陈超云 李炳钻 王建嗣 黄苏萍 洪昆达

【摘 要】目的：对针灸治疗类风湿关节炎的Meta分析/系统评价进行再评价。方法：计算机检索中国知网（CNKI）、万方（Wanfang）、维普（VIP）、Pubmed、Cochrane Library等数据库发表的有关针灸治疗类风湿关节炎的系统评价，检索时间为数据库建立至2019年12月，并用AMSTAR量表和GRADE pro软件分别对纳入研究进行方法学质量和证据等级评价。结果：最终纳入14个研究，AMSTAR评分在5～10分，质量中等，GRADE证据等级偏低。针灸治疗类风湿关节炎总有效率优于对照组，但在晨僵、关节肿胀、视觉模拟评分法评分、类风湿因子、红细胞沉降率、C-反应蛋白等结局指标方面未见明显优势。结论：针灸治疗类风湿关节炎的Meta分析方法學质量中等以及证据等级质量偏低，但是综合近年来该方面的研究进展，推介针灸作为一种补充替代疗法改善类风湿关节炎患者的临床症状，值得尝试。

【关键词】 关节炎，类风湿;针灸;Meta分析/系统评价;系统评价再评价

【ABSTRACT】Objective：To reevaluate the meta-analysis and systematic evaluation for the treatment of rheumatoid arthritis with acupuncture and moxibustion.Methods：Systematic reviews on the treatment of rheumatoid arthritis published in CNKI，Wanfang，VIP，PubMed and Cochrane library were searched by computer from the establishment of the database to December 2019.The methodological quality and evidence level of the included studies were evaluated by AMSTAR scale and software GRADE Pro respectively.Results：A total of 14 studies were included，with AMSTAR score of 5～10，medium quality and low GRADE evidence level.The total effective rate of the treatment group was better than that of the control group，with no obvious advantage in morning stiffness，joint swelling，visual analog score，rheumatoid factor，erythrocyte sedimentation rate，C-reactive protein and other outcome indicators.Conclusion：The quality of meta-analysis methodology in treating rheumatoid arthritis with acupuncture and moxibustion is medium and the quality of evidence level is low.However，based on the research progress in this field in recent years，it is worth trying to recommend acupuncture as a complementary alternative therapy to improve the clinical symptoms of patients with rheumatoid arthritis.

【Keywords】 arthritis，rheumatoid;acupuncture and moxibustion;meta-analysis/systematic review;re-evaluation of systematic review

类风湿关节炎（rheumatoid arthritis，RA）是一种

以慢性、侵袭性关节炎为主要病变的自身免疫性疾病[1]，其主要病理改变为关节滑膜炎症浸润，继而出现关节软骨和骨破坏，甚至导致关节畸形和活动障碍[2]。流行病学调查显示，我国RA患病率为0.42%，总患病人数约500万[3]。RA患者长期关节疼痛，疾病后期关节毁损、畸形，不仅严重影响患者的工作和生活质量，还给家庭和社会带来巨大的经济负担。目前RA治疗多使用非甾体抗炎药、改善病情抗风湿药（DMARDs）、生物制剂等缓解症状[4]，但不良反应也限制其使用，因此寻求安全可靠的补充替代疗法尤为重要。……