicine in the treatment of knee osteoarthritis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2014,26(01):43-48.
点击复制

中药治疗膝骨关节炎临床疗效和安全性的系统评价()
分享到：

《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第26卷
期数:
2014年01期
页码:
43-48
栏目:
骨关节炎
出版日期:
2014-01-28

文章信息/Info

Title:
Systematic review on the clinical curative effects and safety of traditional chinese medicine in the treatment of knee osteoarthritis
作者:
唐萌芽; 翁祝承; 邵利芳
浙江省富阳市中医骨伤医院,浙江 富阳 311400
Author(s):
Tang Mengya*; Weng Zhucheng; Shao Lifang.
*Fuyang TCM Orthopedic-Traumatological Hospital,Fuyang 311400,Zhejiang,China
关键词:
骨关节炎; 膝 中草药 消炎药; 非甾类 Meta分析
Keywords:
Osteoarthritis; knee;  Drugs; Chinese herbal;  Anti-inflammatory agents; non-steroidal;  Meta-analysis
摘要:
目的:系统评价中药治疗膝骨关节炎的临床疗效和安全性。方法:运用计算机检索中国知网、万方数据库、维普数据库2000年1月至2012年9月收录的国内公开发表的中药治疗膝骨关节炎的临床研究文献,并进行Meta分析。结果:共检索出590篇相关文献,通过筛选最终有32篇文献纳入研究,涉及2 950例患者。纳入文献Jadad评分普遍不高,最高分为2分; 32篇文献均说明了基线资料具有可比性; 3篇文献采用随机数字表进行分组,3篇文献按就诊顺序随机分组,其余各篇随机方法未说明; 各篇均未描述随机分配方案的隐藏方法; 1篇文献采用单盲,1篇文献采用双盲,其余各篇均未描述盲法; 各篇均未描述病例失访或退出情况。对32篇文献进行合并分析显示,治疗组和对照组的有效率分别为64.01%和43.96%,治疗组的临床疗效优于对照组(Z=6.850,P=0.000),比数比=2.35,95%可信区间为1.84～3.01。20篇文献提及对用药安全性的观察,其中15篇文献记录了患者用药后不良反应发生情况。治疗组不良反应发生率低于对照组(Z=8.870,P=0.000),比数比=0.14,95%可信区间为0.09～0.21。纳入疗效分析的32篇文献及纳入安全性评价的15篇文献的漏斗图均呈倒漏斗形,图形两侧分布均匀,提示纳入文献发表性偏倚不明显。结论:中药治疗膝骨关节炎疗效优于非甾类消炎药,且不良反应较少。但由于纳入的文献在方法学上存在问题,Meta分析得出的结论有一定的局限性,中药治疗膝骨关节炎的疗效和安全性还需要大样本、多中心、随机双盲的临床对照试验来进一步验证。
Abstract:
Objective:To review systematically the clinical curative effects and safety of traditional chinese medicine in the treatment of knee osteoarthritis(KOA).Methods:All the clinical research articles about traditional Chinese medicine for KOA included from January 2000 to September 2012 were retrieved from China national knowledge internet,Wanfang Database and Vip Database through computer,and then a meta-analysis was conducted.Results:Search terms yielded 590 articles and 32 articles(2 950 patients)were included in the final analysis.The Jadad scores of included articles were not high in general,and the highest score was two points.Comparable baseline data were demonstrated in all of the 32 articles.The random digits table was used for grouping in three articles,and randomization was performed according to the visit sequence in 3 articles,and the method of randomization was not mentioned in the other article.The hiding method for randomization was not described in all of the articles.Single blind was used in one article,double-blind was used in another article,and the blind method were not mentioned in other articles.The cases lost to follow-up and the cases dropped out of the study were not described in each article.Data from 32 articles were pooled and analyzed,and the results showed that the effective rate of treatment group and control group were 64.01% and 43.96% respectively,and the treatment group surpassed the control group in clinical curative effect(Z=6.850,P=0.000; odd ratio,2.35; 95% Confidence Interval 1.84 to 3.01).Observations on the safety of medication were mentioned in 20 articles,15 of which recorded the adverse drug reaction.The incidence rate of adverse reaction of treatment group was lower than that of control group(Z=8.870,P=0.000; odd ratio 0.14; 95% Confidence Interval 0.09 to 0.21).Funnel plots were inverted and symmetrical in 32 articles which involved the curative effect analysis and in 15 articles which involved the safety evaluation,and it indicated that the publication bias was not obvious.Conclusion:The traditional chinese medicine surpassed the non-steroidal anti-inflammatory agents in the clinical curative effects and in the incidence rate of adverse reactions.However,the included articles have problems in the method of research,so the conclusion based on meta analysis is limited.The clinical curative effects and safety of traditional chinese medicine in the treatment of KOA need to be further verified by large sample,multicenter,randomized,controlled,double-blind trails.

参考文献/References:

[1] 刘献祥.中医药治疗膝骨性关节炎的研究现状[J].中医正骨,2012,24(1):3-7.
[2] 施桂英.关节炎概要[M].北京:中国医药科技出版社,2000:327.
[3] 郑广成,郑海伟,张国辉,等.玻璃酸钠关节腔注射配合小针刀松解治疗膝骨关节炎疗效观察[J].中医正骨,2012,24(1):15-17.
[4] Singh G.Recent considerations in nonsteroidal anti-inflammatory drug gastropathy[J].Am J Med,1998,105(1B):31S-38S.
[5] 中华医学会.临床诊疗指南:风湿病分册[M].北京:人民卫生出版社,2005:18.
[6] Jadad AR,Moore RA,Carroll D,et al.Assessing the quality of reports of randomized clinical trials:is blinding necessary?[J].Control Clin Trials,1996,17(1):1-12.
[7] 刘维,薛斌.痹祺胶囊治疗膝骨关节炎临床观察[J].辽宁中医杂志,2011,38(7):1254.
[8] 陆曙华.痹证胶囊治疗膝关节骨性关节炎104例观察[J].实用中医药杂志,2005,21(9):527.
[9] 李忠伟.补肾化瘀方治疗膝骨关节炎48例[J].陕西中医,2010,31(9):1161-1162.
[10] 陈远林,邱仁斌,沈瑞子,等.补肾活血法治疗膝骨关节49例临床观察[J].国际医药卫生导报,2005,11(14):114-115.
[11] 杨少锋.补肾活血法治疗膝关节骨性关节炎50例临床观察[J].中医药导报,2008,14(5):47-48.
[12] 黄海振,陈希,张志海.补肾活血方治疗膝骨关节炎35例[J].湖南中医杂志,2008,24(5):46-48.
[13] 李煜明.补肾活血健膝汤治疗膝骨性关节炎的临床观察[J].中国厂矿医学,2005,18(6):552.
[14] 李念虎.补肾活血中药治疗早中期膝骨性关节炎临床观察[J].中医正骨,2006,18(10):11-13.
[15] 文昌义.补肾温阳法治疗早中期膝关节骨性关节炎[J].光明中医,2010,25(7):1213-1214.
[16] 黄柏强.补肾壮骨方治疗膝骨性关节炎的临床观察[J].湖北中医杂志,2009,31(11):38-39.
[17] 陶娟.补益肝肾法治疗膝骨关节炎30例[J].四川中医,2007,25(1):80-81.
[18] 惠礽华,孟祥奇,姜宏.从痰湿瘀论治膝骨性关节炎的临床观察[J].中医正骨,2007,19(2):12-13.
[19] 甘小明.独活寄生汤加减治疗膝关节骨性关节炎60例[J].湖南中医杂志,2010,26(2):61-62.
[20] 郭会卿.附桂骨痛胶囊治疗膝关节骨性关节炎疗效观察[J].中成药,2007,29(2):173-174.
[21] 王新卫.骨质增生1号治疗膝骨性关节炎126例[J].陕西中医,2005,26(4):333-334.
[22] 陈一凡.活血通络方治疗膝骨性关节炎临床观察[J].内蒙古中医药,2004,23(4):3-4.
[23] 张长彪,关新红.活血通络丸治疗膝骨性关节炎66例[J].甘肃中医学院学报,2010,27(4):43-44.
[24] 孟博达.加味三痹汤治疗骨关节炎38例[J].陕西中医,2003,24(12):1069-1071.
[25] 谭本前,何晓华,凌云.加味四物汤治疗骨性关节炎的临床疗效观察[J].广东医学,2011,32(6):799-800.
[26] 章林.健步关节片治疗膝关节骨性关节炎30例小结[J].湖南中医药导报,2004,10(7):53-54.
[27] 刘亮.筋骨汤治疗膝骨性关节炎76例[J].福建中医药,2002,33(6):22.
[28] 毛国庆.筋骨痛消丸治疗膝关节骨性关节炎临床观察[J].辽宁中医药大学学报,2007,9(1):31-32.
[29] 应森林,孟静岩,李彦.宁骨1号治疗膝关节骨性关节炎的临床研究[J].天津中医药,2006,23(2):121-122.
[30] 陈本华.祛痹方治疗骨关节炎35例临床观察[J].福建中医药,2002,33(1):13-14.
[31] 党建军,刘敏,张久红.强筋健骨丸治疗骨关节炎60例[J].陕西中医,2003,24(9):801-802.
[32] 程国杰,吕发明,阿布都热合曼,等.柔筋补脾法治疗膝关节骨性关节炎临床研究[J].中医正骨,2005,17(10):25-26.
[33] 黄龙才.温阳通络方治疗膝关节骨性关节炎40例[J].湖南中医杂志,2011,27(3):80-81.
[34] 任敬丽,武洁,靳新立,等.宣痹健膝汤治疗增生性膝关节炎36例[J].光明中医,2010,25(1):54-55.
[35] 袁赟.益肾壮骨汤配合熏洗治疗膝关节骨性关节炎36例[J].湖南中医杂志,2010,26(2):65-66.
[36] 李国德.愈痹汤治疗膝关节骨性关节炎30例[J].湖南中医杂志,2010,26(4):50-51.
[37] 阚卫兵,姜玉祥.自拟补肾活血方治疗膝骨关节炎疗效观察[J].广西中医药,2006,29(5):18-19.
[38] 尹相锋,刘德玉.自拟活络汤治疗膝关节骨性关节炎43例[J].吉林中医药,2008,28(10):745-746.

相似文献/References:

[1]孟维娜,明立功,王新德,等.关节镜下清理联合腓骨近1/3段截骨治疗膝骨关节炎[J].中医正骨,2015,27(11):40.
[2]明立功,孟维娜,王新德,等.腓骨近端截骨治疗内侧间室膝骨关节炎的近期疗效观察[J].中医正骨,2015,27(10):25.
[3]张杰,王人彦,张玉柱.膝骨关节炎的治疗进展[J].中医正骨,2015,27(10):68.
[4]梁朝,蔡静怡,闫立,等.针刀疗法改善膝骨关节炎早期疼痛症状的疗效评价[J].中医正骨,2015,27(09):9.
　LIANG Zhao,CAI Jingyi,YAN Li,et al.Evaluation of the curative effect of needle-knife therapy for relieving knee pain in patients with early knee osteoarthritis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(01):9.
[5]王建武,党建军,李强,等.四联疗法治疗膝骨关节炎[J].中医正骨,2015,27(08):44.
[6]刘红娟,郭会利,郭树农.云克联合中药治疗膝骨关节炎的护理[J].中医正骨,2015,27(08):75.
[7]陈卫衡.探索建立系统的膝骨关节炎中医临床科研范式 和理论体系[J].中医正骨,2015,27(07):1.
[8]郑春松,叶蕻芝,李西海,等.透骨消痛胶囊中补肾柔肝药和活血祛风药治疗 骨关节炎作用方式的计算机模拟比较[J].中医正骨,2015,27(07):6.
　ZHENG Chunsong,YE Hongzhi,LI Xihai,et al.Comparison of the mode of action of Bushen Rougan(补肾柔肝)drugs versus Huoxue Qufeng(活血祛风)drugs contained in Tougu Xiaotong Jiaonang(透骨消痛胶囊)for the treatment of osteoarthritis:A computer simulation study[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(01):6.
[9]帅波,沈霖,杨艳萍,等.加味青娥丸治疗膝骨关节炎的作用机制研究[J].中医正骨,2015,27(07):15.
　SHUAI Bo,SHEN Lin,YANG Yanping,et al.Study on the mechanism of action of Jiawei Qing'e Wan(加味青娥丸)for the treatment of knee osteoarthritis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(01):15.
[10]梅其杰,袁长深,段戡,等.壮药骨痹方烫熨联合运动疗法治疗膝骨关节炎的临床研究[J].中医正骨,2015,27(07):27.
　MEI Qijie,YUAN Changshen,DUAN Kan,et al.Clinical study of the curative effect of hot compressing and rubbing with packet of Gubi Fang(骨痹方)combined with exercise therapy in the treatment of knee osteoarthritis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(01):27.

更新日期/Last Update: 2014-01-20