Abstract: Background　Acute episodes of gout arthritis are the main cause of suffering in patients with gout.Long-term western pharmacological therapies bring obvious adverse reactions to patients.Acupuncture and moxibustion therapies，as alternative therapeutic options，have been proved effective in acute gouty arthritis （AGA），but which one is superior to others has not been identified by evidence-based studies.Objective　To compare the clinical efficacy of five acupuncture and moxibustion therapies in AGA using network meta-analysis.Methods　We searched for randomized controlled trials （RCTs） of five acupuncture and moxibustion therapies （electroacupuncture，needling，blood-pricking，warm-needling，red-hot needling） compared with the western pharmacological therapy for AGA from databases of PubMed，EMBase，The Cochrane Library，CNKI，Wanfang Data，VIP，and CBM from inception to September 10th，2019.We used RevMan 5.3 and Stata 14.0 to analyze the data involved.Results　A total of 23 RCTs involving 1 684 patients were eligible for this study.Network meta-analysis results showed that electroacupuncture 〔OR=1.18，95%CI（1.01，1.39），P<0.05〕，warm-needling 〔OR=1.17，95%CI（1.03，1.32）〕，or red-hot needling 〔OR=1.13，95%CI（1.03，1.24），P<0.05〕 showed better overall efficacy than the western pharmacological therapy.Surface under the cumulative ranking curves （SUCRA） values according to the overall effectiveness showed that electroacupuncture was best，followed by blood-pricking，red-hot needling，warm-needling，needling，and western pharmacological therapies.Electroacupuncture 〔SMD=-144.46，95%CI（-248.77，-40.14），P<0.05〕and needling 〔SMD=-98.83，95%CI（-159.51，-38.15），P<0.05〕 were superior to western pharmacological therapies in reducing uric acid.In terms of reducing the VAS score〔only three acupuncture and moxibustion therapies （red-hot needling，needling and blood-pricking） and western pharmacological therapy were included〕，red-hot needling had better efficacy than western pharmacological therapies 〔SMD=-1.40，95%CI（-2.12，-0.68），P<0.05〕.SUCRA values based on VAS reduction showed that red-hot needling was the best，followed by blood-pricking，needling，and western pharmacological therapies.Conclusion　Electroacupuncture has the highest possibility to reduce serum uric acid and improve overall efficiency，red-hot needling can effectively relieve pain.However，due to limited quantity and quality of studies，our conclusion needs to be verified by larger sample size，multi-center and high-quality clinical studies.

Key words: Arthritis

摘要： 背景　痛风性关节炎急性发作是痛风患者痛苦的主要原因，长期西药治疗给患者带来明显的不良反应，针灸疗法作为补充替代疗法对急性痛风性关节炎有良好的疗效，但在不同针灸疗法中何种针灸疗法更能有效改善急性痛风性关节炎症状仍缺乏相应的循证医学证据。目的　运用网状Meta分析方法比较5种针灸疗法与西药治疗急性痛风性关节炎的临床疗效。方法　计算机检索PubMed、EMBase、The Cochrane Library、中国知网（CNKI）、万方数据知识服务平台、维普网（VIP）、中国生物医学数据库（CBM）等数据库中关于5种针灸疗法（电针、针刺、刺血、温针灸、火针）治疗急性痛风性关节炎的随机对照试验（RCT），检索时间为各数据库建库至2019-09-20。采用RevMan 5.3和Stata 14.0软件进行数据分析。结果　共纳入23项RCT，共1 684例患者，网状Meta分析结果显示，电针〔OR=1.18，95%CI（1.01，1.39），P<0.05〕、温针灸〔OR=1.17，95%CI（1.03，1.32），P<0.05〕、火针〔OR=1.13，95%CI（1.03，1.24），P<0.05〕治疗急性痛风性关节炎总有效率高于西药；曲线下面积（SUCRA）排序结果显示电针总有效率最高，其余依次为刺血、火针、温针灸、针刺和西药。在降低血尿酸水平方面，电针〔标准化均数差（SMD）=-144.46，95%CI（-248.77，-40.14），P<0.05〕、针刺〔SMD=-98.83，95%CI（-159.51，-38.15），P<0.05〕均优于西药； SUCRA排序结果显示电针降低血尿酸水平效果最优，其余依次为针刺、刺血、温针灸、火针和西药。在降低视觉模拟评分法（VAS）评分方面，火针优于西药〔SMD=-1.40，95%CI（-2.12，-0.68），P<0.05〕；SUCRA排序结果显示火针降低VAS评分效果最优，其余依次为刺血、针刺和西药。结论　电针治疗急性痛风性关节炎在提高总有效率和降低血尿酸水平方面具有最好的疗效，火针治疗可有效缓解疼痛，受研究数量及质量的限制，未来仍需更大样本量、多中心和高质量的临床研究予以验证本结论。

关键词: 关节炎, 痛风性；急性痛风性关节炎；针灸疗法；电针；针刺；刺血疗法；温针疗法；火针疗法；治疗结果；尿酸；疼痛；网状Meta分析