针刺治疗糖尿病周围神经病变的网状Meta分析及安全性评价

目的：系统评价针刺治疗糖尿病周围神经病变的疗效及安全性。方法：检索国家知识基础设施数据库（CNKI）、中文科技期刊数据库（CCD）、中国学术期刊数据库（CSPD）、中国生物医学文献数据库（CBM）、PubMed、Cochrane Library等数据库，筛选针刺治疗糖尿病周围神经病变的随机对照试验。对纳入的文献进行质量评价，采用Stata14.0及GeMTC 0.14.3软件进行数据分析。结果：最终纳入61项研究，涉及10种针刺相关疗法，共计4 968例患者，其中观察组2 543例，对照组2 425例。网状Meta分析结果显示，电针、电针联合耳穴贴压、针刺联合穴位注射、温针灸、梅花针扣刺、穴位注射联合中药熏洗、刺络放血等疗法总有效率优于甲钴胺；在改善正中神经运动传导速度方面，单纯针刺、针刺联合中药足浴、针刺联合穴位注射、温针灸、梅花针扣刺及穴位注射联合中药熏洗等疗法优于甲钴胺；在改善正中神经感觉传导速度方面，单纯针刺及电针疗法优于梅花针扣刺；在改善腓总神经运动传导速度方面，单纯针刺、电针、电针联合耳穴贴压、针刺联合穴位注射、梅花针扣刺、穴位注射、穴位注射联合中药熏洗及针刺联合中药足浴等疗法优于甲钴胺；在改善腓总神经感觉传导速度方面，电针联合耳穴贴压优于甲钴胺，电针联合耳穴贴压及穴位注射疗法优于温针灸。结论：10种针刺相关疗法治疗糖尿病周围神经病变，针灸综合疗法总体优于甲钴胺治疗，且电针联合耳穴贴压、针刺联合穴位注射以及单纯针刺总体优于甲钴胺治疗。针刺相关疗法安全，各类针刺综合疗法互有优劣，建议结合临床实际情况合理选择。

Bayesian Meta Analysis and Safety Evaluation of Acupuncture-related Therapies in the Treatment of Diabetic Peripheral Neuropathy

To explore the clinical efficacy and safety of acupuncture-related therapies in the treatment of diabetic peripheral neuropathy.Methods:We searched the National Knowledge Infrastructure Database (CNKI),Chinese Science and Technology Journal Database (CCD),Chinese Academic Journal Database (CSPD),Chinese Biomedical Literature Database (CBM),PubMed,Cochrane Library and other databases to screen for acupuncture treatment of diabetic peripheral nerves in randomized controlled trials.The quality of the included literature was evaluated,and Stata 14.0 and GeMTC 0.14.3 software were used for data analysis.Results:A total of 61 RCTs involving 10 kinds of acupuncture-related therapies were included,with a total of 4968 patients,including 2 543 cases in the observation group and 2 425 cases in the control group.The results of network meta-analysis showed that:electroacupuncture,electroacupuncture combined with auricular point pressing,acupuncture combined with acupoint injection,warming needle moxibustion,plum blossom acupuncture,acupoint injection combined with Chinese medicinal fumigation,bloodletting and other therapies were always better than mecobalamin; in improving median nerve motor conduction speed,simple acupuncture,acupuncture combined with Chinese medicinal foot bath,acupuncture combined with acupoint injection,warming needle moxibustion,plum blossom acupuncture and acupoint injection combined with Chinese medicinal fumigation were better than mecobalamin; in terms of improving the median nerve sensory conduction speed,therapies such as simple acupuncture,electroacupuncture,electroacupuncture combined with auricular point pressing,acupuncture combined with acupoint injection,plum blossom acupuncture,acupoint injection,acupoint injection combined with Chinese medicinal fumigation and acupuncture combined with t Chinese medicinal foot bath were better than mecobalamin.In terms of improving the speed of common nerve motor conduction,electro-acupuncture combined with auricular point pressing,electric acupuncture combined with ear point pressing was better than warm needling moxibustion.Conclusion:A total of 10 kinds of acupuncture-related therapies are used to treat diabetic peripheral neuropathy.Comprehensive acupuncture and moxibustion are generally better than mecobalamin therapy,and electroacupuncture combined with ear point pressing,acupuncture combined with acupoint injection,and acupuncture alone are generally better than mecobalamin therapy.Acupuncture-related therapies are safe,and various comprehensive acupuncture therapies have their own advantages and disadvantages.It is recommended to choose a reasonable choice based on the actual clinical situation.