The effect of foot bath of Chinese medicine combined with acupoint injection for diabetic peripheral neuropathy:a meta analysis

目的:运用meta分析技术评价中药足浴联合穴位注射治疗糖尿病周围神经病变的疗效。方法:计算机检索Cochrane Library、Pubmed、Web Of Science、中国生物医学文献数据库、中国知网、中文科技期刊数据库、万方数据库等,收集中药足浴联合穴位注射治疗糖尿病周围神经病变的随机对照试验,检索时间均为建库至2016年10月。对符合条件的文献进行资料提取,用Cochrane Reviewer Handbook 5.1.0偏倚风险评估工具进行质量评价,Meta 分析采用RevMan 5.3软件。结果:共纳入11项研究,共927例。Meta分析结果显示:①中药足浴联合穴位注射可提高糖尿病周围神经病变临床总有效率(OR=5.07,95%CI:3.23-7.94, Z=7.08, P<0.00001)。②改善腓神经(SMD=1.08,95%CI:0.66-1.48, Z=5.30, P<0.00001)、胫神经(SMD=1.08,95%CI:0.58-1.58, Z=4.22, P<0.0001)和正中神经运动传导速度(SMD=0.46,95%CI:0.23-0.68,Z=3.96, P<0.0001)。③增加腓神经(SMD=0.80,95%CI:0.54-1.05, Z=6.06, P<0.00001)和正中神经(SMD=0.66,95%CI:0.38-0.93, Z=4.73, P<0.00001)的感觉运动传导速度④降低中医症候积分(WMD=-4.21,95%CI [-4.95,-3.48], Z=11.25, P<0.00001)。结论:中药足浴联合穴位注射治疗糖尿病周围神经病变临床疗效显著,但应更深入地研究,设计出高质量的随机对照实验以证实其疗效的可靠性。

Objective:The aim of this systematic review was to assess the effect of foot bath of Chinese medicine combined with acupoint injection(FBCMCAI)on patients with diabetic peripheral neuropathy(DPN).Methods:Databases such as Cochrane Library,Pubmed,Web Of Science,China Biology Medicine(CBM),CNKI,VIP and WANFANG DATA were electronically searched to collect the randomized controlled trials(RCTs)(up to October 2016).According to the inclusion and exclusion criteria,literature about effects of FBCMCAI in the treatment of DPN were screened and data were extracted.Literature quality evaluation was appliced by Cochrane Reviewer Handbook 5.1.0.A random or a fixed effects model was used to analyze outcomes by RevMan 5.3 software.Subgroup analysis,sensitivity analysis,and orientation description were performed if necessary.Results:11 randomized controlled trials with a total of 927 patients were included.Meta analysis results revealed that the efficacy of FBCMCAI for DPN was significantly superior to the control treatment(OR=5.07,95%CI:3.23-7.94,Z=7.08,P<0.00001).Besides,there was an increase in motor conduction velocity of peroneal nerve(SMD=1.08,95%CI:0.66-1.48,Z=5.30,P<0.00001),motor conduction velocity of tibial nerve(SMD=1.08,95%CI:0.58-1.58,Z=4.22,P<0.0001)and motor conduction velocity of median nerve(SMD=0.46,95%CI:0.23-0.68,Z=3.96,P<0.0001)in FBCMCAI groups.For another,there was also an increase in sensory motor conduction velocity of the motor nerve(SMD=0.80,95%CI:0.54-1.05,Z=6.06,P<0.00001)and sensory motor conduction velocity of median nerve(SMD=0.66,95%CI:0.38-0.93,Z=4.73,P<0.00001)in the FBCMCAI groups.Symptoms score was significantly reduced after FBCMCAI treatment(WMD=-4.21,95%CI[-4.95,-3.48],Z=11.25,P<0.00001).Conclusion:FBCMCAI may have significant therapeutic efficacy for the treatment of DPN.Diabetic neurologic symptoms and nerve conduction velocities can be improved under FBCMCAI treatment.In-depth research and high quality randomized controlled trials on the efficacy of FBCMCAI are necessary.