Traditional Chinese Medications for Knee Osteoarthritis Pain: A Meta-Analysis of Randomized Controlled Trials.
Traditional Chinese Medications for Knee Osteoarthritis Pain: A Meta-Analysis of Randomized Controlled Trials.
复制标题
DOI：
10.1142/s0192415x16500373
复制
发表时间：
2016
期刊：
影响因子：
--
通讯作者：
Wang C
中科院分区：
文献类型：
--
作者：
Chen B;Zhan H;Marszalek J;Chung M;Lin X;Zhang M;Pang J;Wang C
中药对膝骨关节炎具有镇痛、抗炎作用。我们对目前最好的定量和定性证据进行了首次系统评价，以评估中医药缓解膝关节OA疼痛的有效性。使用3个英文和4个中文生物医学数据库进行了一次全面的文献检索，检索时间为2015年3月1日。我们纳入了中医药治疗膝关节骨性关节炎的随机对照试验，干预持续时间至少为两周。采用视觉模拟评分法（VAS）、西安大略大学和麦克马斯特大学骨关节炎指数（WOMAC）评价中药对疼痛及其他临床症状的影响。还测量了用于评估整体疼痛、身体表现和健康的总有效率。两名研究人员独立提取了研究设计、人群特征、持续时间、干预、结局、偏倚风险和主要结果的数据。我们在适当的时候进行了随机效应荟萃分析。我们还探讨了因素，可以解释异质性进行亚组和荟萃回归分析。23项研究（共计2362例受试者）符合合格性标准。根据中医辨证论治方法，平均用8味中药进行治疗。平均治疗持续时间为7周，每天口服1 - 3次。与非甾体抗炎药和关节内注射透明质酸盐相比，18项研究显示VAS疼痛评分显著改善（平均差异[MD]= 0.56; 95%置信区间[CI]，0.18 - 0.94; p = 0.004），6项研究显示WOMAC疼痛子量表评分显著改善（MD = 2.23; 95%CI，0.56至3.91; p = 0.009），16项试验显示总有效率显著提高（风险比= 1.12; 95%CI，1.05至1.19; p = 0.0003）。此外，中医显示出比标准西方治疗更低的不良事件风险。这一证据表明，中医药在治疗膝关节骨性关节炎中对改善疼痛、功能和健康是安全有效的。然而，在纳入的试验中存在固有的临床异质性（不同的中药配方，对照和治疗方案）。尽管存在这些局限性，但中医药的潜在镇痛作用需要进一步的方法学上严格的研究，以确定中医药对膝关节OA疼痛管理的临床意义。
Traditional Chinese medication (TCM) has analgesic and anti-inflammatory effects in patients with knee osteoarthritis (OA). We conducted the first systematic review of the best quantitative and qualitative evidence currently available in order to evaluate the effectiveness of TCM in relieving pain in knee OA. A comprehensive literature search was conducted using three English and four Chinese biomedical databases from their inception through March 1, 2015. We included randomized controlled trials of TCM for knee OA with intervention durations of at least two weeks. The effects of TCM on pain and other clinical symptoms were measured with the visual analog scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). The total effectiveness rate, which was used to assess overall pain, physical performance and wellness, was also measured. Two researchers independently extracted data on study design, population characteristics, duration, intervention, outcomes, risk of bias, and primary results. We performed a random-effects meta-analysis when appropriate. We also explored factors that could explain the heterogeneity by conducting subgroup and meta-regression analyses. Twenty-three studies, totaling 2362 subjects, met the eligibility criteria. Treatments were formulated with an average of 8 Chinese herbs and were prescribed based on the traditional Chinese diagnostic method of syndrome differentiation. The mean treatment duration was seven weeks, with oral administration occurring one to three times a day. Compared with non-steroidal anti-inflammatory drugs and intra-articular hyaluronate injections, 18 of the studies showed significantly improved VAS pain scores (Mean Difference [MD] = 0.56; 95% confidence interval [CI], 0.18 to 0.94; p = 0.004), six of the studies showed significantly improved WOMAC pain subscale scores (MD = 2.23; 95% CI, 0.56 to 3.91; p = 0.009), and 16 of the trials showed significantly improved total effectiveness rates (risk ratio = 1.12; 95% CI, 1.05 to 1.19; p = 0.0003). In addition, TCM showed a lower risk of adverse events than standard western treatments. This evidence suggests that TCM is safe and effective for improving pain, function, and wellness in treatments of knee OA. However, there is inherent clinical heterogeneity (diverse TCM formulations, controls, and treatment regimens) among the included trials. Despite these limitations, the potential analgesic effects of TCM warrant further methodologically rigorous research to determine the clinical implications of TCM on pain management in knee OA.