Review of systematic reviews of acupuncture for diabetic peripheral neuropathy

针刺治疗糖尿病性周围神经病变系统评价的再评价

Objective:To review the systematic reviews of acupuncture for diabetic peripheral neuropathy(DPN)and to provide evidence for clinical decisions.Methods:Published systematic reviews targeting acupuncture treatment of DPN were searched using computer through both Chinese and English databases till July 1,2019.Two researchers screened the papers based on inclusion and exclusion criteria and conducted report quality evaluation,methodological quality assessment and evidence quality grading using the preferred reporting items for systematic reviews and meta-analyses(PRISMA),assessment of multiple systematic review 2(AMSTAR 2)and grading of recommendations assessment,development and evaluation(GRADE).Results:Ten systematic reviews were included,involving 11 outcome measures.According to PRISMA,6 items were sufficiently reported while 1 item was not;AMSTAR 2 appraised that all the included systematic reviews were of low quality in the methodological evaluation;according to GRADE,of the 30 clinical evidences,only 5 were graded moderate while the remained were graded low or extremely low.Descriptive analysis showed that acupuncture can significantly improve DPN symptoms,accelerate the conduction velocities of sensory and motor nerves,and up-regulate the content of plasma nitric oxide(NO),while the adverse reaction rate was low.Conclusion:Acupuncture can produce satisfactory clinical efficacy in treating DPN,but the existing problems,such as low-quality evidence,unitary outcome measures,poor methodological quality of systematic reviews and nonstandard reporting,need to be treated cautiously;meanwhile,more high-quality clinical trials are required to elevate the level of evidence.

目的:对针刺治疗糖尿病性周围神经病变(DPN)的系统评价进行再评价,以为临床决策提供依据.方法:计算机检索中英文数据库中有关针刺治疗DPN的系统评价,检索时间至2019年7月1日,由两名研究者根据纳入、排除标准进行文献筛选,对最终纳入文献使用荟萃分析报告标准(PRISMA)、系统评价质量评价工具(AMSTAR 2)和证据质量分级和推荐强度系统(GRADE)方法进行报告质量评价、方法学质量评价和证据质量等级评价.结果:共纳入10个系统评价,11个结局指标.PRISMA评价结果为6个条目报告充分,1个条目报告最不充分;AMSTAR 2方法学质量评价结果为所有系统评价均为极低质量;GRADE分级显示30个临床证据中仅有5个中级证据,其余均为低级证据或极低级证据.描述分析结果显示针刺能明显改善DPN症状,提高感觉神经及运动神经的传导速度,提高血浆一氧化氮(NO)含量,且不良反应发生率低.结论:针刺治疗DPN具有较好的临床疗效,但存在证据质量太低、结局指标太过单一、系统评价方法学质量较低、报告不规范等问题,临床使用应谨慎对待,同时需要更多高质量临床试验来提升证据级别.