针刺对比西药治疗糖尿病周围神经病变有效性的Meta分析＊

目的 针刺对比西药治疗糖尿病周围神经病变的有效性。方法 采用计算机检索中英文数据库,收集针刺治疗糖尿病周围神经病变（diabetic peripheral neuropathy,DPN）的随机对照试验（randomized controlled trials,RCTs）研究资料,检索时间从建库至2019年10月。由两名研究员对文献进行筛选、资料信息提取以及证据质量评价,应用RevMan 5.3以及Stata 14.0软件对其有效率及其他效应结局指标进行Meta分析。结果 15篇研究被纳入,共1153例参与者。Meta分析结果示：针刺对比西药在治疗DPN的临床有效率【数据与正文不符】[RR = 0.39,95%CI（0.29,0.54）,P < 0.000 1]、多伦多量表（Toronto clinical scoring system,TCSS）评分[WMD = -1.62,95%CI（-2.21,-1.03）,P < 0.001]、正中神经运动神经传导速度（motor nerve conduction velocity,MNCV）[WMD = 0.50,95%CI（-0.31,1.30）,P = 0.22]、正中神经感觉神经传导速度（sensory nerve conduction velocity,SNCV）[WMD = 0.77,95%CI（0.19,1.34）,P = 0.009]、腓神经MNCV[WMD = 1.94,95%CI（0.90,2.99）,P = 0.000 3]、腓神经SNCV[WMD = 0.77,95%CI（0.19,1.34）,P = 0.000 9]均优于常规药物疗法,差异有统计学意义。针刺联合西药对比西药治疗DPN在临床有效率[RR = 0.25,95%CI（0.12,0.53）,P = 0.000 3]、正中神经MNCV[WMD = 2.33,95%CI（1.19,3.47）,P < 0.000 1]、正中神经SNCV[WMD = 2.28,95%CI（0.61,3.96）,P = 0.000 8]、腓神经SNCV[WMD = 2.28,95%CI（0.61,3.96）,P = 0.000 9]、腓神经MNCV[WMD = 1.76,95%CI（0.17,3.35）,P = 0.03]均优于西药组,差异有统计学意义。对于异质性较大的结局指标采用敏感性分析检测,发现各项结局指标结果均较为稳健。用漏斗图以及Egger"s test对有效率进行检测后发现有发表偏移。结论 当前研究结果表明针刺对比西药在DPN中可改善临床症状体征,且可以改善正中神经MNCV、SNCV以及腓神经MNCV、SNCV的神经传导速度,但设计严谨、方法科学的高质量文献太少,其可靠性偏低,因此上述结果仍需要进一步验证。

Meta-analysis on Effectiveness of Acupuncture Compared with That of Western Medicine in Treatment of Diabetic Peripheral Neuropathy

Objective To compare effectiveness of acupuncture with that of western medicine in treating diabetic peripheral neuropathy (DPN).Methods Chinese and English databases were retrieved from their establishment till October 2019 to collect study data on randomized controlled trials (RCTs) of acupuncture in treating DPN. Two researchers selected literatures, extracted data and evaluated quality of evidence. RevMan 5.3 software and Stata 14.0 software were used to perform a meta-analysis on their effectiveness and other effect outcome indicators.Results A total of 15 studies were included, involving 1153 patients. The meta-analysis showed that compared with western medicine in treating DPN, acupuncture"s clinical effective rate [RR = 0.30, 95%CI (0.20, 0.45), P < 0.000 1], Toronto clinical scoring system (TCSS) score [WMD = -1.62, 95%CI (-2.21, -1.03), P < 0.001], median nerve motor nerve conduction velocity (MNCV) [WMD = 0.50, 95%CI (-0.31, 1.30), P = 0.22], median nerve sensory nerve conduction velocity (SNCV) [WMD = 0.77, 95%CI (0.19, 1.34), P = 0.009], peroneal nerve MNCV [WMD = 1.94, 95%CI (0.90, 2.99), P = 0.000 3] and peroneal nerve SNCV [WMD = 0.77, 95%CI (0.19, 1.34), P = 0.000 9] were better than those of conventional western medicine therapy, with statistically significant differences. Compared with western medicine in treating DPN, acupuncture plus western medicine"s clinical effective rate [RR = 0.25, 95%CI (0.12, 0.53), P = 0.000 3], median nerve MNCV [WMD = 2.33, 95%CI (1.19, 3.47), P < 0.000 1], median nerve SNCV [WMD = 2.28, 95%CI (0.61, 3.96), P = 0.000 8], peroneal nerve SNCV [WMD = 2.28, 95%CI (0.61, 3.96), P = 0.000 9] and peroneal nerve MNCV [WMD = 1.76, 95%CI (0.17, 3.35), P = 0.03] were better than those in the western medicine group, with statistically significant differences. Sensitivity analysis was conducted in the outcome indicators with high heterogeneity, and results of the outcome indicators were relatively robust. Publication bias was found after using a funnel plot and Egger"s test for the effective rates.Conclusion The present study results show that compared with western medicine in treating DPN, acupuncture can improve clinical symptoms and signs, and increase median nerve MNCV and SNCV as well as peroneal nerve MNCV and SNCV. However, there is a lack of high-quality, well-designed literatures, and the reliability is low, so the above results need further verification.