Witt C, Brinkhaus B, Jena S, Linde K, Streng A, Wagenpfeil S, Hummelsberger J, Walther H U, Melchart D, Willich S N
Institute of Social Medicine, Epidemiology, and Health Economics, Charité University Medical Centre, Berlin, Germany.
Lancet. 2005;366(9480):136-43. doi: 10.1016/S0140-6736(05)66871-7.
Acupuncture is widely used by patients with chronic pain although there is little evidence of its effectiveness. We investigated the efficacy of acupuncture compared with minimal acupuncture and with no acupuncture in patients with osteoarthritis of the knee.
Patients with chronic osteoarthritis of the knee (Kellgren grade < or =2) were randomly assigned to acupuncture (n=150), minimal acupuncture (superficial needling at non-acupuncture points; n=76), or a waiting list control (n=74). Specialised physicians, in 28 outpatient centres, administered acupuncture and minimal acupuncture in 12 sessions over 8 weeks. Patients completed standard questionnaires at baseline and after 8 weeks, 26 weeks, and 52 weeks. The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index at the end of week 8 (adjusted for baseline score). All main analyses were by intention to treat.
294 patients were enrolled from March 6, 2002, to January 17, 2003; eight patients were lost to follow-up after randomisation, but were included in the final analysis. The mean baseline-adjusted WOMAC index at week 8 was 26.9 (SE 1.4) in the acupuncture group, 35.8 (1.9) in the minimal acupuncture group, and 49.6 (2.0) in the waiting list group (treatment difference acupuncture vs minimal acupuncture -8.8, [95% CI -13.5 to -4.2], p=0.0002; acupuncture vs waiting list -22.7 [-27.5 to -17.9], p<0.0001). After 52 weeks the difference between the acupuncture and minimal acupuncture groups was no longer significant (p=0.08).
After 8 weeks of treatment, pain and joint function are improved more with acupuncture than with minimal acupuncture or no acupuncture in patients with osteoarthritis of the knee. However, this benefit decreases over time.
尽管几乎没有证据表明针灸有效，但慢性疼痛患者广泛使用针灸疗法。我们研究了针灸与微针刺法以及不进行针刺治疗相比，对膝骨关节炎患者的疗效。
慢性膝骨关节炎（凯尔格伦分级≤2级）患者被随机分配至针灸组（n = 150）、微针刺法组（在非穴位进行浅刺；n = 76）或等待名单对照组（n = 74）。28个门诊中心的专科医生在8周内分12次进行针灸和微针刺法治疗。患者在基线时以及8周、26周和52周后完成标准问卷。主要结局指标为第8周结束时的西安大略和麦克马斯特大学骨关节炎指数（WOMAC）（根据基线评分进行调整）。所有主要分析均采用意向性分析。
2002年3月6日至2003年1月17日共纳入294例患者；8例患者随机分组后失访，但纳入最终分析。第8周时，针灸组经基线调整后的WOMAC指数均值为26.9（标准误1.4），微针刺法组为35.8（1.9），等待名单组为49.6（2.0）（针灸组与微针刺法组的治疗差异为 -8.8，[95%置信区间 -13.5至 -4.2]，p = 0.0002；针灸组与等待名单组为 -22.7 [-27.5至 -17.9]，p < 0.0001）。52周后，针灸组与微针刺法组之间的差异不再显著（p = 0.08）。
治疗8周后，对于膝骨关节炎患者，针灸在改善疼痛和关节功能方面比微针刺法或不进行针刺治疗更有效。然而，这种益处会随着时间推移而降低。
