针刺治疗骨关节炎的疗效定量评价:基于模型的荟萃分析OA
Quantitative assessment of acupuncture's effectiveness in osteoarthritis:a model-based meta-analysis
研究旨在定量分析针刺治疗骨关节炎的临床疗效及其影响因素,比较不同类型针刺与假针刺以及假针刺与口服安慰剂的效应差异,以阐明针刺的疗效特征,为其治疗骨关节炎的应用提供定量数据支持.系统检索 PubMed、Cochrane Library、万方和中国知网数据库中关于针刺治疗骨关节炎的随机对照试验,检索时限为各数据库建库至 2025 年 10 月 31 日.采用时间效应模型和协变量模型,定量评估温针刺、传统针刺、电针刺以及假针刺的临床疗效及其影响因素.通过亚组分析探讨可能影响针刺疗效相关因素的趋势,并将假针刺的效应与既往已明确的口服安慰剂效应进行比较,以评估假针刺是否具有治疗获益.共纳入 72 篇文献,涉及 4919 例受试者.结果显示,在VAS 疼痛评分、WOMAC 疼痛评分、WOMAC 僵硬评分及WOMAC功能评分方面,温针显著优于假针刺.电针与传统针刺疗效相当,两者在各结局指标上较假针刺均有数值上的改善,但差异未达统计学显著性.与口服安慰剂效应相比,假针刺具有明确疗效,其中非穴位假针刺的疗效稳定性略优于非穿透性假针刺.亚组分析表明,结局指标基线值越高、女性受试者比例越低、病程越短、针刺频率越高,则针刺治疗骨关节炎的疗效越显著.研究建立了针刺治疗骨关节炎的时间效应模型,阐明了其疗效特征与临床优势,并为临床实践及未来临床试验提供了关键的定量数据.
Objective:This study aimed to quantitatively analyze the clinical efficacy of acupuncture for osteoarthritis and its influencing factors.It compared the effects of different types of acupuncture with sham acupuncture,as well as sham acupuncture with oral placebos,to elucidate the efficacy characteristics of acupuncture and provide quantitative data to support its use in the treatment of osteoarthritis. Methods:Randomized controlled trials on acupuncture for osteoarthritis were retrieved from the PubMed,Cochrane Library,Wanfang,and CNKI databases,including studies published up to October 31,2025.Using time-course and covariate models,we quantitatively assessed the clinical efficacy and influencing factors of warm acupuncture,traditional acupuncture,electroacupuncture,and sham acupuncture.Subgroup analyses were conducted to explore trends related to potential factors affecting acupuncture efficacy.Furthermore,the effects of sham acupuncture were compared with previously established oral placebo responses to evaluate whether sham acupuncture confers therapeutic benefits. Results:A total of 72 articles involving 4,919 participants were included.The findings indicated that warm acupuncture significantly outperformed sham acupuncture in Visual Analogue Scale(VAS)pain,Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC)pain,WOMAC stiffness,and WOMAC function scores.Electroacupuncture and traditional acupuncture exhibited similar efficacy,with both treatments showing numerical improvements over sham acupuncture;however,these improvements were not statistically significant.Comparisons with oral placebo responses suggested that sham acupuncture was effective,with nonacupoint sham acupuncture slightly outperforming nonpenetrating sham acupuncture.Subgroup analyses indicated that higher baseline values of outcome measures,a lower proportion of female participants,shorter disease duration,and higher acupuncture frequency were associated with greater efficacy of acupuncture for osteoarthritis. Conclusion:This study establishes a time-course model for acupuncture in the treatment of osteoarthritis,clarifying its efficacy characteristics and clinical advantages while providing essential quantitative data for clinical practice and future trials.
冯傲博;黄继汉;吕映华;许羚;刘渊;郑青山;吴璐一;李禄金
上海中医药大学临床药物研究中心,上海上海中医药大学临床药物研究中心,上海||经典名方与现代中药融合创新国家重点实验室,上海中医药大学,上海上海中医药大学临床药物研究中心,上海上海中医药大学临床药物研究中心,上海上海中医药大学临床药物研究中心,上海上海中医药大学临床药物研究中心,上海上海中医药大学附属岳阳中西医结合医院,上海上海中医药大学临床药物研究中心,上海||经典名方与现代中药融合创新国家重点实验室,上海中医药大学,上海
骨关节炎针刺安慰剂WOMAC基于模型的荟萃分析
AcupunctureModel-based meta-analysisOsteoarthritisPlaceboWOMAC
《针灸和草药（英文）》 2026 (2)
247-257,11
This work was supported by Shanghai Municipal Health Commission Smart Healthcare Special Project(2025ZHYL037),the National Key R&D Program of China(SQ2024YFC3500039),and the Open Research Program of the State Key Laboratory of Integration and Innovation of Classic Formula and Modern Chinese Medicine(LSLSKL20240203).The funders had no role in the study design,data collection,analysis,interpreta-tion,or the decision to submit for publication.
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