当归四逆汤与西药治疗糖尿病周围神经病变疗效比较的系统评价*

Comparison of therapeutic effect of Danggui Sini Decoction and Western medicine in treating peripheral neuropathy in patients with diabetes:a systemic evaluation

关键词:  当归四逆汤  糖尿病周围神经病变  随机对照试验  系统评价

Key words:  Danggui Sini Decoction  diabetic peripheral neuropathy  randomized controlled trial  systemic review

摘要:

[目的]比较当归四逆汤与西药治疗糖尿病周围神经病变(DPN)的有效性。[方法]计算机检索中国生物医学文献数据库(CBM,1979～2010年)、中国知网(CNKI,1979～2010年)、维普中文科技期刊数据库(VIP,1989～2010年)和万方数据资源系统(WF1,998～2010年)。辅以手工检索天津中医药大学图书馆过刊资料库。收集当归四逆汤和西药比较治疗DPN的临床随机对照试验,由两名评价者独立提取资料并按照Cochrane Review Handbook 5.0进行质量评估。统计学分析采用Rev Man 5.1.1软件。[结果]共纳入10篇临床随机对照试验,共有759例。Meta分析结果显示:1)正中神经传导速度(感觉神经):当归四逆汤与弥可保比较[WMD=3.759,5% CI(-1.07,8.56)]无差别。2)临床总有效率:当归四逆汤与弥可保比较[RR=1.35,95% CI(1.19,1.54)]差异有统计学意义。[结论]当归四逆汤比弥可保在改善DPN正中神经传导速度上尚无优势,当归四逆汤单用或与其他西药合用比单用西药在改善腓总神经传导速度和临床总有效率上有一定优势,尚需要更多高质量的随机双盲对照试验来进一步证实当归四逆汤治疗DPN的疗效。

Abstract:

[Objective] To compare the effect of Danggui Sini Decoction and Western medicine in the treatment of diabetic peripheral neuropathy.[Methods] Randomized controlled trials (RCTs) involving Danggui Sini Decoction and Western medicine in treatment of diabetic peripheral neuropathy (DPN) were identified from CBM (1978 to 2010),VIP (1989 to 2010),WANFANG Database (1998 to 2010),CNKI (1979 to 2010).We also manually searched the relevant journals from the reading room for passed issues in Tianjin University of TCM.Data were extracted and evaluated by two reviewers independently.Cochrane Review Handbook 5.0 was used for quality assessment. Rev Man 5.1.1,one of the Cochrane Collaboration's software,was used for data analyses.[Results]A total of 10 clinical trials involving 759 patients were included.Meta-analyses showed:1) The sensory nerve conduction velocity of median nerve in the experimental group(the group used with Danggui Sini Decoction) had no significant difference when compared with the methylcobalamin group [WMD=3.75,95% CI(-1.07,8.56)].2) In terms of the total effective rate,significant difference was noted between Danggui Sini Decoction and methylcobalamin[RR=1.35,95% CI(1.19,1.54)].[Conclusion] The results do not support a significant benefit of Danggui Sini Decoction over methylcobalamin in the improvement of motive nerve conduction velocity of median nerve in patients with DPN.Combined or not combined with Western medicine,the effect of Danggui Sini Decoction is superior than Western medicine in the improvement of nerve conduction velocity of common peroneal nerve and in the total effective rate.More double-blind,randomized controlled trials with high quality are required to define the role of Angelica Sini Decoction further in the treatment of DPN.