【DPN.Meta分析.2016】糖尿病周围神经病变治疗的系统评价

文献DOI：10.1111/dme.13083

文献PMID：26822889

文献原文链接：http://doi.org.sci-hub.tw/10.1111/dme.13083

Diabet. Med. 33, 1466–1476 (2016)

Systematic Review or Meta-analysis：Systematic review of treatments for diabetic peripheral neuropathy

系统评价或Meta分析：糖尿病周围神经病变治疗的系统评价

【Abstract】

Aim：To evaluate treatment options for neuropathic pain and sensory symptoms resulting from diabetic peripheral neuropathy of the feet.

Methods：The databases PubMed, Embase and Web-of-Science were searched for randomized controlled trials, published in the period from database inception to 2 July 2015, that evaluated treatments for diabetic peripheral neuropathy of the feet with placebo or standard treatment as comparators. Participants in these trials included people with diabetes mellitus and diabetic peripheral neuropathy who were given any treatment for diabetic peripheral neuropathy. Risk of bias was assessed using the Delphi list of criteria. Data from the trials were extracted using standardized data extraction sheets by two authors independently. All analyses were performed using REVMAN 5.2. In case of clinical homogeneity, statistical pooling was performed using a random effects model.

Results：This review included 27 trials on pharmacological, non-pharmacological and alternative treatments. In the meta-analysis of trials of a-lipoic acid versus placebo, total symptom score was reduced by -2.45 (95% CI -4.52; -0.39) with 600 mg i.v. a-lipoic acid (three trials), and was reduced by -1.95 (95% CI -2.89; -1.01) with 600 mg oral a-lipoic acid (two trials). Significant improvements in diabetic peripheral neuropathy symptoms were found with opioids, botulinum toxin A, mexidol, reflexology and Thai foot massage, but not with micronutrients, neurotrophic peptide ORG 2677 and photon stimulation therapy.

Conclusion：In this review, we found that a-lipoic acid, opioids, botulinum toxin A, mexidol, reflexology and Thai foot massage had significant beneficial results.

摘要翻译：

目的：评估由于足部糖尿病周围神经病引起的神经性疼痛和感觉症状的治疗选择。

方法：搜索数据库PubMed、Embase和Web-of-Science进行随机对照试验，发表于数据库从开始至2015年7月2日期间，评估用安慰剂或标准治疗作为比较剂治疗足部糖尿病周围神经病变。这些试验的参与者包括糖尿病和糖尿病周围神经病变患者，他们接受任何糖尿病周围神经病变治疗。使用Delphi标准列表评估偏倚风险。两名作者独立使用标准化数据提取表试验数据。所有分析均使用REVMAN 5.2进行。在临床同质性的情况下，使用随机效应模型进行统计汇总。

结果：该评价包括27项药理学、非药理学和替代治疗试验。在α-硫辛酸与安慰剂试验的荟萃分析中，静脉注射600 mg α-硫辛酸（三项试验）总体症状评分减少了-2.45（95％CI -4.52; -0.39），用600mg口服α-硫辛酸（两项试验）总体症状评分减少-1.95（95％CI -2.89; -1.01）。阿片类药物、肉毒杆菌毒素A、mexidol、反射疗法和泰式足部按摩发现糖尿病周围神经病变症状显著改善，但微量营养素，神经营养肽ORG 2677和光子刺激疗法没有。

结论：在这篇综述中，我们发现α-硫辛酸、阿片类药物、肉毒杆菌毒素A、美西多醇、反射疗法和泰式足部按摩具有显著的有益效果。