Are Kidney-Tonifying and Blood-Activating Medicinal Herbs Better than NSAIDs for Knee Osteoarthritis? A Systematic Review and Meta-Analysis
Are Kidney-Tonifying and Blood-Activating Medicinal Herbs Better than NSAIDs for Knee Osteoarthritis? A Systematic Review and Meta-Analysis
复制标题
补肾活血中药治疗膝骨关节炎比非甾体抗炎药更好吗？
DOI：
10.1155/2019/9094515
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发表时间：
2019-11-25
影响因子：
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通讯作者：
Liu, Jun
中科院分区：
文献类型：
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作者：
Huang, Hetao;Pan, Jianke;Liu, Jun
目的比较补肾活血中药与非甾体类抗炎药治疗膝骨关节炎的疗效和安全性。方法检索比较KTBAM与NSAIDs治疗KOA疗效的随机对照试验（RCT）。主要结局包括功能结局、疼痛和不良反应的评价。使用科克伦偏倚风险（ROB）工具评估方法学质量。结果共纳入38项随机对照试验（3994例受试者）。结果表明，抗肿瘤药的总有效率（P < 0.00001，RR = 1.08，CI = 1.05 ~ 1.11，I2 = 4%）明显高于非甾体类抗炎药（P < 0.00001，RR = 0.36，CI = 0.24 ~ 0.53，I2 = 33%），而胃肠道不良反应发生率明显低于非甾体类抗炎药（P < 0.00001，RR = 0.36，CI = 0.24 ~ 0.53，I2 = 33%）。KTBAM显示膝关节学会量表（KSS）评分改善更大（平均差异（MD）= 7.17，95% CI 0.71 - 13.64，P=0.03）。关于视觉模拟量表（VAS）评分、WOMAC评分和Lequence评分，KTBAM组和NSAID组之间无显著差异。本次系统评价的GRADE质量等级表明，极低质量证据表明KTBAM的总有效率较高，而中等质量证据表明KTBAM的不良反应较低，KSS评分较高。低质量证据显示VAS评分、WOMAC评分或Lequence评分的改善无显著差异。结论KTBAM在总有效率、不良反应发生率及KSS评分方面均优于NSAIDs，具有上级优势。KTBAM和NSAID在改善KOA患者的VAS评分、WOMAC评分和Lequence评分方面无显著差异。因此，KTBAMs可能是治疗KOA的一种替代有效方法。然而，仍需要高质量、设计良好、长期随访的随机对照试验。
Objective To compare the efficacy and safety of kidney-tonifying and blood-activating medicinal herbs (KTBAMs) and nonsteroidal anti-inflammatory drugs (NSAIDs) in the treatment of knee osteoarthritis (KOA). Methods Randomized controlled trials (RCTs) from online databases that compared the efficacy of KTBAMs and NSAIDs in the treatment of KOA were retrieved. The main outcomes included the evaluation of functional outcomes, pain, and adverse effects. The Cochrane risk-of-bias (ROB) tool was used to assess methodological quality. Results A total of 38 RCTs (3994 participants) were included in our meta-analysis. We found that KTBAMs had a significantly higher total effective rate (P < 0.00001, risk ratio (RR) = 1.08, confidence interval (CI) = 1.05 to 1.11, I2 = 4%) and a lower gastrointestinal adverse reaction rate (P < 0.00001, RR = 0.36, CI = 0.24 to 0.53, I2 = 33%) than NSAIDs. KTBAMs showed greater improvements in the Knee Society Scale (KSS) scores (mean difference (MD) = 7.17, 95% CI 0.71 to 13.64, P=0.03). Regarding the visual analog scale (VAS) scores, WOMAC scores, and Lequence scores, there were no significant differences between the KTBAM group and the NSAID group. The GRADE quality level of this systematic review indicated that the very low-quality evidence showed that KTBAMs had a higher total effective rate, while the moderate-quality evidence showed that the adverse reactions of KTBAMs were lower and the KSS scores were higher. Low-quality evidence showed no significant differences in improving VAS scores, WOMAC scores, or Lequence scores. Conclusion KTBAMs were superior to NSAIDs in terms of a higher total effective rate, a lower adverse reaction rate, and a higher KSS score. There were no significant differences between KTBAMs and NSAIDs in improving VAS scores, WOMAC scores, and Lequence scores of patients with KOA. Therefore, KTBAMs may be an alternative effective method for treating KOA. However, high-quality, well-designed RCTs with long-term follow-up are still required.