葛根素治疗糖尿病视网膜病变有效性的Meta分析

Meta-analysis of the effectiveness of puerarin in the treatment of diabetic retinopathy

目的:系统评价葛根素治疗糖尿病视网膜病变的有效性。方法:计算机检索PubMed、Web of Science、Cochrane Library、CNKI、万方和维普数据库,搜集关于葛根素治疗糖尿病视网膜病变的随机对照试验(RCT),检索时限均从建库至2022年7月18日。由2位评价员独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果:共纳入6个研究,包括365例患者。Meta分析结果显示,与对照组相比,葛根素组在提高患者综合疗效有效率方面差异有统计学意义[OR=3.15,95%CI(1.88,5.28),P<0.0001];两组在提高患者视力水平方面差异有统计学意义[MD=0.73,95%CI(0.44,1.01),P<0.00001],使用葛根素组视力改善效果有效率明显高于未使用葛根素组。在调节血液流变学指标方面,在控制全血粘度(高切)[MD=-0.19,95%CI(-3.17,2.78),P=0.90]水平方面差异无统计学意义。调节全血粘度[MD=-0.75,95%CI(-1.04,-0.46),P<0.00001]、全血粘度(低切)[MD=-0.75,95%CI(-1.04,-0.46),P<0.00001]、血浆比粘度[MD=0.13,95%CI(0.05,0.20),P=0.01]、血沉[MD=-1.60,95%CI(-2.97,-0.24),P=0.02]、红细胞聚集指数[MD=-1.20,95%CI(-1.33,-1.07),P<0.00001]水平上差异有统计学意义。结论:现有证据表明,葛根素单用或联合常规治疗糖尿病视网膜病变可提高综合疗效有效率和改善视力水平、血液流变学水平(除全血比粘度(高切)以外)。但受纳入研究数量和质量的限制,上述结论尚待更多高质量研究予以验证。

Objective:To systematically evaluate the effectiveness of puerarin in the treatment of diabetic retinopathy(DR).Method:By searching the databases of PubMed,Cochrane Library,Web of Science,CNKI,WanFang Data and Vip,randomized controlled trials(RCTs)on pueraria in the treatment of DR were collected,and the search time frame was from the database inception to July 18,2022.After two reviewers independently screened the literature,extracted the data and evaluated the risk of bias of the included studies,the meta-analysis was performed by using RevMan 5.3 software.Result:A total of 6 studies including 365 patients were included.The results of meta-analysis showed that the puerarin group had a statistically significant difference in improving the effective rate of comprehensive efficacy in patients compared with the control group(OR=3.15,95%CI(1.88,5.28),P<0.0001).There was a significant difference between the two groups in improving the visual acuity level of the patients(MD=0.73,95%CI(0.44,1.01),P<0.00001),and the effectiveness of visual improvement in the puerarin group was significantly higher than that in the groups without puerarin treatment.In terms of regulating the hemorheological indexes,there was no significant difference in controlling the whole blood viscosity(high cut)(MD=-0.19,95%CI(-3.17,2.78),P=0.90).There were significant differences in adjusting the whole blood viscosity(MD=-0.75,95%CI(-1.04,-0.46),P<0.00001),whole blood viscosity(low cut)(MD=-0.75,95%CI(-1.04,-0.46),P<0.00001),plasma specific viscosity(MD=-0.13,95%CI(0.05,0.20),P=0.01),erythrocyte sedimentation rate(MD=-1.60,95%CI(-2.97,-0.24),P=0.02),and erythrocyte aggregation index(MD=-1.49,95%CI(-1.63,-1.35),P<0.00001).Conclusion:Current evidence shows that puerarin alone or combined with conventional treatment can improve the effective rate of comprehensive efficacy,and the levels of visual acuity and hemorheology(except whole blood specific viscosity(high cut))in the treatment of DR.Nevertheless,the above conclusions need to be further verified by more high-quality studies due to the limitation of the number and quality of included studies.