Clinical College of Traditional Chinese Medicine, Hubei University of Chinese Medicine, Wuhan, China.
Ann Palliat Med. 2021 Nov;10(11):11430-11444. doi: 10.21037/apm-21-2565.
Many studies have demonstrated that acupuncture combined with Chinese herbal medicine (CHM) effectively treats knee osteoarthritis (KOA), with few side effects. However, few systematic reviews have offered evidence-based support. Here we conducted a meta-analysis on the combination of acupuncture with CHM in treating KOA.
Databases including CNKI, Wanfang, VIP, PubMed, EMBASE, and Cochrane library were systematically searched for articles on the treatment of KOA by acupuncture combined with CHM from the establishment of the database to May 2021. Three researchers independently searched, screened, extracted, and included articles that met the inclusion standards. The primary outcome measure was overall response rate (ORR), and the secondary outcome measures included Visual Analogue Scale (VAS) score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, and Lysholm score. ORR was a binary variable, while other indicators were continuous variables. The quality of literature was assessed with a modified Jadad scale. The RevMan 5.3 software provided by the Cochrane Collaboration was used for statistical analysis.
Thirty-three randomized controlled trials involving 3,954 patients were included. Meta-analysis showed that ORR [odds ratio (OR) =5.41; 95% confidence interval (CI): (4.38, 6.68); P<0.00001], VAS score [mean difference (MD) =-1.86; 95% CI: (-2.44, -1.29); P<0.00001], WOMAC score [MD =-13.05; 95% CI: (-21.70, -4.41); P=0.003], and Lysholm score [MD =10.47; 95% CI: (5.21, 15.72); P<0.0001] in the combination group were significantly superior to those in the control group.
Compared with acupuncture alone or CHM/Western drug alone, acupuncture combined with CHM can effectively alleviate knee pain, improve knee function, and increase the quality of life. Thus, this combination can be used as a conservative treatment for KOA. However, due to the small number of high-quality articles and possible biases in our analysis, our conclusions need to be further verified in more and higher-quality studies.
许多研究表明，针灸结合中药（CHM）治疗膝骨关节炎（KOA）有效，副作用少。然而，很少有系统评价提供循证支持。在这里，我们对针灸结合 CHM 治疗 KOA 进行了荟萃分析。
系统检索中国知网、万方、VIP、PubMed、EMBASE 和 Cochrane 图书馆等数据库，从数据库建立到 2021 年 5 月，检索针灸结合 CHM 治疗 KOA 的文献。由 3 名研究人员独立搜索、筛选、提取和纳入符合纳入标准的文献。主要结局指标为总有效率（ORR），次要结局指标包括视觉模拟评分（VAS）评分、西安大略和麦克马斯特大学骨关节炎指数（WOMAC）评分和 Lysholm 评分。ORR 为二分类变量，其他指标为连续变量。采用改良 Jadad 量表评估文献质量。使用 Cochrane 协作网提供的 RevMan 5.3 软件进行统计分析。
共纳入 33 项随机对照试验，涉及 3954 例患者。Meta 分析显示，ORR [比值比（OR）=5.41；95%置信区间（CI）：（4.38，6.68）；P<0.00001]、VAS 评分[均数差（MD）=-1.86；95%CI：（-2.44，-1.29）；P<0.00001]、WOMAC 评分[MD=-13.05；95%CI：（-21.70，-4.41）；P=0.003]和 Lysholm 评分[MD=10.47；95%CI：（5.21，15.72）；P<0.0001]在联合组明显优于对照组。
与单纯针灸或 CHM/西药相比，针灸结合 CHM 能有效缓解膝关节疼痛，改善膝关节功能，提高生活质量。因此，这种联合治疗可作为 KOA 的保守治疗方法。然而，由于高质量文章数量较少，以及我们分析中可能存在偏倚，我们的结论需要在更多、更高质量的研究中进一步验证。
