文献检索，用中文搜 PubMed

BACKGROUND

Gouty arthritis is a common metabolic disease caused by long-term purine metabolism and elevated serum uric acid. In recent years, the incidence of gouty arthritis has been increasing year by year. As an effective method for treating gouty arthritis, acupuncture combined with herbal medicine has been widely used in clinical practice. However, the evidence for the treatment needs to be evaluated through systematic review and meta-analysis. Methods. The Cochrane Library, PubMed, Web of Science, EMBASE, China CBM database, Clinical Trials, CNKI, China Wanfang database, and VIP information database were searched from the establishment of each database to March 2021. Randomized controlled trials (RCTs) were included in the study, and the therapeutic effects of acupuncture combined with herbal medicine conventional therapy, or acupuncture combined with herbal medicine anti-inflammatory drugs, or acupuncture combined with herbal medicine acupuncture/herbal medicine alone were compared in the subjects with gouty arthritis. Two authors screened all references, assessed the risk of bias, and independently extracted the data. The binary outcome was summarized using 95% confidence intervals (CIs) and risk ratios (RRs). The overall quality of the evidence was assessed with hierarchy, and meta-analysis was performed with a random-effects model.

RESULTS

A total of 14 randomized controlled trials (1,065 participants, 540 treatment groups, and 525 control groups) with treatment courses of 5 to 21 days were included. Acupuncture combined with herbal medicine and acupuncture was compared in three trials, acupuncture combined with herbal medicine and conventional therapy was compared in 14 of them, and acupuncture combined with herbal medicine and anti-inflammatory drugs was compared in 8 of them. The clinical efficacy (clinical symptoms, serological tests, and visual analogue scale (VAS) results) was significantly improved in the acupuncture combined with herbal medicine treatment group (=0.0005, 95% CI 0.03 to 0.13; 687 participants; 8 trials), and the efficacy in reducing uric acid was also better ( < 0.00001; 95% CI -102.89, -68.37; 100 participants; 2 trials; evidence with moderate quality). The effect of acupuncture combined with herbal medicine was better than that of acupuncture alone (RR 1.22, 95%CI 1.06 to 1.41; 139 participants; 3 trials), the effect of acupuncture combined with herbal medicine was better than that of herbal medicine alone (RR 1.31 95%CI 1.08 to 1.57, 100 participants, 2 trials, evidence with moderate quality), and the effect of acupuncture combined with herbal medicine was better than that of colchicine ( = 0.02, RR 1.14 95%CI 1.02 to 1.27, 2 trials, evidence with moderate quality). The incidence of adverse events was considerably different between the two groups, and the acupuncture combined with herbal medicine group was significantly superior to the control group in terms of adverse events ( < 0.00001; 95% CI (0.08 to 0.32)).

CONCLUSIONS

The efficacy of acupuncture combined with herbal medicine was better than conventional drug therapy in treating gouty arthritis. The study results must be interpreted with caution due to the high or unclear risk of bias of the trials included in the study. PROSPERO registration number: CRD42020202544. INPLASY registration number: 202090006.

BACKGROUND

RESULTS

CONCLUSIONS

背景

痛风性关节炎是一种由长期嘌呤代谢紊乱和血清尿酸升高引起的常见代谢性疾病。近年来，痛风性关节炎的发病率逐年上升。针灸联合中药作为治疗痛风性关节炎的一种有效方法，已在临床实践中广泛应用。然而，其治疗证据需要通过系统评价和荟萃分析进行评估。方法：检索Cochrane图书馆、PubMed、Web of Science、EMBASE、中国生物医学文献数据库、Clinical Trials、中国知网、中国万方数据库和维普资讯数据库，检索时间从各数据库建库至2021年3月。纳入研究的为随机对照试验（RCT），比较针灸联合中药与传统疗法、或针灸联合中药与抗炎药、或针灸联合中药与单纯针灸/中药治疗痛风性关节炎患者的疗效。两名作者筛选所有参考文献，评估偏倚风险，并独立提取数据。二分类结局采用95%置信区间（CI）和风险比（RR）进行汇总。采用等级法评估证据的总体质量，并采用随机效应模型进行荟萃分析。

结果

共纳入14项随机对照试验（1065名参与者，540个治疗组和525个对照组），治疗疗程为5至21天。其中3项试验比较了针灸联合中药与单纯针灸，14项试验比较了针灸联合中药与传统疗法，8项试验比较了针灸联合中药与抗炎药。针灸联合中药治疗组的临床疗效（临床症状、血清学检查和视觉模拟量表（VAS）结果）显著改善（P = 0.0005，95%CI 0.03至0.13；687名参与者；8项试验），降低尿酸的疗效也更好（P < 0.00001；95%CI -102.89，-68.37；100名参与者；2项试验；中等质量证据）。针灸联合中药的效果优于单纯针灸（RR 1.22，95%CI 1.06至1.41；139名参与者；3项试验），针灸联合中药的效果优于单纯中药（RR 1.31，95%CI 1.08至1.57，100名参与者，2项试验，中等质量证据），针灸联合中药的效果优于秋水仙碱（P = 0.02，RR 1.14，95%CI 1.02至1.27，2项试验，中等质量证据）。两组不良事件发生率差异显著，针灸联合中药组在不良事件方面显著优于对照组（P < 0.00001；95%CI（0.08至0.32））。