补肾活血类方剂治疗膝关节骨性关节炎的Meta分析及中药处方数据挖掘

Meta-analysis of kidney-tonifying and blood-activating formula in the treatment of knee osteoarthritis and data mining of herbal prescriptions

关键词:  补肾活血  膝关节骨性关节炎  Meta分析  数据挖掘  中药

Key words:  kidney-tonifying and blood-activating  knee osteoarthritis  Meta-analysis  data mining  Chinese herbal medicine

摘要:

[目的] 系统评价口服补肾活血类中药方剂治疗膝关节骨性关节炎（KOA）的疗效与安全性，并挖掘其组方规律。[方法] 检索中国知网、万方数据知识服务平台、PubMed等8个数据库中2015年1月—2025年4月发表的随机对照试验（RCT），筛选符合纳入标准的研究，提取数据并进行Meta分析。采用RevMan 5.4和Stata 17.0软件进行统计分析，对总有效率、西安大略表马斯特大学骨性关节炎可视化量表指数（WOMAC）评分、视觉疼痛模拟（VAS）评分、Lequesne指数及不良反应等指标进行合并分析。同时，对纳入处方的中药进行频次、性味归经、关联规则及聚类分析。[结果] 共纳入14项RCT，涉及1 198例患者。Meta分析显示，补肾活血类中药在总有效率[OR=2.58，95%CI（1.87，3.57）]、WOMAC评分[OR=-2.64，95%CI（-3.96，-0.96）]、VAS评分[OR=-0.63，95%CI（-0.85，-0.42）]和关节炎患者疼痛（Lequesne）指数[OR=-1.09，95%CI（-1.37，-0.80）]方面均优于常规西药（P < 0.01），且不良反应[OR=0.60，95%CI（0.25，1.34）]无显著差异（P=0.25）。数据挖掘显示，高频药物为牛膝、地黄、当归等，药性以温、平为主，归经以肝、肾、脾为主；核心药对为牛膝-鸡血藤（置信度100%）。[结论] 单纯应用补肾活血类中药治疗KOA在改善临床症状、关节功能及疼痛方面显示出优于单纯常规西药治疗的疗效趋势，且安全性相当。其组方规律符合“补肾活血”的中医理论，牛膝-鸡血藤为核心药对，值得进一步深入研究。

Abstract:

[Objective]To systematically evaluate the efficacy and safety of oral kidney-tonifying and blood-activating Chinese herbal formulas in treating knee osteoarthritis(KOA), and to explore the prescribing patterns.[Methods]Randomized controlled trials (RCTs)published between January 2015 and April 2025 were retrieved from eight databases including CNKI, Wanfang Database, and PubMed. Studies meeting the inclusion criteria were screened, and data were extracted for Meta - analysis. Statistical analysis was performed using RevMan 5.4 and Stata 17.0 software. Outcomes such as total effective rate, WOMAC score, VAS score, Lequesne index, and adverse events were pooled. Additionally, frequency analysis, property-flavor-meridian distribution, association rule analysis, and cluster analysis were conducted on the included herbal prescriptions.[Results]A total of 14 RCTs involving 1 198 patients were included. The meta-analysis showed that kidney-tonifying and blood-activating herbal formulas were superior to conventional Western medicine in terms of total effective rate [OR=2.58, 95%CI(1.87, 3.57)], WOMAC score[OR=-2.64, 95%CI(-3.96, -0.96)], VAS score[OR=-0.63, 95%CI(-0.85, -0.42)], and Lequesne index[OR=-1.09, 95%CI(-1.37, -0.80), P < 0.05], with no significant difference in adverse events[OR=0.60, 95%CI(0.25, 1.34), P=0.25]. Data mining revealed that high - frequency herbs included Achyranthes bidentata, Rehmannia glutinosa and Angelica sinensis. Herbal properties were primarily warm and neutral, and meridians were mainly linked to the liver, kidney, and spleen. The core herb pair was Achyranthes bidentata and Spatholobus suberectus(confidence 100%).[Conclusion]When used alone, kidney-tonifying and blood-activating Chinese herbal formulas demonstrate a superior trend in efficacy compared to conventional Western medicine alone in improving clinical symptoms, joint function, and pain in patients with KOA, with comparable safety. The prescribing pattern aligns with the traditional Chinese medicine theory of"tonifying the kidney and activating blood", with the Achyranthes-Spatholobus pair being central. Further in-depth research is warranted.