中医适宜技术治疗糖尿病病人胰岛素注射相关皮下脂肪增生有效性和安全性的Meta分析

Efficacy and safety of appropriate techniques of traditional Chinese medicine in the treatment of subcutaneous fat hyperplasia associated with insulin injection in patients with diabetes:a Meta-analysis

目的:系统性评价中医适宜技术治疗糖尿病病人胰岛素注射相关皮下脂肪增生的疗效和安全性。方法:检索中国知网、万方数据库、维普数据库、PubMed、EMbase、the Cochrane Library数据库从建库至2022年7月1日发表的文献,进行文献筛选与资料提取。纳入使用中医适宜技术治疗胰岛素注射相关皮下脂肪增生的随机对照试验,通过Cochrane Reviews Handbook 5.1.0推荐的工具进行偏倚风险评估,使用RevMan V.5.4软件分析结局指标。结果:共纳入13篇文献,12项中医适宜技术(3项灸法和9项中药外敷法),涉及1 007例病人,Meta分析结果显示:与对照组相比,中医适宜技术治疗皮下脂肪增生总有效率更高[RR=1.30,95%CI(1.22,1.38),P<0.01],能进一步降低空腹血糖[MD=-0.47,95%CI(-0.91,-0.02),P=0.04]和餐后2 h血糖[MD=-0.78,95%CI(-1.25,-0.30),P<0.01],不良反应发生率更低[RR=0.56,95%CI(0.33,0.95),P=0.03];但在减少皮下硬结面积方面二者差异无统计学意义[MD=-6.93,95%CI(-15.43,1.57),P=0.11]。结论:现有证据表明,中医适宜技术能有效治疗胰岛素注射相关皮下脂肪增生,比传统方法疗效更好,安全性更高。

Objective:To systematically evaluate the efficacy and safety of traditional Chinese medicine(TCM)in treating diabetic patients with insulin injection-related subcutaneous fat hyperplasia.Methods:Literatures were retrieved from CNKI,WanFang Database,VIP,PubMed,EMbase,the Cochrane Library.The retrieval time was the literature published from the establishment of the database to July 1,2022,and literature screening and data extraction were conducted.Randomized controlled trials using appropriate techniques of traditional Chinese medicine for the treatment of insulin injection-related subcutaneous fat hyperplasia were included.Bias risk was assessed using tools recommended by Cochrane Reviews Handbook 5.1.0.RevMan V.5.4 software was used to analyze outcome indicators.Results:A total of 13 articles were included,12 TCM appropriate techniques(3 moxibustion methods and 9 TCM external application methods),involving 1007 patients.The results of Meta-analysis suggested that,compared with the control group,the total effective rate of the treatment of subcutaneous fat hyperplasia with the appropriate technique of traditional Chinese medicine was higher[RR=1.30,95%CI(1.22,1.38),P<0.01],which could further reduce the fasting blood glucose[MD=-0.47,95%CI(-0.91,-0.02),P=0.04]and 2 h postprandish blood glucose[MD=-0.78,95%CI(-1.25,-0.30),P<0.01],and the incidence of adverse reactions was lower[RR=0.56,95%CI(0.33,0.95),P=0.03].However,there was no significant difference in the reduction of subcutaneous indural area[MD=-6.93,95%CI(-15.43,1.57),P=0.11].Conclusion:Existing evidence shows that the appropriate technique of traditional Chinese medicine can effectively treat the hyperplasia of subcutaneous fat associated with insulin injection,and it has better efficacy and higher safety than traditional methods.