| Objective: To systematically evaluate the clinical efficacy of thunderfire moxibustion in the treatment of knee osteoarthritis,to carry out Meta analysis and trial sequential analysis of the clinical trial of thunderfire moxibustion in the treatment of knee osteoarthritis,and to provide more data support and evidence-based medical basis for the treatment KOA of thunderfire moxibustion.Methods: To develop the corresponding document retrieval strategy,searched database of CNKI,WF,CSTJ,Pub Med,Embase and Cochrane Library about clinical trial literature on the treatment of knee osteoarthritis with thunderfire moxibustion.Search time for each database from the establishment of the database to December 31,2020.After the application of End Note X7 software to exclude repeated documents,according to the inclusion criteria and exclusion criteria designed in this study,qualified documents were selected by reading abstracts or browsing the full text.Established Microsoft Excel 2007 forms to input relevant information into the literature.The quality of the literature was evaluated by the bias risk assessment table by the Cochrane collaboration network provided and the Jadad scale.The Meta analysis of the included research was carried out by Review Manager 5.3 software and TSA v0.9software,and the appropriate outcome index was analyzed sequentially.Using GRADE profiler 3.6.1 software,all outcome indicators were classified GRADE evidence quality.The main evaluation indexes included total effective rate,cure rate,VAS score,WOMAC score,Lequesne index score,Lysholm score,HSS score,C-reactive protein,erythrocyte sedimentation rate and adverse reaction rate.The measurement data was expressed as Mean Deviation or Standardized Mean Deviation,and the enumeration data was expressed as Relative Ratio.Results: A total of 17 RCT studies were included,published from2009 to 2020.A total of 1601 subjects were studied,including 807 subjects in thunderfire moxibustion group and 794 subjects in non-thunderfire moxibustion group.The results showed that the overall therapeutic efficiency of the intervention KOA of thunderfire moxibustion group was better than that of the non-thunderfire moxibustion group[RR=1.19,95 % CI(1.14,1.25),Z=7.17,P < 0.000,01].The clinical cure rate of the intervention KOA of thunderfire moxibustion group was higher than that of non-thunderfire moxibustion group[RR=2.02,95%CI(1.51,2.69),Z=4.77,P<0.000,01].The VAS score of thunder fire moxibustion group was lower than that of non-fire moxibustion group[SMD=-1.52,95 % CI(-2.08,-0.96),Z=5.34,P <0.000,01].Thunderfire moxibustion group can reduce the WOAMC score,the curative effect is similar to that of non-thunderfire moxibustion group[MD=-5.04,95 % CI(-10.51,0.42),Z=1.81,P=0.07].Thunderfire moxibustion group can reduce Lequesne index score,its efficiency is higher than that of non-thunderfire moxibustion group[MD=-3.81,95 %CI(-5.59,-2.04),Z=4.21,P < 0.000,1].C-reactive protein level of patients with thunderfire moxibustion group was lower than that of non-thunderfire moxibustion group[MD=-2.02,95 %CI(-2.95,-1.09),Z=4.25,P < 0.000,1].Thunderfire moxibustion group can reduce the rate of erythrocyte sedimentation rate in KOA patients.Two groups have a comparable effect[MD=-1.29,95 %CI(-3.62,1.04),Z=1.08,P=0.28].The incidence of adverse reactions was lower in the thunderfire moxibustion group than in the non-thunderfire moxibustion group[RR=0.22,95%CI(0.06,0.82),Z=2.26,P=0.02].The trial sequential analysis indicated that the cumulative Z value of the total effective rate and the VAS score pass through the traditional and TSA bounds,and the results were reliable.Conclusion: Based on the results of this analysis,the short-term curative effect of thunder fire moxibustion in the treatment of knee osteoarthritis was accurate,which can relieve pain symptoms,improve joint function,improve joint activity,and effectively regulate the release level of inflammatory markers.There was a positive effect on the affected joints.In view of the low overall quality of this analysis,high quality clinical trials are still needed to verify the results of this study. |
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