Choi Tae-Young, Lee Myeong Soo, Kim Jong In, Zaslawski Christopher
Clinical Research Division, Korea Institute of Oriental Medicine, Daejeon 34054, Republic of Korea.
Clinical Research Division, Korea Institute of Oriental Medicine, Daejeon 34054, Republic of Korea.
Maturitas. 2017 Jun;100:33-48. doi: 10.1016/j.maturitas.2017.03.314. Epub 2017 Mar 21.
The aim of this study was to update previous reviews and examine recent evidence from randomised clinical trials (RCTs) of the use of moxibustion for osteoarthritis (OA). Twelve databases were searched from inception through to September 2016 with no language limits applied. Data extraction and risk-of-bias assessments were performed by two independent reviewers. A total of 19 RCTs met all inclusion criteria and were evaluated. Three RCTs compared the effects of moxibustion with those of sham moxibustion in patients with knee OA (KOA) and found favourable effects of moxibustion on pain reduction (n=305; SMD, -0.46; 95% CI: -0.86 to -0.06, P=0.02, I=65%), including at follow-up (n=305; SMD, -0.36; 95% CI: -0.70 to -0.01, P=0.04, I=54%). Eleven RCTs compared the effects of moxibustion with those of conventional oral drug therapies. Eight RCTs reported a total symptom score and the meta-analysis showed superior effects of moxibustion compared with drug therapies for this measure (n=691; SMD, -0.24; 95% CI: -0.78 to 0.29; P=0.37, I=91%) and response rate (n=758 knees; RR, 1.10; 95% CI: 1.05-1.16, P <0.0001, I=0%). Three RCTs found superior or equivalent effects of moxibustion on symptom score compared with intra-articular injection or topical drug therapy. The existing trial evidence is sufficiently convincing to suggest that moxibustion, compared with sham moxibustion and oral drugs, is effective for pain reduction and symptom management in KOA. The level of evidence is moderate, given the high risk of bias and small sample size.
本研究的目的是更新以往的综述，并审视艾灸用于骨关节炎（OA）的随机临床试验（RCT）的最新证据。检索了12个数据库，涵盖从建库至2016年9月的数据，且未设语言限制。由两名独立审阅者进行数据提取和偏倚风险评估。共有19项RCT符合所有纳入标准并接受评估。三项RCT比较了艾灸与假艾灸对膝骨关节炎（KOA）患者的疗效，发现艾灸在减轻疼痛方面有良好效果（n = 305；标准化均数差，-0.46；95%置信区间：-0.86至-0.06，P = 0.02，I² = 65%），随访时亦是如此（n = 305；标准化均数差，-0.36；95%置信区间：-0.70至-0.01，P = 0.04，I² = 54%）。十一项RCT比较了艾灸与传统口服药物疗法的疗效。八项RCT报告了总症状评分，荟萃分析显示，就该指标而言，艾灸的效果优于药物疗法（n = 691；标准化均数差，-0.24；95%置信区间：-0.78至0.29；P = 0.37，I² = 91%），在缓解率方面亦是如此（n = 758膝；风险比，1.10；95%置信区间：1.05 - 1.16，P < 0.0001，I² = 0%）。三项RCT发现，与关节腔内注射或局部药物治疗相比，艾灸在症状评分方面有更好或相当的效果。现有试验证据足以令人信服地表明，与假艾灸和口服药物相比，艾灸对减轻KOA患者的疼痛和症状管理有效。鉴于偏倚风险高且样本量小，证据水平为中等。
