| 1.Research backgroundKnee osteoarthritis is a joint articular cartilage deformation,destruction and bone hyperplasia characterized by chronic joint disease,clinical knee joint swelling and pain,and even limited activity,the disease.The final morbidity rate was 53%.The occurrence of knee osteoarthritis was related to age,obesity,trauma and genetic factors,but the exact pathogenesis was unclear.The disease is common in the elderly population,the recent study found that the incidence of young people has increased.In China,the prevalence of knee osteoarthritis is about 8.1%,and its incidence increases with age,China has gradually entered the aging society,according to statistics,in 2016,the population of 60 years of age and above is 230.86 million and accounts for 10.7%of the total population,80%of the elderly people over 70 years age are suffering with knee osteoarthritis,as the most common in the elderly population and the most important joint disease,knee osteoarthritis will become a threat to the elderly population health,causing to become one of the most important factors of the elderly population disability.Therefore,the researches of prevention and treatment of knee osteoarthritis has a far-reaching social significance.Knee osteoarthritis is a category of Chinese medicine "bone paralysis",and Chinese medicine in the treatment of knee osteoarthritis to obtain a more satisfactory effect.Chinese medicine argues that kidney qi deficiency and blood stasis is the main pathological mechanism of knee osteoarthritis,therefore,Bushen Huoxuetongluo is an important treatment of knee osteoarthritis,in view of this,we hope that through objectively evaluating the treatment of Bushen Huoxue for knee osteoarthritis,we can improve the efficacy of Chinese medicine treatment of knee osteoarthritis and provide a reference for clinical.2.Purpose of studySearch comprehensively and list systematically the clinical studies of knee osteoarthritis treated by kidney nourishing and blood activating,and extract and summary the evidences of the clinical researches,and to evaluate the efficacy and safety of oral Chinese medicine of kidney nourishing and blood activating compared with western medicines or other traditional Chinese medicine in the treatment of knee osteoarthritis.to provide evidence-based medicine for the treatment of knee osteoarthritis in Chinese medicine and to provide a reference for the clinical prescription medication.3.Research methodsAccording to the Cochrane systematic evaluation method,this study does a comprehensive search of the various databases,to access enough relevant clinical researches,extract the general information of these literatures,the quality of its method to evaluate the quality of its method and analysis the results of the various researches,and to statistics the frequency of medication in the included studies.The method is as follows:3.1 Document retrievalSearch the electronic databases with computers,including CNKI,VIP,Wan Fang Data,PubMed,Cochrane Central Register of Controlled Trial,and Embase Database.Chinese search uses keyword words and free words,and foreign language search Mesh words with keyword words.The retrieval period of each database is from the date of construction date to December 31,2016.3.2 Inclusion criteria3.2.1 Study typeClinical randomized controlled trials are included which have been published.And these studies are the comparisons between the Chinese medicine treatment of kidney nourishing and blood activating for knee osteoarthritis and western medicine or different traditional Chinese medicines.3.2-2 Study objectionsDiagnosed by the criteria from ACR for the of knee osteoarthritis patients,age and gender are not limited.3.2.3 InterventionsInterventions in the experimental group are oral Chinese medicine of kidney nourishing and blood activating.And interventions in the control group include western medicine or other oral Chinese medicine treatment.3.2.4 OutcomeIt includes efficient,VAS score,WOMAC score,Social economic evaluation and adverse events.3.3 Exclusion criteriaThe following categories of studies are not included:(l)repeated published research literature;(2)after the arthroscopic surgery;(3)lack of basic information of subjects or interventions;(4)researches without specific number.4.Evaluation methodsTwo researchers independently screen these literatures,extract relevant information and do cross-check,in case of differences,they will make a consultation or ask a third party for help,to collect the relevant characteristics and information of these literatures:(1)including the article title,the first author,published Time;(2)demographic baseline characteristics,such as gender ratio,age distribution,duration,sample size,etc.;(3)treatment of drugs,duration,and the main outcomes.According to the Cochrane Collaborative Network System Evaluator Manual,version 5.1.0,the bias risk assessment method for RCT was evaluated for studies that met the inclusion criteria and were analyzed using the RevMan 5.3 software provided by the Cochrane Collaboration Network.The Two classifiers variable data is evaluated by the odds ratio(OR)or the risk ratio(RR),the continuity variable data is evaluated by the mean difference(MD)and make the effect of the 95%confidence interval to be the effect scale.If the interventions of two or more studies are consistent and the same outcome indicators are reported,the meta-analysis can be combined,the heterogeneity test is performed,and the corresponding effect model is selected.5.Results of the studyA total of 1,600 articles are obtained from the preliminary search,and 24 are included.Except for one of the domestic studies published in English,the rest were domestic Chinese studies.Of the 24 studies,1690 patients had osteoarthritis,and the average sample size was 70.4.The results of Meta-analysis show that the treatment of Kidney Nourishing and Blood Activating of Chinese Herbal Medicine for knee osteoarthritis was better than using western medicine alone(OR=2.63,95%CI 1.86 to 3.72,P<0.00001).Pain visual analogue scale(VAS score),the treatment of Kidney Nourishing and Blood Activating of Chinese medicine in reducing the VAS score has a difference with the control group,when the medication longer,the treat group can effectively relieve pain.It also has a difference in improving WOMAC score with the control group.It is also better than the control group in improving James score.Kidney Nourishing and Blood Activating of Chinese medicine in the treatment of knee osteoarthritis,the incidence of adverse reactions was significantly less than the control group,it has a higher safety.In addition,the study of a total of 24 cases,there are 59 Chinese herbal medicine prescription,among them there are 51 kinds of Chinese medicine used more than 3 times.They are mainly composed by four categories of drugs,which are 15 flavors the liver and kidney nourishing medicine,21 flavors activating blood medicine,6 flavors rheumatoid Chinese medicine,6 flavors nourishing qi and blood medicine.6.Research conclusionsFrom the perspective of evidence-based medicine,and a comprehensive combination of 24 study reports of randomized controlled trials about Kidney Nourishing and Blood Activating of Chinese medicine for knee osteoarthritis,this kind of medicine for knee osteoarthritis treatment has a good effect.Traditional Chinese medicine compound and conventional treatment of Western medicine combined,can better reduce the VAS score and other indicators,in patients with knee osteoarthritis joint pain has a greater advantage,especially in long-term medication,the advantages of obvious,and short-term relief Arthritis pain,compared with NSAIDs,the advantage is not obvious.From the safety of NSAIDs as the representative of the conventional treatment of the majority of adverse reactions for gastrointestinal reactions,kidney and blood circulation of traditional Chinese medicine treatment in this area has obvious advantages,adverse reaction rate was significantly lower than conventional Western medicine treatment.Through the treatment of knee osteoarthritis of the treatment of knee osteoarthritis analysis found that the prescription of Kidney Nourishing and Blood Activating of Chinese medicine for knee osteoarthritis composition mainly by and other components the liver and kidney nourishing medicine,activating blood medicine,rheumatoid Chinese medicine,nourishing qi and blood medicine,which make up Liver and kidney commonly used drugs are the first five:shudi,duzhong,yinyanghuo,xuduan,sangjisheng.the top five of activating blood medicine commonly used drugs are:niuxi,jixueteng,danshen,chuanxiong,honghua,.And insect drugs and rattan medicine are also the indispensable two categories of drugs in clinical treatment of knee osteoarthritis... |
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