中西医结合治疗糖尿病性黄斑水肿的Meta分析

A meta-analysis of treating diabetic macular edema in the integrative medicine

目的:基于Meta分析评价单纯西医与中西医结合治疗糖尿病性黄斑水肿的临床疗效的差异。方法:分别在中国知网、万方数据库、维普中文科技期刊数据库、中国生物医学文献服务系统、PubMed、Cochrane图书馆、Embase收集自建库至2021年3月的中西医结合治疗糖尿病性黄斑水肿的随机对照试验,提取最佳矫正视力(Best Corrected Visual Acuity,BCVA)、黄斑中心凹视网膜厚度(Central Macular Thickness,CMT)、荧光素钠血管造影(Fluorescein Fundns Anglography,FFA)黄斑区荧光渗漏、不良反应、临床疗效5个结局指标的数据。Meta分析采用RevMan 5.3统计软件。结果:纳入文献13篇,共包括1037只眼,中西医结合组504只眼,西医组533只眼。Meta分析结果提示,中西医结合组在随访1周、1个月、2个月、3个月、6个月时CMT的改善明显优于西医组,差异有统计学意义;中西医结合组在随访1个月、6个月时BCVA改善明显优于西医组;中西医结合组在1个月、3个月、6个月时FFA黄斑区荧光渗漏情况明显减轻或消失,差异具有统计学意义;在不良反应发生率方面,两组的差异不具有统计学意义。结论:与单纯西医治疗糖尿病性黄斑水肿相比,中西医结合治疗可以更好地提高患者的BCVA、降低CMT及FFA黄斑区荧光渗漏即减轻黄斑水肿,但并不能减少炎症等相关的不良反应。鼓励临床医师在西医常规治疗的基础上,在中医理论的指导下联合使用相关中药。

Objective:The difference in clinical efficacy between simple Western medicine alone and the integrative medicine on treating diabetic macular edema was analyzed and evaluated based on a Meta-analysis.Methods:The randomized controlled trials of treating diabetic macular edema in the integrative medicine from the establishment of the databases to March 2021 were retrieved from CNKI,Wanfang Database,VIP,Sino Med,Pubmed,the Cochrane Library and Embase databases.The data of 5 outcome indicators such as BCVA,CMT,fluorescence leakage in macular area under FFA,adverse reactions and clinical efficacy were extracted.The Meta-analysis was performed by RevMan 5.3 statistical software.Results:13 studies were included.There were 1037 eyes,including 504 eyes in the integrative medicine group and 533 eyes in the Western medicine group.The results of the Meta-analysis indicated that the amelioration of CMT in the integrative medicine group was significantly better than the Western medicine group during the followed-up period of 1 week,1 month,2 months,3 months and 6 months,and the difference was statistically significant.The amelioration of BCVA in the integrative medicine group was significantly better than the Western medicine group during the followed-up period of 1 month and 6 months.The fluorescence leakage in macular area under FFA in the integrative medicine group was significantly reduced or disappeared at 1 month,3 months and 6 months,and the difference between the two groups was statistically significant.The difference was not statistically significant in the incidence of adverse reactions between the two groups.Conclusion:Compared with Western medicine treatment,the integrative medicine treatment can improve BCVA,reduce CMT and fluorescence leakage in macular area under FFA of diabetic macular edema patients,but can not reduce the incidence of adverse reactions.Clinicians are encouraged to apply traditional Chinese medicine plus conventional Western medicine to treat diabetic macular edema under the guidance of traditional Chinese medicine theory.