• 1. 四川大學(xué)華西醫(yī)院內(nèi)分泌科,成都6100412. 成都市第二人民醫(yī)院內(nèi)分泌科,成都610017;

目的 　了解甲基維生素B12治療糖尿病周圍神經(jīng)病變的療效和安全性.
方法 　按照國(guó)際Cochrane協(xié)作網(wǎng)的系統(tǒng)評(píng)價(jià)方法,檢索全世界關(guān)于甲基維生素B12治療糖尿病周圍神經(jīng)病變的隨機(jī)或半隨機(jī)對(duì)照試驗(yàn),包括Cochrane 圖書館2003年第4期、臨床對(duì)照試驗(yàn)資料庫(kù)、MEDLINE、EMBASE、中國(guó)生物醫(yī)學(xué)文獻(xiàn)光盤數(shù)據(jù)庫(kù)、中文科技期刊全文數(shù)據(jù)庫(kù)以及所有納入研究的參考文獻(xiàn).由兩位評(píng)價(jià)者獨(dú)立地對(duì)符合納入標(biāo)準(zhǔn)的試驗(yàn)進(jìn)行質(zhì)量評(píng)價(jià)和資料提取.采用下列指標(biāo)對(duì)甲基維生素B12治療糖尿病周圍神經(jīng)病變的療效和安全性進(jìn)行評(píng)價(jià):臨床癥狀體征的總有效率、感覺及運(yùn)動(dòng)神經(jīng)傳導(dǎo)速度以及嚴(yán)重不良反應(yīng)的發(fā)生率.
結(jié)果 　30個(gè)試驗(yàn)共納入1 949例糖尿病周圍神經(jīng)病變患者.大部分試驗(yàn)的方法學(xué)質(zhì)量較低.甲基維生素B12與其他B族維生素比較的13個(gè)試驗(yàn)的"漏斗圖"圖分析顯示基本對(duì)稱,提示發(fā)表偏倚的可能性較小,結(jié)果比較可靠,但是不一定能代表整體發(fā)表偏倚情況.Meta分析結(jié)果顯示:甲基維生素B12可明顯改善糖尿病周圍神經(jīng)病變的臨床癥狀和體征,且療效優(yōu)于其他B族維生素;甲基維生素B12改善某些周圍神經(jīng)傳導(dǎo)速度的療效優(yōu)于其他B族維生素;在治療期間,試驗(yàn)未發(fā)現(xiàn)嚴(yán)重不良反應(yīng).
結(jié)論 　甲基維生素B12可能是一種相對(duì)安全和有效的治療糖尿病周圍神經(jīng)病變的藥物.但由于納入試驗(yàn)的方法學(xué)質(zhì)量低下和可能存在發(fā)表偏倚,證據(jù)強(qiáng)度不足,尚有待大樣本、高質(zhì)量的多中心隨機(jī)雙盲對(duì)照試驗(yàn)加以證實(shí).

引用本文： 賈海燕,田浩明,魏 東. 甲基維生素B12治療糖尿病周圍神經(jīng)病變的系統(tǒng)評(píng)價(jià). 中國(guó)循證醫(yī)學(xué)雜志, 2005, 05(8): 609-618. doi: 復(fù)制

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