ABSTRACT
To evaluate the efficacy and safety of Chinese patent medicine in the treatment of knee osteoarthritis(KOA) with network Meta-analysis, and provide evidence-based medicine evidences for clinical practice. PubMed, Cochrane Library, EMbase, CNKI, Wanfang, VIP and CBM were used to search for clinical randomized controlled trials(RCTs) on Chinese patent medicines for treatment of knee osteoarthritis, with a time limit from the establishment of each database to March 2020. The bias risk assessment tool recommended by Cochrane was used to evaluate the quality of the included RCTs. The network Meta-analysis was performed by Stata 14.0 software. A total of 5 788 patients in 58 RCTs were included, involving 9 kinds of Chinese patent medicines. The results of the network Meta-analysis indicated that in terms of total effective rate, the top three optimal medication regimens were Jinwu Gutong Capsules + Amino Acid Glucose(AAG), Xianling Gubao + AAG and Biqi Capsules; the top three interventions to reduce the VAS score were Panlongqi Tablets > Xianling Gubao + AAG > Xianling Gubao + non steroidal anti-inflammatory drugs(NSAIDs); the top three interventions to reduce the total score of WOMAC were Jintiange Capsules+NSAIDs> Jinwu Gutong Capsules + AAG > Biqi Capsules + NSAIDs; the top three medication schemes with better curative effect to reduce Lequesnse index were Xianling Gubao + NSAIDs > Biqi Capsules + NSAIDs > Jintiange Capsules + NSAIDs; the top three interventions to reduce TNF-α level Xianling Gubao + AAG > Jintiange Capsules > Jintiange Capsules + AAG=Jinwu Gutong Capsules + AAG. In terms of safety, the top five interventions with the least adverse reactions were Biqi Capsules > Jinwu Gutong Capsules > Biqi Capsules + NSAIDs > Xianling Gubao + NSAIDs > Jintiange Capsules. The combined application of Chinese patent medicine and NSADIs or AAG can improve the clinical treatment effect and reduce adverse reactions in KOA patients.
Subject(s)
Humans , Biological Products , China , Drugs, Chinese Herbal , Network Meta-Analysis , Nonprescription Drugs , Osteoarthritis, Knee/drug therapyABSTRACT
BACKGROUND: Preliminary studies have found that ligustrazine can effectively improve the levels of nitric oxide and prostaglandin E2, and alleviate the inflammatory response of osteoarthritis, but the related mechanism remains unclear. OBJECTIVE: To observe the effect of ligustrazine on the expression levels of type Ⅱ collagen fiber α 1, vascular endothelial growth factor (VEGF) mRNA and miR20b in the articular cartilage of knee osteoarthritis model, and to explore the mechanism of ligustrazine for early-stage knee osteoarthritis in rats. METHODS: Healthy male Sprague-Dawley rats were randomized into normal, model, high- and low-dose ligustrazine, and positive control groups. Rats in the latter four groups were used to establish the model of early-stage knee osteoarthritis by intra-articular injection of papain, and were then intragastrically given the administration of normal saline, 100 and 50 mg/kg ligustrazine, and 24 mg/kg celecoxib, respectively. The normal group was given the same volume of normal saline. The treatment in each group lasted for 6 weeks. Then, the rat cartilage was taken, and changes of cartilage tissues were assessed by Mankin scores. Expression levels of type Ⅱ collagen fiber α 1, VEGF mRNA and miR20b in the cartilage were detected by qRT-PCR. RESULTS AND CONCLUSION: The order of Mankin scores was as follows: normal group < high-dose ligustrazine group < positive control group < low-dose ligustrazine group < model group (P < 0.05). The mRNA expression levels of type Ⅱ collagen fiber α 1 and VEGF were the highest in the normal group, followed by the high-dose ligustrazine group, positive control group, low-dose ligustrazine group, and model group (P < 0.05). The expression level of miR20b was significantly up-regulated except the model group, and its order was follows: high-dose ligustrazine group < positive control group < low-dose ligustrazine group. Our results indicate that ligustrazine has a positive effect on early-stage knee osteoarthritis in rats, and the possible mechanisms by which ligustrazine promotes cartilage repair are to up-regulate miR20b expression and to inhibit VEGF mRNA expression.
ABSTRACT
<p><b>OBJECTIVE</b>To explore the efficacy and feasibility of dog days moxibustion plaster therapy in treatment of allergic rhinitis of different patterns/syndromes.</p><p><b>METHODS</b>Allergic rhinitis of lung deficiency and invasion of cold, spleen qi deficiency and kidney yang deficiency, 56 patients for each pattern/syndrome were randomized into a plaster therapy group and a nasal spray group, 28 cases in each one. In the plaster therapy group, according to the pattern/syndrome differentiation, with literature retrieval method, 3 acupoints of high frequency utility in clinic were selected as one group in acupoint plaster therapy. For lung deficiency and invasion of cold pattern/syndrome, Feishu (BL 13), Fengmen (BL 12) and Hegu (LI 4) were selected. For spleen qi deficiency pattern/syndrome, Pishu (BL 21), Zusanli (ST 36) and Dazhui (GV 14) were selected. For kidney yang deficiency pattern/ syndrome, Shenshu (BL 23), Dingchuan (EX-B 1) and Bailao (EX-HN 15) were selected. Separately, on July 13, 2013, July 23, 2013, August 2, 2013 and August 12, 2013, the aucpoint plaster therapy was applied, 2 to 4 h (1 to 2 h for children) each time. In the nasal spray group, beclometasone dipropionate aqueous nasal spray, 2 presses one nostril each time, 2 to 3 times a day, continuously for 4 weeks. The symptom score and efficacy were compared before and after treatment in the patients of the two groups.</p><p><b>RESULTS</b>The symptom scores of 3 patterns/syndromes were all apparently improved after treatment as compared with those before treatment in the patients of the two groups (all P<0.05), and the result in the plaster therapy group was better than that of the nasal spray group (P<0.05, P<0.01). For lung deficiency and invasion of cold pattern/syndrome, the total effective rate was 87.3% (20/24) in the plaster therapy group, better than 84.6% (22/26) in the nasal spray group (P<0.05). For spleen qi deficiency pattern/syndrome, the total effective rate was 83.3% (20/24) in the plaster therapy group, obviously better than 76.9% (22/26) in the nasal spray group (P<0.05). For kidney yang deficiency pattern/syndrome, the total effective rate was 79.2% (19/24) in the plaster therapy group, better than 76.9% (22/26) in the nasal spray group (P<0.05).</p><p><b>CONCLUSION</b>The dog days moxibustion plaster therapy achieves definite efficacy on allergic rhinitis at the acupoints selected based on the differentiation of different patterns/syndromes and the efficacy is better than beclometasone dipropionate aqueous nasal spray.</p>