中药熏洗辅助治疗糖尿病痛性神经病变的Meta分析

A meta-analysis of TCM medicine fumigation and washing in the adjuvant treatment of diabetic painful neuropathy

目的:系统评价中药熏洗辅助治疗糖尿病痛性神经病变的临床疗效,为临床应用提供循证医学依据。方法:综合检索中国知网、万方医学网、维普中文数据库、中国生物医学文献数据库、PubMed、EMbase和Cochrane Library数据库,检索时间为建库至2022年3月,收集中药熏洗联合常规西医治疗(试验组)对比单用常规西医治疗(对照组)对糖尿病痛性神经病变临床疗效的随机对照试验。由2位研究人员独立依据纳入和排除标准进行筛选并提取文献数据,应用Cochrane偏倚风险评价工具进行质量评价,应用RevMan 5.3软件进行Meta分析。结果:共纳入9项符合标准的临床随机对照试验,总样本量686例,包括试验组346例、对照组340例,纳入文献的总体质量一般。Meta分析结果显示,在提高临床总有效率方面试验组优于对照组,差异有统计学意义(RR=1.43,95%CI=[1.30,1.58],P<0.00001);在降低视觉模拟评分(Visual Analogue Scale,VAS)方面试验组优于对照组,差异有统计学意义(MD=-1.86,95%CI=[-2.06,-1.67],P<0.00001)。结论:中药熏洗辅助治疗糖尿病痛性神经病变有较好的疗效,应用中药熏洗辅助治疗可以进一步改善临床症状,减轻疼痛程度,具有一定的临床应用前景。由于纳入文献的整体质量及数量限制,结论仍需要高质量、多中心、大样本的随机对照试验进一步验证。

Objective:To evaluate the clinical efficacy of fumigation and washing with TCM medicine in the treatment of diabetic painful neuropathy,and to provide evidence-based medicine for the clinical application.Methods:The databases of CNKI,Wanfang,VIP,SinoMed,PubMed,EMbase and Cochrane Library were searched from their establishment to March 2022.Randomized controlled trials of the clinical efficacy of TCM medicine fumigation and washing plus conventional Western medicine treatment(the experimental group)versus conventional Western medicine treatment alone(the control group)were collected for diabetic painful neuropathy.Two researchers independently screened and extracted literature data according to inclusion and exclusion criteria.Cochrane bias risk assessment tool was used for quality evaluation,and RevMan 5.3 software was used for meta-analysis.Results:A total of 9 randomized controlled clinical trials meeting the criteria were included,with a total sample size of 686 cases,including 346 cases in the experimental group and 340 cases in the control group.The overall quality of the included literatures was average.The results of meta-analysis showed that the experimental group was better than the control group in improving the total clinical response rate,the difference was statistically significant(RR=1.43,95%CI=[1.30,1.58],P<0.00001).Visual analog scale(VAS)reduction in the experimental group was better than that in the control group,and the difference was statistically significant(MD=-1.86,95%CI=[-2.06,-1.67],P<0.00001).Conclusion:The adjuvant treatment of TCM medicine fumigation and washing has a good effect in the treatment of diabetic painful neuropathy,the application of TCM medicine fumigation adjuvant treatment can further relieve the clinical symptoms,reduce the degree of pain,which has certain clinical application prospect.Due to the overall quality and quantity limitations of the included literature,the conclusion still need to be further verified by high-quality,multi-center,large-sample randomized controlled trials.