中药熏洗联合西药治疗糖尿病周围神经病变疗效的系统评价

Effectiveness of Traditional Chinese Medicine Fumigation on Diabetic Peripheral Neuropathy: A Systematic Review

目的评价中药熏洗联合西药治疗糖尿病周围神经病变的疗效。方法计算机检索CBM、VIP、CNKI、Wan Fang Data及Pub Med、EMbase、Cochrane Library数据库,并结合人工筛查相关期刊及论文参考文献,筛查符合纳入标准的随机对照试验,文献检索时间均从建库至2014年1月。依据Cochrane handbook文献质量评价标准,对纳入文献进行方法学质量评价。使用Rev Man 5.1进行数据合并分析,结局数据依据研究疗程差异进行亚组分析。结果纳入32篇随机对照试验,包含2 886例受试者。Meta分析结果显示,(1)总有效率:中药熏洗组的总有效率显著优于对照组[RR=1.34,95%CI(1.28,1.39),P=0.00]。(2)不同疗程有效率:2周疗程,中药熏洗组的总有效率优于对照组[RR=1.24,95%CI(1.13,1.36),P=0.00];1个月疗程,中药熏洗组的总有效率优于对照组[RR=1.35,95%CI(1.27,1.43),P=0.00];2个月疗程,中药熏洗组的总有效率高于对照组,[RR=1.53,95%CI(1.32,1.78),P=0.00]。(3)其他指标有效率:中药熏洗组的腓总神经运动神经传导速度[MD=2.58,95%CI(1.77,3.40),P=0.00]、腓总神经感觉神经传导速度[MD=2.04,95%CI(1.08,3.00),P=0.00]、血浆黏度[SMD=-1.02,95%CI(-1.35,-0.69),P=0.00]优于对照组,且差异具有统计学意义。结论中药熏洗联合西药治疗糖尿病周围神经病变具有显著疗效,但纳入文献的方法学质量不高,使证据的临床推广应用受到限制。

Objective To evaluate the effectiveness of traditional Chinese medicine fumigation on patients with diabetes peripheral neuropathy. Methods The retrieval as well as manual screening of related journal and references were conducted in databases including CBM, VIP Database, CNKI, WanFang Database, PubMed, EMbase and the Cochrane Library databases from inception to January 2014 to search randomized controlled trials according to inclusion and excluding criteria. The methodological quality of the studies was evaluated by the Cochrane handbook of literature quality evaluation method, and then relevant data were pooled by RevMan5.1 software for meta-analysis. Subgroup analysis was conducted by the duration of interventions. ResuIts Thirty-two randomized controlled trials involving 2886 patients were included. Meta-analysis results showed that： （1） the overall effective rate of traditional Chinese medicine fumigation group was significantly higher than that of control group[RR=1.34, 95% CI（1.28, 1.39）, P=0.00]. （2）For two-week/ one-month/ two-month course of treatment： the overall effective rate of traditional Chinese medicine fumigation group was higher than that of control group [RR=1.24, 95% CI （1.13, 1.36）, P=0.00; RR=1.35, 95% CI （1.27, 1.43）, P=0.00; RR=1.53, 95%CI （1.32, 1.78）, P=0.00 respectively]. （3） The traditional Chinese medicine fumigation group performed better in terms of motor nerve conduction velocity [MD=2.58, 95% CI （1.77, 3.40）, P=0.00], sural total nerve sensory nerve conduction velocity [MD=2.04, 95%CI （1.08, 3.00）, P=0.00] and plasma viscosity [SMD=1.02, 95%CI （-1.35, -0.69）, P=0.00], with statistical difference. ConcIusion The effectiveness of Chinese medicine fumigation for diabetic peripheral neuropathy is significant, but the clinical practice is limited by the low quality of included trials.