蜂蜜敷料治疗糖尿病足溃疡疗效和安全性:Meta分析

Efficacy and safety of honey dressing in the treatment of diabetic foot ulcers: a Meta-analysis

目的评价蜂蜜敷料治疗糖尿病足溃疡(DFU)的疗效和安全性。方法检索PubMed、EMbase、Web of Science、The Cochrane Library、CBM、CNKI、万方、维普数据库中有关蜂蜜敷料治疗DFU的随机对照试验(RCT),检索时限为建库至2017年12月,采用RevMan5.3进行数据合并,Egger′s和Begg′s检验进行发表偏倚检测,GRADE profiler 3.6进行证据等级评价。结果共纳入8个RCT,合计767例患者。Meta分析显示,蜂蜜敷料组DFU完全愈合率(RR=1.32,95%CI:1.10~1.57,P=0.003)、平均愈合时间(SMD=-1.12,95%CI:-2.06^-0.19,P=0.02)、愈合百分比(SMD=1.84,95%CI:0.27~3.42,P=0.02)及细菌完全清除率(RR=2.56,95%CI:1.33~4.92,P=0.005)方面优于对照组;两组截肢/趾率比较,差异无统计学意义(RR=0.55,95%CI:0.19~1.54,P=0.25);纳入文献均未报道严重不良反应;GRADE推荐等级为B级,中等程度推荐。结论蜂蜜敷料是一种相对安全有效的DFU治疗方法,可以尝试在临床上进行探索性应用。

Objective To evaluate the efficacy and safety of honey dressing in the treatment of diabetic foot ulcers (DFU). Methods Databases of PubMed, EMbase, Web of Science, The Cochrane Library, CBM, CNKI, WanFang and VIP were searched to collect randomized controlled trials (RCT) about the honey dressing for DFU from database building to December, 2017. RevMan5.3 was used for data merge, Egger′s and Begg′s test were used for publication bias detection. GRADE profiler 3.6 was used for evidence grades assessment. Results A total of 8 RCTs involving 767 patients with DFU were included in this study. The results showed that honey dressing was more favorable than control dressing in complete healing rate (RR=1.32, 95%CI: 1.10-1.57, P=0.003), mean healing time (SMD=-1.12, 95%CI:-2.06--0.19, P=0.02), percentage of healing (SMD=1.84, 95%CI: 0.27-3.42, P=0.02) and wound bacterial clearance rate (RR=2.56, 95%CI: 1.33-4.92, P=0.005), while there was no significant difference between these two groups in amputation rate (RR=0.55, 95%CI: 0.19-1.54, P=0.25). No serious side effects were reported in all of these studies. GRADE recommendation level is B grade, medium recommendation. Conclusion Honey dressing is a relatively safe and effective method in the treatment of DFU.