| Objective: To evaluate the curative effect of oral Chinese medicine on knee osteoarthritis with deficiency of liver and kidney.Methods:Type in retrieval type computer retrieval database both at home and abroad,and set up the retrieval time for January 1,2012 to January31,2022,included in the search results,according to the standard screen out suitable literature into and out of a randomized controlled clinical research,sorting into the baseline data,diagnostic criteria,intervention,outcome indicators such as information,for quality evaluation into the literature research.Revman5.4 software was used to conduct meta-analysis on effective cases,VAS,WOMAC score,IL-1β,TNF-αand other outcome indicators,to evaluate the efficacy of oral Chinese medicine in the treatment of knee osteoarthritis with liver and kidney deficiency.Results:Literature quality evaluation: Eventually into 15 study,a total of 1798 patients with liver and kidney deficiency type of knee osteoarthritis,906 cases of oral Chinese medicine group,western medicine group 892 examples,each document number of cases between60～227 cases,in terms of random method,15 articles,8 by random number table method,1 block stratified random method is used,the rest does not describe specific random method.In terms of allocation hiding and blinding,two articles described the specific implementation of allocation hiding and blinding,while the rest did not.Abscission occurred in 6 studies,all of which described the causes of abscission and the number of cases,and the abscission rate was less than 9%.The remaining 9 studies had no abscission.The selectivity was judged by whether the expected outcome index was reported,and there were selectivity reports in 2 literatures.Three of the 15 studies had incomplete baseline data and the rest had complete descriptions.Meta-analysis: 11 studies were included on the efficacy of oral Chinese medicine in the treatment of knee osteoarthritis with liver and kidney deficiency.P = 0.26;OR = 5.06;95% CI[3.52,7.29];P<0.00001,after excluding the two low-quality studies,the meta-analysis results were: I~2=0%;P = 0.99,OR = 3.51;95% CI[2.36,5.22];P < 0.00001,suggesting that oral Chinese medicine or combination of Chinese and Western medicine in the treatment of liver and kidney deficiency osteoarthritis is more effective than western medicine.In terms of improvement of VAS score,14 studies were included,and subgroup analysis was conducted according to the type of western medicine in the control group,treatment duration and medication regimen in the Chinese medicine group.Meta-analysis results of overall improvement of VAS score were as follows: I~2=99%;P < 0.00001;OR = 1.33;95% CI[2.00,0.67];（P < 0.0001）.In VAS subgroup analysis,the control group was divided into celecoxib group（I ~2 =99%;P<0.00001）and ammonia-glucose group（I ~2 =94%;P<0.00001）.The 4-week group was divided according to the treatment course（I~2=99%;P<0.00001）,6-week group（I~2=88%;P=0.003）,8-week group（I~2=96%;P<0.00001）,12 weeks group（I~2=91%;P<0.00001）.The group was divided into simple Chinese medicine group according to medication regimen（I~2=91%;P<0.00001）and integrated Chinese and Western medicine group（I~2=99%;P<0.00001）.Sensitivity analysis was conducted by funnel plot,9 studies with high heterogeneity were excluded and 5 studies with homogeneity were included.Meta-analysis was conducted by fixed effect model,and the results were as follows: X~2=1.55;I squared = 0%;P = 0.82;MD = 1.45;95%CI[1.65,1.24];Pindicating that oral Chinese medicine had more advantages in reducing VAS scores than western medicine alone in treating KOA.Twelve studies were included in a subgroup analysis of reductions in the WOMAC osteoarthritis Index based on type of western medicine and duration of treatment in the control group.The control group was divided into celecoxib group（I ~2 =97%;P<0.00001）and ammonia-glucose group（I~2 =90%;P<0.00001）.The4-week group was divided according to the treatment course（I~2=96%;P< 0.00001）,8-weeks group（I~2=0%;P=0.35）,12-week group（I~2=95%;P< 0.00001）.The group was divided into simple Chinese medicine group（I ~2 =95%;P<0.00001）and integrated Chinese and Western medicine group（I ~2 =91%;P<0.00001）.Sensitivity analysis was conducted by funnel plot,8 studies with high heterogeneity were excluded and 4 studies with homogeneity were included.Meta-analysis was conducted by fixed effect model,and the results were as follows: X~2=1.78;I squared = 0%;P=0.62;MD = 6.84;95%CI[8.12,5.57];Pindicating that oral Chinese medicine treatment of KOA was more advantageous than western medicine alone in reducing WOMAC osteoarthritis index.In terms of IL-1βreduction,three studies were included,one heterogeneous source study was excluded,and fixed effect model was used.Results: I~2=0%;P=0.51;SMD = 1.13;95%CI[1.41,0.84];Psuggesting that oral Chinese medicine or the addition of Chinese medicine is better than oral Western medicine in reducing IL-1β level.In terms of TNF-α reduction,four studies were included and the overall meta-analysis results were obtained using a random-effects model: I~2=87%;P<0.0001;SMD = 1.07;95%CI[1.65,0.49];P=0.0003,divided into 4 weeks combined celecoxib group according to western medicine and treatment duration（I~2=0%;P=0.68）and aminoglycose for 8 weeks（I~2=76%;P=0.04）,including 4 weeks combined celecoxib group（I~2=0%;P=0.68）;SMD = 1.54;95%CI[1.84,1.24];Pthe effect of reducing TNF-α level was better than control group.The results indicated that oral Chinese medicine or adding Chinese medicine to reduce TNF-α level was better than that of western medicine alone.Conclusion: Oral Chinese medicine can improve the effective rate of knee osteoarthritis with liver and kidney deficiency,improve VAS score,WOMAC score,and reduce IL-1β,TNF-α levels than western medicine alone. |
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