| 刘静,李伦兰,单文山,等.关节腔内注射透明质酸治疗膝骨关节炎康复效果的Meta分析[J].安徽医药,2018,22(7):1380-1387. |
| 关节腔内注射透明质酸治疗膝骨关节炎康复效果的Meta分析 |
| Intra-articular injection of hyaluronic acid in the treatment of knee osteoarthritis meta analysis of rehabilitation effect |
| 投稿时间：2017-03-27 |
| DOI： |
| 中文关键词: 骨关节炎, 膝 透明质酸 随机对照试验 Meta 分析 |
| 英文关键词: Osteoarthritis, knee Hyaluronic acid Randomized controlled trial Meta-analysis |
| 基金项目:安徽省自然科学基金项目(1508085MH183) |
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| 中文摘要: |
| 目的 评价关节腔内注射透明质酸对膝骨关节炎功能康复和生活质量效果,为临床应用提供指导依据。 方法 计算机检索中文数据库(CNKI、CBM 、维普和万方)和英文数据库(PubMed、Web of Science、Cochrane Library、SCIE、ScienceDirect、BP)中关于关节腔内注射透明质酸治疗膝骨关节炎的随机对照试验,检索年限均为2007年2月至2017年2月。由2名研究者按照纳入排除标准进行文献筛选、资料提取、质量评价,采用 RevMan 5.3软件进行Meta 分析,以WOMAC 6周疼痛指数、僵硬、日常生活能力为结局指标的漏斗图提示存在发表偏倚。结果 共纳入9篇文章,共有1404例患者,透明质酸组702例,盐水组702例。Meta分析的结果显示:透明质酸组与盐水组在WOMAC疼痛指数[6周:MD=-0.02,95%CI:(-0.62～0.59),P=0.95；12周:MD=-0.43,95%CI:(-1.17～0.31),P=0.25；24周:MD=3.15,95%CI:(-2.42～8.73),P=0.27]、WOMAC僵硬指数[6周:MD=0.05,95%CI:(-0.21～0.30),P=0.70；12周:MD= -0.11,95%CI:(-0.73～0.51),P=0.73；24周:MD=0.87,95%CI:(-0.16～1.90),P=0.10]、WOMAC日常生活自理指数[6周:MD=0.30,95%CI:(-0.82～1.41),P=0.60；12周:MD=0.41,95%CI:(-2.20～3.02),P=0.76]、50 m步行试验[6周:MD=1.16,95%CI:(-2.11～4.44),P=0.49；12周:MD=1.30,95%CI:(-1.85～4.45),P=0.42]、VAS[6周:MD=-0.09,95%CI:(-0.62～0.44),P=0.74；12周:MD=0.39,95%CI:(-0.43～1.21),P=0.35]中比较均差异无统计学意义,WOMAC改善日常生活自理能力优于盐水组[24周:MD=6.85,95%CI:(6.39～7.31),P<0.0001],有统计学意义。结论 关节腔内注射透明质酸对提高长期日常生活质量作用明显；然而缓解膝骨关节炎的疼痛、僵硬程度和提高中短期生活质量效果不明显,这可能与样本量大小以及随访时间的设置有一定联系,该结论尚需增大样本量和设置相同随访时间进行研究论证。 |
| 英文摘要: |
| Objective Literature of the hyaluronic acid in the treatment of knee were analyzed by Meta analysis to evaluation of intra-articular injection of hyaluronic acid on osteoarthritis of the knee joint functional recovery and quality of life, which provide guidance for clinical application. Methods The computer were taken to retrospective analyze Chinese database (CNKI, CBM, VIP and Wanfang ) and English database (PubMed, web of Science, Cochrane Library, SCIE, ScienceDirect, BP) of intra-articular injection of hyaluronic acid in the treatment of knee osteoarthritis with randomized controlled trial from February 2007 to February 2017. The literature analysis, data extraction and quality evaluation were carried out according to the inclusion exclusion criteria by 2 researchers, and the Meta analysis was performed by RevMan 5.3 software, Funnel plot of WOMAC 6 week pain index, stiffness, and daily living ability was used to indicate the presence of publication bias. Results Total of 9 articles were included in this study. There were a total of 1404 patients with hyaluronic acid in the treatment group (n=702) and saline group (n=702). The results of Meta analysis showed that the hyaluronic acid group and the saline group in WOMAC pain index [6 weeks:MD=-0.02,5% CI:(-0.62,0.59), P=0.95; 12 weeks:MD=-0.43,5 % CI:(-1.17,0.31), P=0.25; 24 weeks:MD=3.15,5%CI:(-2.42,8.73),P=0.27], WOMAC stiffness index [6 weeks:MD= 0.05,5 % CI:(-0.21,0.30),P=0.70; 12 weeks:MD= -0.11,5 % CI:(-0.73,0.51), P=0.73; 24 weeks:MD=0.87,95%CI:(-0.16,1.90),P=0.10] WOMAC daily life index [6 weeks:MD=0.30,95%CI:(-0.82,1.41),P=0.60; 12 weeks:MD=0.41,95%CI:(-2.20,3.02),P=0.76 ];50m walking test [6 weeks :MD=1.16,95 % CI:(-2.11,4.44),P=0.49]; 12 weeks:MD=1.30,95%CI:(-1.85,4.45), P=0.42; VAS [6 weeks:MD=-0.09,5 %CI:(-0.62,0.44), P= 0.74; 12 weeks:MD=0.39,5%CI:(-0.43,1.21),P=0.35] in comparison; There were no significant differences.WOMAC self-care ability of daily life compared with the saline group had improved [24 weeks:MD=6.85,5 % CI:(6.39,7.31), P< 0.0001]. Conclusion The effect of intra-articular injection of hyaluronic acid on the improvement of the quality of life in the long term is obvious, with no obvious effect on relieving pain, stiffness and improving the quality of life. It may have certain connection with sample amount and the follow-up time setted, which need further study. |
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