己酮可可碱治疗糖尿病神经病变效果与安全性系统评价

A systematic review of the efficacy and safety of pentoxifylline in the treatment of diabetic neuropathy

目的系统评价己酮可可碱(pentoxifylline,PTX)治疗糖尿病神经病变(diabetic neuropathy,DN)的疗效与安全性。方法系统检索Pub Med、Embase、Cochrane Library、Web of Science、OVID、中国生物医学文献数据库、维普数据库、万方数据库及中国知网,搜集关于己酮可可碱治疗DN的研究,检索时限为建库至2019年12月10日,语种限定为中文和英文。由两位研究者独立筛选文献并对纳入研究进行方法学质量评价,再提取资料,然后进行定性分析。结果共纳入16篇原始研究,合计研究对象928例。其中随机对照试验11篇,类实验性研究5篇。纳入研究的主要结局指标有血液流变学指标、神经传导速度、电流感觉阈值、疼痛、密歇根神经筛查量表、血糖、血压、血脂、勃起功能及不良反应。结论 PTX可增加DN患者红细胞变形能力,降低全血黏度、血浆黏度、血小板最大聚集率、纤维蛋白原及红细胞聚集指数,可用于临床DN的辅助治疗,且相对安全。

Objective To evaluate the efficacy and safety of pentoxifylline(PTX) in the treatment of diabetic neuropathy(DN).Methods PubMed,Embase,Cochrane Library,Web of Science,Ovid,Chinese Biomedical Literature Database,VIP database,Wanfang database and China National Knowledge Internet were systematically searched to collect the sudies on the treatment of DN with PTX.The search duration was from the establishment of the database to December 10,2019,and the languages were limited to Chinese and English.Two researchers independently screened the literature,evaluated the methodological quality of the included sudies,extracted the data,and then conducted qualitative analysis.Results A total of 16 original studies were included,with a total of 928 subjects.There were 11 randomized controlled trials and 5 quasi-randomized controlled trials.The main outcome indicators included in the study were hemorheology,nerve conduction velocity,current perception threshold,pain,Michigan neuropathy screening instrument,blood glucose,blood pressure,blood lipid,erectile function and adverse reactions.Conclusion PTX can increase erythrocyte deformability,reduce whole blood viscosity,plasma viscosity,maximum platelet aggregation rate,fibrinogen and erythrocyte aggregation index in patients with DN.It can be used as an adjuvant treatment for DN and is relatively safe.