中医药治疗糖尿病周围神经病变的系统评价再评价

Re-evaluation of System Evaluation of TCM Therapy in the Treatment of Diabetic Peripheral Neuropathy

目的:对中医药治疗糖尿病周围神经病变的系统评价/Meta分析进行再评价。方法:系统检索Pubmed、Cochrane Library、Web of science、Medline complete、中国生物医学文献数据库(CMB)、中国知网(CNKI)、万方数据库(WanFang)及中国维普全文数据库(VIP)中中医药治疗糖尿病周围神经病变的系统评价/Meta分析文献,由2名研究者独立筛选文献并提取资料,采用AMSTAR和GRADE系统工具分别进行方法学质量和证据等级评价。结果:共纳入13篇系统评价/Meta分析文献,包括52个结局指标。AMSTAR工具评价结果显示,报告最差的条目为“是否提供前期设计方案”(12篇未提供),其次为条目“是否考虑检索灰色文献”(11篇不充分)与条目“是否说明相关利益冲突”(7篇未说明)。GRADE分级结果显示,5项结局指标证据质量为中级,其余均为低或极低级,导致降级最主要原因为研究的局限性(52个结局指标)和发表偏倚(45个结局指标)。结论:目前中医药治疗糖尿病周围神经病变疗效的系统评价/Meta分析方法学质量总体不高,证据水平普遍较低,今后的研究应严格按照循证医学科研设计思路进行,从而为中医药治疗糖尿病周围神经病变的临床疗效提供可靠证据。

Objective:To re-evaluate system evaluation or Meta analysis of TCM therapy for diabetic peripheral neuropathy(DPN).Methods:The literature on system evaluation or Meta analysis of TCM therapy for DPN was collected by retrieving from Pubmed,Cochrane Library,Web of science,Medline complete,CMB,CNKI,Wanfang and VIP.Two investigators indepently screened the literature and extracted the data,AMSTAR and GRADE system tools were used to assess the quality of methodology and evidence grades respectively.Results:The study included 13 papers on system evaluation or Meta analysis,containing 52 outcome indicators.The results of AMSTAR tool displayed that the worst item reported was"whether to provide the early-stage design"(unprovided in 12 papers),the next was the item"whether to consider searching grey literature"(inadequate in 11 papers)and the one"whether to illustrate conflict of interest"(unspecified in seven articles).GRADE classfication results showed that the evidence of five outcome indicators was of intermediate quality,and others were of low or very low quality,the main reasons of causing degradation were limitations of the study(53 outcome indicators)and publication bias(45 outcome indicators).Conclusion:Since the methodological quality of system evaluation or Meta analysis of TCM therapy for DPN is generally not high,and the evidence is in lower level,the future studies should strictly be designed according to the idea of evidence-based medicine scientific research,thus providing reliable evidence for clinical efficacy of TCM therapy for DPN.