α-硫辛酸联合依帕司他治疗糖尿病周围神经病变的系统评价与meta分析

α-lipoic acid combined with epalrestat for diabetic peripheral neuropathy:system evaluation and meta-analysis

目的系统评价α-硫辛酸联合依帕司他治疗糖尿病周围神经病变(Diabetic peripheral neuropathy DPN)的疗效。方法检索中国学术期刊全文数据库(Pub Med、Cochrane、EMbase、CNKI)、中国生物医学文献数据库(CBM)、维普期刊全文数据库(VIP)、万方数据库(Wan Fang)中的关于α-硫辛酸联合依帕司他治疗糖尿病周围神经病变的随机对照试验(自建库至2016年12月)。根据Cochrane系统评价手册,由2名研究者独立筛选文献、评价质量和提取数据后,采用Review Manager 5.3软件对数据进行分析。结果共13个随机对照试验(RCTs)(包括1 196例患者)纳入研究。对照组:依帕司他(A组)/α-硫辛酸(B组);试验组:α-硫辛酸联合依帕司他。从提高正中神经感觉、运动速度的角度看,试验组胜过对照组,差异有统计学意义,感觉(A组:SMD=1.97,95%CI:0.55~3.39,P<0.01;B组:SMD=1.39,95%CI:0.88~1.91,P<0.01),运动(A组:SMD=1.76,95%CI:0.52~3.01,P<0.01;B组:SMD=1.58;95%CI:0.88~2.28,P<0.01)。就提高腓总神经感觉(B组)、运动传导速度而言,试验组亦胜过对照组,差异有统计学意义,感觉(B组:SMD=1.15,95%CI:0.79~1.52,P<0.01),运动(A组:SMD=2.07,95%CI:0.66~3.48,P<0.01;B组:SMD=1.18,95%CI:0.88~2.67,P<0.01);在提高腓总神经感觉(A组)传导速度方面,差异无统计学(SMD=0.61,95%CI:-0.44~1.66,P>0.05)。结论与单独用药相比,α-硫辛酸联合依帕司他治疗糖尿病周围神经病变的疗效更胜一筹。

[Objective] To evaluate the efficacy of α-lipoic acid combined with epalrestat for diabetic peripheral neuropathy （DPN）. [Methods] The databases of PubMed, Coehrane,EMbase, CNKI CBM,VIP and WanFang were searched to collect ran- domized controlled trials （RCTs） about α-lipoic acid combined with epalrestat in treatment of DPN,which were published from database establishment to December 2016. Two researchers independently selected studies,assessed study quality and extracted data according to the evaluation system of Cochrane Handbook,and the included RCTs were analyzed by using Review Manager 5.3 software.[Results] A total of 13 RCTs including 1 196 patients were analyzed. The control groups included epalrestat（group A）α-lipoic acid group （group B ）, and the experimental group was ct-lipoic acid combined with epalrestat group. In the aspect of improving conduction velocity of sensory and motor nerve of nervus medianus, experimental group were superior to the control group, and there were statistically significant differences ： sensory （group A ： SMD = 1.97,95% C1：0.55-3.39,P〈0.01 ; group B ： SMD=1.39,95%CI：0.88-1.91 ,P〈O.01 ）,motor （group A： SMD=1.76,95%CI：0.52-3.01 ,P〈O.O1 ;group B： SMD=1.58,95%CI： 0.88-2.28,P〈0.01）. In the aspect of improving conduction velocity of sensory （group B） and motor nerve of nervus peroneus eommunis, experimental group were superior to the control group,there were statistically significant differences： sensory （group B：SMD=l.15,95%CI：O.79-l.52,P〈O.O1）,motor （group A：SMD=2.07,95%C1：O.66-3.48,P〈O.O1;group B：SMD=l.18,95%CI： 0.88-2.67 ,P〈0.01 ）. In the aspect of improving conduction velocity of sensory （group A） of nervus peroneus communis, there were no statistically significant differences （SMD =0.61,95% CI： -0.44-1.66,P 〉0.05）. [ Conehtsion ] α-lipoie acid combined with epalrestat in treatment of diabetic peripheral neuropathy is superior to either a-lipoic acid or epalrestat.