复方血栓通联合羟苯磺酸钙口服治疗糖尿病视网膜病变的系统评价

Systematic review of Fufang Xueshuan Tong combined with calcium dobesilate in treating diabetic retinopaphy

[目的]系统评价复方血栓通联合羟苯磺酸钙口服治疗糖尿病视网膜病变的有效性,设计相关临床随机对照试验(RCT)的系统评价。[方法]计算机检索中国期刊全文数据库(CNKI)、维普资讯中文期刊服务平台(VIP)、万方期刊数据库、中国生物医学文献数据库(CBM)、PubMed、Cochrane图书馆数据库(时间由建库截止到2018年3月),筛选符合纳入标准的RCT,按照Cochrane系统评价员手册偏倚风险评估标准对纳入文献进行偏倚风险评价,提取相关数据,使用Review Manager 5.3进行Meta分析。[结果]符合纳入标准的有13篇文献,Meta分析结果显示能提高临床综合疗效[OR=5.69,95%CI(3.54,9.14),P<0.000 01];改善眼底情况:视野灰度值[WMD=-1.00,95%CI(-1.15,-0.86),P<0.000 01]、血管瘤体积[WMD=-3.43,95%C(I-4.22,-2.64),P<0.000 01]、出血斑面积[WMD=-1.06,95%CI(-1.39,-0.72),P<0.000 01];改善中医症状积分[WMD=-3.93,95%C(I-4.87,-2.99),P<0.000 01];降低全血低切黏稠度[WMD=-0.61,95%C(I-1.01,-0.22),P<0.002];减少复发[OR=0.13,95%CI(0.04,0.47),P=0.002];另外,各有2项研究显示复方血栓通联合羟苯磺酸钙口服能够降低血清血管内皮因子(VEGF)和胰岛素样生长因子1(IGF-1)、高敏C反应蛋白(hs-CRP)。[结论]对比单纯使用羟苯磺酸钙、复方血栓通与羟苯磺酸钙联合口服,能够进一步提高治疗糖尿病所引发的视网膜病变的综合疗效,对改善患者眼底情况效果尤其明显,但是尚需要更多高质量RCT来提高研究水平。

[Objective] To evaluate the therapeutic effect of Fufang Xueshuan Tong combined with calciumdobesilate in treating diabetic retinopaphy. To design a systematic review of randomized controlled trials.[Methods] Search databases as CNKI,VIP,Wanfang,CBM, PubMed and Cochrane Library (time from build libraries to March 2018) relevant journals and the literature of RCTs of the combination of Fufang Xueshuan Tong and calciumdobesilate in treating diabetic retinopaphy were all enrolled. To evaluate the bias of the literature according to the standard of the Cochrane system evaluation member manual bias risk assessment and extract the data. The meta-analyses were performed with Review Manager 5.3 software.[Results] Thirteen articles were enrolled. The result of Meta-analyses showed that intervention measures could improve the clinical comprehensive effect [OR=5.69,95%CI (3.54,9.14),P<0.000 01],improve fundus situation(vision grayscale values [WMD=-1.00,95%CI(-1.15,-0.86),P<0.000 01],the volume of hemangioma [WMD=-3.43,95%CI (-4.22,-2.64),P<0.000 01],the contact area [WMD=-1.06,95%CI (-1.39,-0.72),P<0.000 01]),increase TCM symptom complex score [WMD=-3.93,95%CI(-4.87,-2.99),P<0.000 01], reduce the whole blood viscosity [WMD=-0.61,95%CI(-1.01,-0.22),P< 0.002],reduce recurrence [OR=0.13,95%CI(0.04,0.47),P=0.002]. Besides,four articles indicated that fufangxueshuantong combined with calciumdobesilate could reduce the levels of VEGF,IGF-1 and hs-CRP.[Conclusion] The combination of Fufang Xueshuan Tong and calciumdobesilate would enhance the comprehensive therapeutic effect of diabetic retinopaphy. However,we need more high-quality RCTs to improve the research.