摘要
目的通过网状Meta分析方法比较6种活血化瘀类中成药治疗糖尿病周围神经病变(DPN)的疗效。方法整理国内指南中推荐治疗DPN的活血化瘀类中成药,通过临床调查确定常用治疗DPN的中成药;检索中英文医学数据库上述活血化瘀类中成药单用或联合甲钴胺/维生素B12治疗DPN的随机对照试验(RCT),检索时间截止2020年3月12日,运用Stata 13.1、Win BUGS 1.4.3软件及R3.2.4软件gemtc程度包进行疗效综合分析与比较。结果本研究纳入6种常用中成药共24篇RCT文献。结果显示,正中神经运动传导速度:基础治疗与糖脉康颗粒比较(MD=-3.20,95%CI[-6.22,-0.48]);基础治疗与糖脉康颗粒+甲钴胺比较(MD=-4.87,95%CI[-9.00,-1.25]);基础治疗与银杏叶片+甲钴胺比较(MD=-4.93,95%CI[-8.37,-1.70]);基础治疗与血塞通软胶囊+甲钴胺比较(MD=-7.94,95%CI[-12.66,-3.49]);甲钴胺与糖脉康颗粒+甲钴胺比较(MD=-4.63,95%CI[-6.64,-2.61]);甲钴胺与银杏叶片+甲钴胺比较(MD=-4.69,95%CI[-7.29,-1.80]);甲钴胺与血塞通软胶囊+甲钴胺比较(MD=-7.69,95%CI[-10.84,-4.48]);糖脉康颗粒与血塞通软胶囊+甲钴胺比较(MD=-4.74,95%CI[-9.07,-0.44])。正中神经感觉传导速度:银杏叶片+甲钴胺与基础治疗比较(MD=3.69,95%CI[0.83,6.91]);复方丹参滴丸+甲钴胺与甲钴胺比较(MD=3.62,95%CI[0.05,7.25]);糖脉康颗粒+甲钴胺与甲钴胺比较(MD=3.94,95%CI[2.12,5.73]);银杏叶片+甲钴胺与甲钴胺比较(MD=4.30,95%CI[1.81,6.81])。结论部分中成药联合甲钴胺在改善正中神经运动和感觉传导速度方面优于基础治疗及单用甲钴胺。综合结局指标排序趋势为银杏叶片+甲钴胺、糖脉康颗粒+甲钴胺干预措施较优。但每个干预措施纳入的研究数偏少且方法学质量较低,临床实践应用该证据时尚需谨慎。
Objective To systematically evaluate the efficacy and safety of the blood-activating stasis-removingChinese patent medicines for diabetic peripheralneuropathies(DPN)using the network Meta-analysis.Methods Wecollected the blood-activating stasis-removing Chinese patent medicines for DPN recommended by the Chinese guideline and supplemented the Chinese common patent medicines to treat DPN through the clinical investigation.Network Meta-analysis was used to review the effect of treatment.We searched the Chinese and English medicinedatabases from the inceptions of these databases to March 12th 2020.The randomized controlled trials(RCTs)aboutthe blood-activating stasis-removing Chinese patent medicines alone or combined with mecobalamin/vitamin B12 for DPN were included.The statistical analyses were carried out with the Stata 13.1,Win BUGS 1.4.3 and"gemtc"packages in R 3.2.4 software.Results The study included the 6 kinds of Chinese patent medicines and a total of 24 RCTs.(1)Median nerve motor conduction velocity:the following result has statistical significance:control VS Tangmaikang Granule(MD=-3.20,95%CI[-6.22,-0.48]);Tangmaikang Granule+mecobalamin VS control(MD=-4.87,95%CI[-9.00,-1.25]);Ginkgo leaf tables+mecobalamin VS control(MD=-4.93,95%CI[-8.37,-1.70]);control VS Xuesaitong capsule+mecobalamin(MD=-7.94,95%CI[-12.66,-3.49]);Tangmaikang Granule+mecobalamin VS mecobalamin(MD=-4.63,95%CI[-6.64,-2.61]);Ginkgo leaf tables+mecobalaminVS mecobalamin(MD=-4.69,95%CI[-7.29,-1.80]);Xuesaitong capsule+mecobalamin VS mecobalamin(MD=-7.69,95%CI[-10.84,-4.48]);Tangmaikang Granule VS Xuesaitong capsule+mecobalamin(MD=-4.74,95%CI[-9.07,-0.44]).(2)Median nerve sensory conduction velocity:Ginkgo leaf tables+mecobalamin VS control(MD=3.69,95%CI[0.83,6.91]);Fufang Salvia miltiorrhiza+mecobalamin VS mecobalamin(MD=3.62,95%CI[0.05,7.25]);Tangmaikang Granule+mecobalamin VS mecobalamin(MD=3.94,95%CI[2.12,5.73]);Ginkgo leaf tables+mecobalamin VS mecobalamin(MD=4.30,95%CI[1.81,6.81]).Conclusion The effectiveness of part of the blood-activating stasis-removing Chinese patent medicines combined with mecobalamin is superior to the treatment of thegeneral and mecobalamin groups.After different affecting factors are considered comprehensively,the ranking trendof two outcomes is probably that Ginkgo leaf tables+mecobalamin and Tangmaikang Granule+mecobalamin areoptimal interventions.Given that the studies on every intervention are in small case numbers and of lowmethodological quality,this evidence should be used with great caution for making clinical decision in practice.
作者
左进红
肖晶旻
谢倩文
陈婧
何怡瀚
刘少南
杨丽虹
郭新峰
陈军
ZUO Jinhong;XIAO Jingmin;XIE Qianwen;CHEN Jing;HE Yihan;LIU Shaonan;YANG Lihong;GUO Xinfeng;CHEN Jun(Zhongshan People’s Hospital,Zhongshan 528403 Guangdong,China;Second Clinical Medical College,Guangzhou University of Chinese Medicine,Guangzhou 510405 Guangdong,China;Guangdong Provincial Hospital of Chinese Medicine,Guangzhou 510120 Guangdong,China;Guangdong Provincial Key Laboratory of Clinical Research on Traditional Chinese Medicine Syndrome,Guangzhou 510120 Guangdong,China;Shenzhen Traditional Chinese Medicine Hospital,Shenzhen 518033 Guangdong,China)
出处
《中药新药与临床药理》
CAS
CSCD
北大核心
2020年第7期867-873,共7页
Traditional Chinese Drug Research and Clinical Pharmacology
基金
2019年度广东省中医药局面上科研项目(20191275)。
关键词
糖尿病周围神经病变
活血化瘀
中成药
网状Meta分析
Diabetic peripheral neuropathies(DPN)
blood-activating and stasis-removing agents
Chinese patent medicine
network Meta-analysis
