长春西汀治疗糖尿病周围神经病变的Meta分析

Analysis on Vinpocetine for Treating Diabetic Peripheral Neuropathy

目的系统评价长春西汀治疗糖尿病周围神经病变的疗效及安全性。方法计算机检索Cochrane图书馆、EMBase、PubMed、中国期刊全文数据库(CNKI)、中国生物医学文献数据库(CBM)、中文科技期刊全文数据库(VIP)中关于长春西汀治疗糖尿病周围神经病变的随机对照试验(RCT)。由2名数据员按纳入与排除标准独立筛选,并对纳入研究的方法学质量进行评价,提取资料;用RevMan 5.14软件对数据进行Meta分析。结果共纳入14篇RCT,包括1 307例患者。Meta分析结果显示,长春西汀治疗糖尿病周围神经病变有效率优于常规治疗[RR=1.42,95%CI(1.32,1.53),P<0.000 01];长春西汀对糖尿病周围神经病变的正中神经MNCV改善[MD=3.89,95%CI(0.84,6.93),P=0.01],腓神经MNCV改善[MD=4.23,95%CI(3.25,5.22),P<0.000 01]、正中神经SNCV改善[MD=2.14,95%CI(1.53,2.75),P=0.01]及腓神经SNCV改善[MD=4.22,95%CI(2.97,5.48),P<0.000 01]均优于常规治疗。长春西汀对血糖的影响,治疗前后差异无统计学意义(P>0.05)。结论基于现有临床证据,长春西汀治疗糖尿病周围神经病变有效,安全性好。但因纳入研究质量不统一,该结论尚需更多大样本、高质量临床随机对照试验予以证实。

Objective To evaluate the effectiveness and safety of vinpocetine for treating diabetic peripheral neuropathy（DPN）. Methods The randomized controlled trials（RCT） of vinpocetine for treating DPN were retrieved from the Cochrane Library, EMbase, PubMed, CBM, CNKI and VIP. Two reviewers independently screened RCT according to the inclusion and exclusion criteria, and assessed the method-ological quality of included trials for extracting the data. The obtained data were performed the meta analysis by the RevMan 5.14 soft-ware. Results 14 RCT involving 1 307 patients were ultimately included. The meta-analysis Results showed that the effective rate of vinpocetine was superior to that of the conventional therapy[RR=1.42, 95% CI（1.32, 1.53）, P〈0.000 01]; the improvement of the median nerve＇s motor nerve conduction velocity（MNCV） [ MD = 3.89, 95% CI（0. 84, 6. 93）, P = 0.01 ], the improvement of the peroneal nerve＇s MNCV[ MD =4. 23, 95% C1（3.25,5.22）, P〈0.00001],the improvement of the median nerve＇s sensory nerve conduction veloc-ity （SNCV）[MD=2. 14, 95% CI（1.53, 2.75）, P=0.01] and the improvement of the peroneal nerve＇s SNCV[MD=4.22, 95% CI （2. 97, 5.48）, P〈 0. 000 01] were superior to those of the conventional therapy, the differences showing statistical significance. There was no statistically significant difference in the improvement of blood glucose between the two groups （P 〉 0. 05）. Conclusion Accord- ing to the existing clinical evidences, vinpocetine is effective with good safety for treating DPN. Howerver, due to the disunity of the in- cluded trial quality, more large sample size, high-quality RCTs are needed to confirm.