摘要
目的 ：通过Meta分析和序贯分析（TSA）系统评价运动疗法对国内膝骨关节炎患者（KOA）的干预效果。方法 ：计算机检索中国期刊全文数据库（CNKI）、维普数据库（VIP）、万方数据库和中国生物医学文摘数据库（CBM）中,纳入运动疗法治疗国内膝骨关节炎患者且Jadad评分≥2个的随机对照试验（RCT）,2名研究者独立严格进行纳入研究的质量评价和资料提取,采用Rev Man5.3软件对患者进行Meta分析,采用TSA v 0.9软件进行TSA分析。结果 ：最终纳入17篇RCT,共1407例患者。Meta分析结果显示：与对照组相比,运动治疗组患者总有效率明显提高（RR=1.15,95%CI：1.04~1.27,P=0.006）,且TSA结果显示累计Z值穿过了传统界值和TSA界值,进一步肯定了Meta分析的结果 ;运动治疗组患者VAS评分低于对照组（MD=-0.91,95%CI：-1.38^-0.44,P=0.0001）,TSA结果显示样本量已经达到期望信息值（RIS）,但累计的Z值仅穿过传统界值,提示Meta分析为假阳性结果 ;运动治疗组LKSS评分明显增加（MD=15.30,95%CI：0.44~30.16,P〈0.05）,且TSA结果显示累计Z值穿过了传统界值和TSA界值,进一步肯定了Meta分析的结果 ;运动治疗组患者WOMAC评分明显低于对照组（MD=-5.47,95%CI：-7.42^-3.52,P〈0.00001）,HSS评分明显高于对照组（MD=7.85,95%CI：5.96~9.75,P〈0.00001）。亚组分析提示,在疗程不足1个月时,运动疗法仅在降低VAS评分上有统计学意义,而在疗程1个月以上时,运动疗法在提高总有效率和LKSS评分有统计学意义,但在降低VAS评分上没有统计学意义。结论 ：在提高国内KOA患者总有疗效和LKSS评分方面,运动疗法疗效肯定,但早期疗效不稳定;在降低国内患者VAS评分方面,运动疗法具有短期疗效,长期疗效不佳。
Objective ：To systematically review the efficacy of exercise therapy in knee osteoarthritis by using meta-analysis and trial sequential analysis（TSA）. Methods ：Such databases as CNKI,VIP database,Wan Fang data and CBM were searched in order to collect randomized clinical trials with jadad scores ≥ 2 points about the efficacy of exercise therapy for knee osteoarthritis. Two researchers independently screened literatures according to the inclusion and exclusion criteria,and evaluated the methodological quality of included studies. We carried out meta-analysis and TSA analysis by using Rev Man 5.3 version and TSA v 0.9 respectively. Results ：Totally 17 RCT including 1407 cases were included eventually. The analysis showed that exercise therapy was associated with increased total effective rate（RR=1.15,95%CI ：1.04~1.27,P=0.006）. And TSA indicated that cumulative Z-curve strode both the conventional threshold value and the TSA threshold value which suggested a positive result of metaanalysis. Exercise therapy had further decreased VAS scores（MD=-0.91,95%CI ：-1.38--0.44,P=0.0001）,however,TSA revealed that the cumulative Z-curve did not strode TSA threshold value until the included sample size was more than required information size which suggested that the reliability of the meta-analysis was a false positive result. Besides,the results of meta-analysis showed that exercise therapy had a higher LKSS scores（MD=15.30,95%CI ：0.44-30.16,P〈0.05）. And the result of meta-analysis was be validated because TSA indicated that the cumulative Z-curve strode both the conventional and TSA threshold value. What＇s more,exercise therapy was also associated with the decreased WOMAC scores（MD=-5.47,95%CI ：-7.42--3.52,P〈0.00001）and the increased HSS scores（MD=7.85,95%CI ：5.96-9.75,P〈0.00001）. And subgroup analysis suggested that exercise therapy was statistically significant only in reducing the VAS score in less than one months,whereas there was no statistically significant reduction in VAS score in more than 1 months,but it was statistically significant in improving overall response rates and LKSS scores. Conclusion ：Exercise therapy is superior in improving the overall response rates and LKSS scores among domestic KOA patients,but the early efficacy is of instability;and it has a short-term efficacy in reducing VAS scores whereas with poor long-term efficacy.
出处
《辽宁中医药大学学报》
CAS
2018年第1期178-183,共6页
Journal of Liaoning University of Traditional Chinese Medicine
基金
广东省自然科学基金项目(2015A030310203)
关键词
运动疗法
膝骨关节炎
META分析
序贯分析
exercise therapy
knee osteoarthritis
Meta-analysis
trial sequential analysis
