摘要
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。
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 efficacy[RR=0.30,95%CI(0.24~0.36)],reduce the Toronto score[MD=-1.35,95%CI(-1.57~-1.13),P<0.00001],raise motor nerve conduction velocity of median nerve[MD=3.45,95%CI(2.45~4.45),P<0.00001]and common peroneal nerve[MD=2.99,95%CI(2.00~3.98),P<0.00001],and sense nerve conduction velocity of median nerve[MD=3.27,95%CI(2.10~4.44),P<0.00001],and common peroneal nerve[MD=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 blood[MD=-0.72,95%CI(-0.98~-0.46)P<0.00001],and Whole blood low cut[MD=-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 group[RR=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.
作者
张美珍
郝晓晖
李晓文
杨亚男
李艳杰
刘旭菲
倪青
ZHANG Meizhen;HAO Xiaohui;LI Xiaowen;YANG Yanan;LI Yanjie;LIU Xufei;NI Qing(Guang′anmen Hospital,Chinese Academy of Traditional Chinese Medicine,Beijing 100053,China;Graduate school,Beijing University of Traditional Chinese Medicine,Beijing 100029,China)
出处
《世界中医药》
CAS
2021年第5期708-716,720,共10页
World Chinese Medicine
基金
北京市自然科学基金项目(7182143)——基于糖代谢信号通路和均匀设计的抗糖尿病中药组分配伍优化。
关键词
益气活血通络
糖尿病周围神经病变
随机对照试验
META分析
有效率
中医药:神经传导速度
不良反应
Enriching qi,promoting blood circulation and dredging meridians
Diabetic peripheral neuropathy
Randomized controlled trials
Meta-analysis
Efficacy
Traditional Chinese medicine
Nerve conduction velocity
Adverse reactions
作者简介
张美珍(1992.01—),女,博士研究生在读,研究方向:内分泌代谢病的中医药防治,E-mail:1044388932@qq.com;通信作者:倪青(1968.09—),男,博士,主任医师,教授,博士研究生导师,研究方向:内分泌及代谢病的中医药治疗,E-mail:13701253942@163.com。
