针灸治疗类风湿关节炎随机对照临床研究Meta分析

摘要

目的：系统评价针灸治疗类风湿关节炎(RA)的有效性和安全性。方法计算机检索中国期刊全文数据库(CNKI)、中文科技期刊数据库(VIP)、中国学术期刊数据库(万方数据)、中国生物医学文献数据库(CBM)、Embase、PubMed数据库,选择针灸治疗与常规药物治疗的临床随机对照试验文献进行Meta分析。结果纳入24篇文献,共计2006例患者。Meta 分析显示：针灸治疗与常规药物治疗总有效率比较,差异有统计学意义[OR＝2.73,95%CI(2.18,3.41),Z＝8.78,P＜0.00001]。亚组分析显示：针灸与药物疗法在降低类风湿因子(RF)水平方面比较,差异有统计学意义[MD＝-2.92,95%CI(-5.60,-0.25),P＜0.05]；针灸与药物疗法在降低红细胞沉降率(ESR)水平方面比较,差异有统计学意义[MD＝-2.99,95%CI(-4.78,-1.21),P＜0.05]；针灸与药物疗法在降低C反应蛋白(CRP)水平方面比较,差异有统计学意义[MD＝-1.44,95%CI(-2.44,-0.44),P＜0.05]。结论针灸治疗RA在总有效率及降低RF、ESR、CRP水平方面明显优于常规药物疗法,但仍需通过大样本、多中心、高质量的临床随机对照试验来验证。%Objective To systematically assess the effectiveness and safety of acupuncture and moxibustion for treatment of rheumatoid arthritis. Methods Articles were searched from databases, i.e., CNKI, VIP, WanFang Data, CBM, Embase, and PubMed. Articles about RCT on acupuncture and moxibustion for rheumatoid arthritis and traditional medicine therapy were under meta-analysis. Results Totally 24 articles involving 2006 patients were included. The results of meta-analysis indicated that the overall effective rate of treatment in the group receiving acupuncture and moxibustion was higher than that in the drug group, with statistical significance [OR=2.73, 95%CI (2.18, 3.41), Z=8.78, P<0.000 01]. Sub-group analysis showed that:acupuncture and moxibustion showed statistical significance in decreasing serum RF levels compared with drug therapy [MD=-2.92, 95%CI (-5.60, -0.25), P<0.05]. Acupuncture and moxibustion showed statistical significance in decreasing serum ESR levels compared with drug therapy [MD=-2.99, 95%CI (-4.78, -1.21), P<0.05]. Acupuncture and moxibustion showed statistical significance in decreasing serum CPR levels compared with drug therapy [MD=-1.44, 95%CI (-2.44, -0.44), P <0.05]. Conclusion The overall effective rates of acupuncture and moxibustion for rheumatoid arthritis and the decreasing levels of RF, ESR, CRP are superior to drug therapy, but it still needs larger samples, multi-center, and high quality RCT to verify.