益气养阴活血法治疗糖尿病视网膜病变的meta分析

Meta-analysis on the treatment of diabetic retinopathy by Yiqi Yangyin Huoxue method

目的系统评价益气养阴活血法治疗糖尿病视网膜病变(diabetic retinopathy,DR)的临床疗效。方法检索中国生物医学文献数据库(CBM)、中文科技期刊数据库(重庆维普)、中国知识资源总库(CNKI)、中国学术期刊数据库(万方数据)、Cochrane Library和PubMed数据库建库至2021年12月31日有关益气养阴活血法治疗DR的临床研究文献,应用RevMan 5.3软件进行meta分析。结果共纳入文献18篇,涉及患者1487例。Meta分析结果显示,应用益气养阴活血法治疗DR在提高临床总有效率[RR(95%CI)为1.31(1.21,1.41),P<0.001],改善视力[MD(95%CI)为0.12(0.07,0.17),P<0.001],改善全血低切还原黏度[MD(95%CI)为-2.80(-3.76,-1.84),P<0.001]、全血高切还原黏度[MD(95%CI)为-0.69(-1.15,-0.24),P=0.003]、血浆黏度[MD(95%CI)为-0.31(-0.51,-0.12),P=0.002],降低血清VEGF水平[SMD(95%CI)为-1.04(-1.26,-0.81),P<0.001],改善中医证候积分[MD(95%CI)为-3.79(-6.16,-1.42),P=0.002],降低TNF-α水平[SMD(95%CI)为-2.53(-3.55,-1.50),P<0.001]方面优于单纯西医疗法(P<0.05)。结论应用益气养阴活血法治疗DR,可改善患者视力、血液流变学指标和中医证候,提高临床总有效率,降低VEGF和TNF-α水平,临床安全性较好,但仍需大样本、高质量研究支持结论。

Objective To systematically evaluate the clinical efficacy of Yiqi Yangyin Huoxue method for the treatment of diabetic retinopathy(DR).Methods Clinical research literature about Yiqi Yangyin Huoxue method for the treatment of DR was retrieved from China Biomedical Literature Database(CBM),VIP information Chinese Periodical Service Platform(VIP),China National Knowledge Infrastructure(CNKI),Wanfang data,Cochrane Library and PubMed database from the establishment of the databases to December 31,2021.RevMan5.3 software was used for meta-analysis.Results A total of 18 articles were included,with a total of 1487 patients.The results of meta-analysis showed that Yiqi Yangyin Huoxue method for the treatment of DR had curative effect advantages in improving the total clinical effective rate[RR=1.31,95%CI(1.21,1.41),P<0.001],the vision[MD=0.12,95%CI(0.07,0.17),P<0.001],the level of whole blood reduced viscosity low shear[MD=-2.80,95%CI(-3.76,-1.84),P<0.001],the level of whole blood reduced viscosity high shear[MD=-0.69,95%CI(-1.15,-0.24),P=0.003],and plasma viscosity[MD=-0.31,95%CI(-0.51,-0.12),P=0.002],decreasing serum vascular endothelial growth factor[SMD=-1.04,95%CI(-1.26,-0.81),P<0.001],increasing TCM symptom score[MD=-3.79,95%CI(-6.16,-1.42),P=0.002],reducing the level of tumor necrosis factor-α[SMD=-2.53,95%CI(-3.55,-1.50),P<0.001]which were better than that of pure Western medicine(P<0.05).Conclusion The application of Yiqi Yangyin Huoxue method for the treatment of DR can improve vision,hemorheology and TCM symptoms,improve the total clinical response rate,and reduce the levels of VEGF and TNF-α,with high clinical safety.