五种常用中医外治法联合常规西药治疗糖尿病周围神经病变有效性和安全性的贝叶斯网状Meta分析

Efficacy and Safety of the Five Commonly Used External Therapies of TCM Combined with Conventional Western Medicine in Treating Diabetic Peripheral Neuropathy:a Bayesian Network Meta-analysis

背景糖尿病周围神经病变(DPN)是糖尿病患者常见并发症之一,而以针刺为代表的中医外治法在治疗DPN方面有一定优势,但何种中医外治法联合常规西药治疗DPN的疗效较好尚缺少循证医学证据。目的采用贝叶斯网状Meta分析评价5种常用中医外治法联合常规西药治疗DPN的有效性和安全性。方法经预调查后确定常用的DPN中医外治法有5种,分别为针刺、中药足浴、穴位按摩、穴位注射、艾灸。采用计算机检索Cochrane Library、Web of Science、PubMed及中国生物医学文献服务系统(SinoMed)、维普网(VIP)、万方数据知识服务平台(Wanfang Data)、中国知网(CNKI),检索时限均为建库至2020-12-29,筛选关于上述5种常用中医外治法联合常规西药治疗DPN有效性和安全性的随机对照试验(RCTs)。运用RevMan 5.3、Stata 15.0、ADDIS 1.16.6软件完成绘图及数据分析。结果最终纳入44项RCTs,包含3471例DPN患者。贝叶斯网状Meta分析结果显示,5种常用中医外治法联合常规西药在提高总有效率方面均优于单纯使用常规西药治疗,其中针刺效果最佳〔OR=0.20,95%CI(0.11,0.36)〕;除穴位按摩之外,其他4种常用中医外治法联合常规西药在改善正中神经运动传导速率(MNCV)方面均优于单纯使用常规西药治疗,其中中药穴位注射效果最佳〔MD=-4.50,95%CI(-5.91,-3.11)〕;5种常用中医外治法联合常规西药在改善正中神经感觉传导速率(SNCV)方面均优于单纯使用常规西药治疗,其中艾灸效果最佳〔MD=-9.03,95%CI(-12.59,-5.47)〕;除穴位按摩之外,其他4种常用中医外治法联合常规西药在改善腓总神经MNCV方面均优于单纯使用常规西药治疗,其中艾灸效果最佳〔MD=-6.34,95%CI(-9.31,-3.30)〕;除穴位按摩之外,其他4种常用中医外治法联合常规西药在改善腓总神经SNCV方面均优于单纯使用常规西药治疗,其中针刺效果最佳〔MD=-5.70,95%CI(-8.03,-3.31)〕。结论基于现有文献证据优先推荐针刺联合常规西药治疗DPN,尤其是在提高总有效率和改善腓总神经SNCV方面,但仍需更多高质量研究进一步验证。

Background Diabetic peripheral neuropathy(DPN)is one of the common complications in diabetic patients,and TCM external therapies represented by acupuncture has some advantages in treating DPN,but what combination of TCM external therapies and conventional Western medicine has the best efficacy in treating DPN is still lacking evidence-based medical studies.Objective To evaluate the efficacy and safety of the five commonly used external therapies of TCM combined with conventional Western medicine in treating DPN by Bayesian Network Meta-analysis.Methods The five commonly used external therapies of TCM confirmed by pre-survey were acupuncture,foot bath,acupoint massage,acupoint injection and moxibustion,respectively.The Cochrane Library,Web of Science,PubMed,SinoMed,VIP,Wanfang Data and CNKI were searched by computer from their inception to December 29th,2020,to screen randomized controlled trials(RCTs)about efficacy and safety of the five commonly used external therapies of TCM combined with conventional Western medicine in treating DPN.RevMan 5.3,Stata 15.0 and ADDIS 1.16.6 software were used for plotting and data analysis.Results A total of 44 RCTs were enrolled,including 3471 patients with DPN.Bayesian network Meta-analysis showed that the five commonly used external therapies of TCM combined with Western medicine were all superior to conventional Western medicine alone in improving overall efficacy rate,of which acupuncture had the best effect〔OR=0.20,95%CI(0.11,0.36)〕.Except for acupoint massage,the other four commonly used external therapies of TCM combined with conventional Western medicine were all superior to conventional Western medicine alone in improving median nerve motor conduction velocity(MNCV),with acupoint injection being the most effective〔MD=-4.50,95%CI(-5.91,-3.11)〕.The five commonly used external therapies of TCM combined with conventional Western medicine were all superior to conventional Western medicine alone in improving median nerve sensory conduction velocity(SNCV),in which moxibustion had the best effect〔MD=-9.03,95%CI(-12.59,-5.47)〕.Except for acupoint massage,the other four commonly used external therapies of TCM combined with conventional Western medicine were all superior to conventional Western medicine alone,with moxibustion having the best effect〔MD=-6.34,95%CI(-9.31,-3.30)〕.Except for acupoint massage,the other four commonly used external therapies of TCM combined with conventional western medicine were all superior to conventional Western medicine alone in improving SNCV of the common peroneal nerve,with acupuncture showing the best efficacy〔MD=-5.70,95%CI(-8.03,-3.31)〕.Conclusion Acupuncture combined with conventional Western medicine is recommended preferentially in treating DPN based on available literature evidence,especially in improving overall efficacy rate and SNCV of the common peroneal nerve,but more high-quality studies are still needed for further validation.