益气活血通络法治疗糖尿病周围神经病变Meta分析

目的:系统评价益气活血通络法治疗糖尿病周围神经病变的有效性。方法:检索CNKI、万方、VIP、CBM、Cochrane library、EMbase、PubMed、ClinicalTrails.gov等数据库,查找所有比较益气活血通络中药或联合西药治疗糖尿病周围神经病变的随机对照试验。利用RevMan 5.3软件进行统计分析、Risk of Bias(ROB)表进行质量评价。结果:共纳入23篇随机对照试验,包括1608例患者。纳入文献的方法学质量较低。采用益气活血通络法治疗糖尿病周围神经病变,能够明显提高临床总有效率(RR=0.30,95%CI为0.24~0.36,P<0.00001)和降低Toronto积分(MD=-1.35,95%CI为-1.57~-1.13,P<0.00001),可显著提高正中神经MCV(MD=3.45,95%CI为2.45~4.45,P<0.00001)、SCV(MD=3.27,95%CI为2.10~4.44,P<0.00001)和腓总神经MCV(MD=2.99,95%CI为2.00~3.98,P<0.00001)、SCV(MD=3.43,95%CI为2.02~4.84,P<0.00001)的传导速度,降低全血高切度(MD=-0.72,95%CI为-0.98~-0.46,P<0.00001)和低切度(MD=-1.52,95%CI为-2.82~-0.21,P=0.02)水平。观察组治愈时间优于对照组(RR=1.71,95%CI为1.49~1.97,P<0.00001),差异有统计学意义。23篇RCTs中19篇研究明确无不良反应发生,4项研究说明有不良反应发生,无严重不良事件发生。结论:益气活血通络法治疗糖尿病周围神经病变,可提高疗效,降低Toronto积分,改善代谢紊乱症状和血流变。因纳入研究的文献质量较低,影响疗效的可靠性,今后还需高质量的随机对照试验加以证实。

Meta-analysis of Enriching Qi,Promoting Blood Circulation and Dredging Meridians Therapy for Diabetic Peripheral Neuropathy Treatment

Objective:To systematically assess the efficacy of enriching qi,promoting blood circulation and dredging meridians therapy for treating diabetic peripheral neuropathy.Methods:A total of 8 databases(CNKI,Wanfang,VIP,CBM,Cochrane Library,EMBASE,PubMed ClinicalTrails.gov)were searched to identify all published randomized controlled trials of enriching qi,promoting blood circulation and dredging meridians herbs combined with western medicine for the treatment of diabetic peripheral neuropathy.The Revman 5.3 software was used for statistical analysis,and the risk of bias(ROB)table was used for quality evaluation.Results:A total of 23 RCTs were identified,including 1608 patients.The methodological quality of the included studies was low.Using activating qi,promoting blood circulation and dredging meridians therapy to treat diabetic peripheral neuropathy can significantly increase the total clinical efficacyRR=0.30,95%CI(0.24~0.36)],reduce the Toronto scoreMD=-1.35,95%CI(-1.57~-1.13),P<0.00001],raise motor nerve conduction velocity of median nerveMD=3.45,95%CI(2.45~4.45),P<0.00001]and common peroneal nerveMD=2.99,95%CI(2.00~3.98),P<0.00001],and sense nerve conduction velocity of median nerveMD=3.27,95%CI(2.10~4.44),P<0.00001],and common peroneal nerveMD=3.43,95%CI(2.02~4.84),P<0.00001].The Meta-analysis indicated that the therapy can lower the level of high shear rate of whole bloodMD=-0.72,95%CI(-0.98~-0.46)P<0.00001],and Whole blood low cutMD=-1.52,95%CI(-2.82~-0.21),P=0.02].The cure time of the treatment group was better than that of the control groupRR=1.71,95%CI(1.49~1.97),P<0.00001].A total of 19 studies clearly showed no adverse reactions among the 23 RCTs,4 studies showed adverse reactions.However,no serious adverse events occurred in all studies.Conclusion:Enriching qi,promoting blood circulation and dredging meridians therapy in the treatment of diabetic peripheral neuropathy can improve the efficacy,reduce the Toronto score,improve the symptoms of metabolic disorders and hemorheology.Due to the quality of included studies is low,which affects the reliability of efficacy,high-quality RCTs are needed to confirm such conclusion in the future.