针灸联合甲钴胺不同注射方式治疗糖尿病周围神经病变的网状Meta分析

Acupuncture combined with different mecobalamin injection methods for diabetic peripheral neuropathy： A network Meta-analysis

关键词:  糖尿病周围神经病变  针灸  甲钴胺注射液  贝叶斯定理  网状Meta

Key words:  diabetic peripheral neuropathy  acupuncture  mecobalamin injection  Bayes Theorem  network Meta-analysis

摘要:

[目的] 系统评价针灸联合甲钴胺不同注射方式治疗糖尿病周围神经病变的疗效及安全性。[方法] 计算机检索PubMed、Web of Science、EMbase、Cochrane图书馆、中国知网、维普数据库、中国生物医学文献数据库和万方数据库中关于针灸和/或甲钴胺注射液治疗糖尿病周围神经病变的随机对照试验，采用贝叶斯框架进行网络荟萃分析。[结果] 研究纳入 54 项随机对照试验，共计4 236例患者。9 种干预措施中，针灸+甲钴胺穴位注射+常规疗法对提高总有效率（93.55%），改善正中感觉神经传导速度（91.63%）和腓总感觉神经传导速度（98.72%）最有效。甲钴胺穴位注射+常规疗法是改善正中运动神经传导速度（81.70%）和腓总运动神经传导速度（79.85%）最好的治疗方法。最常见的不良事件包括皮疹、恶心、呕吐、心律失常、出汗。甲钴胺静脉注射患者发生的不良事件较多。[结论] 针灸+甲钴胺穴位注射+常规疗法是提高总有效率和感觉神经传导速度的首选治疗方法，甲钴胺穴位注射+常规疗法是提高运动神经传导速度的首选治疗方法。

Abstract:

[Objective] This study aimed to systematically evaluate the efficacy and safety of acupuncture combined with different Mecobalamin Injection methods in treating diabetic peripheral neuropathy（DPN）. [Methods] A computer search of PubMed，Web of Science，EMbase，Cochrane Library，China National Knowledge Infrastructure（CNKI），VIP Chinese Sci-Tech Journal Database（VIP），China Biology Medicine disc，and Wanfang Academic Journal Full-text Database was conducted for randomized controlled trials（RCTs） on acupuncture and/or mecobalamin injection for the treatment of DPN. A Bayesian framework was used for network Meta-analysis. [Results] Fifty four RCTs with a total of 4 236 patients were included in this study. Among nine interventions，acupuncture plus acupoint injection of mecobalamin plus usual treatment（AC+AIM+UT） was the most effective in improving overall response rate（93.55%），median sensory nerve conduction velocity（SCV，91.63%），and peroneal SCV（98.72%）. In terms of improvement in median motor nerve conduction velocity（MCV） and peroneal MCV，acupoint injection of mecobalamin plus usual treatment（AIM+UT） was the best therapy（81.70% and 79.85%，respectively）. The most common adverse events included skin rashes，nausea，vomiting，arrhythmia，and sweating. More adverse events occurred in patients treated by intravenous injection of mecobalamin. [Conclusion] AC+AIM+UT is the preferred therapy for improving overall response rate and sensory nerve conduction velocity，while AIM+UT is the treatment of choice for improving motor nerve conduction velocity.