冉興無 1 , 李寧 2 , 劉雅 3
  • 1. 四川大學(xué)華西醫(yī)院內(nèi)分泌科,成都,6100412. 四川大學(xué)華西醫(yī)院針灸科3. 成都市第二人民醫(yī)院內(nèi)科;

目的 　評價川芎嗪(tetramethylpyrazine,TMP)治療糖尿病周圍神經(jīng)病變(diabetic peripheral neuropathy,DPN)的療效與安全性.
方法 　計算機(jī)檢索中國生物醫(yī)學(xué)文獻(xiàn)光盤數(shù)據(jù)庫(1978～2003年3月)、中國中醫(yī)藥科技文獻(xiàn)數(shù)據(jù)庫(1980～2003年3月)、Medline(1970～2003年3月)、EMbase(1970～2003年3月)和Cochrane圖書館(2003年3期),手檢 lt;中醫(yī)雜志 gt;(1990～2002年)、 lt;新醫(yī)學(xué) gt;(1990～2002年)、 lt;中國中西醫(yī)結(jié)合雜志 gt;(1990～2002年)和 lt;中醫(yī)藥研究 gt;(1990～2002年),收集以TMP為干預(yù)措施治療DPN的隨機(jī)對照試驗(yàn)(RCT),按Cochrane系統(tǒng)評價方法,由兩位研究者獨(dú)立地對符合納入標(biāo)準(zhǔn)的試驗(yàn)進(jìn)行資料提取,并進(jìn)行研究方法的質(zhì)量評估和對提取的有效數(shù)據(jù)進(jìn)行Meta分析.
結(jié)果 　有6個試驗(yàn),共669例DPN患者符合納入標(biāo)準(zhǔn),但其方法學(xué)質(zhì)量均較差.Meta分析結(jié)果顯示,TMP治療較西藥治療能明顯改善患者肢體麻木和疼痛[OR合并=10.12,95%CI(6.70,15.28),P=0.000]以及腓神經(jīng)和正中神經(jīng)傳導(dǎo)速度[WMD=4.28,95%CI(3.74,4.82),P=0.000;WMD=4.35,95%CI(3.89,4.32),P=0.000].僅有1個試驗(yàn)報道了TMP的不良反應(yīng),如頭暈和頭痛.
結(jié)論 　TMP對治療DPN可能有一定療效,但由于尚缺乏高質(zhì)量的RCT證據(jù)支持,TMP治療DPN的療效尚不能作出最后結(jié)論,還需進(jìn)行更多高質(zhì)量的RCT才能得出肯定性結(jié)論.

引用本文： 冉興無,李寧,劉雅. 川芎嗪治療糖尿病周圍神經(jīng)病變的系統(tǒng)評價. 中國循證醫(yī)學(xué)雜志, 2004, 04(6): 393-397. doi: 復(fù)制

1. ［1］Tesfaye S, Stevens LK, Stephenson JM, FullerJH, Plater M,Ionescu-Tirgoviste C, Nuber A, Pozza G, WardJD. Prevalence of diabetic peripheral neuropathy and its relation to glycaemic control and potential risk factors: the EUR ODIAB IDDM Complications Study [J]. Diabetologia, 1996; 39( 11 ):1 377-1 384.
2. ［2］Partanen J, Niskanen L, Lehtinen J, Mervaala E, Siitonen O,Uusitupa M. Natural history of peripheral neuropathy in patients with non-insulin-dependent diabetes mellitus [J]. N Engl JMed, 1995; 333(2): 89-94.
3. ［3］Cai YQ, Du JH. Observation of the result of Tetramethylpyrazine for the treaunent of 50 cases of diabetic peripheral neuropathy [J]. Chinese Journal of Traditional Science and Technology, 2000; 7(6): 415-416.
4. 蔡英奇,杜積慧.TMP注射液治療糖尿病周圍神經(jīng)病變50例[J].中國中醫(yī)藥科技,2000;7(6):415～416.
5. ［4］Fan DF, Weng XG, Dou JF. The clinical observation of Tetramethylpyrazine for diabetic peripheral neuropathy [J ]. Chinese Journal of Integrated Traditional and Western Medicine,1999; 19(9): 550-551.
6. 樊東方,翁孝剛,竇敬芳.TMP治療糖尿病周圍神經(jīng)病變的臨床觀察[J].中國中西醫(yī)結(jié)合雜志,1999;19(9):550～551.
7. ［5］Huang YF, Wang FJ. The clinical efficacy of Tetramethylpyrazine combinated with Raceanisodamine Hydrochloride therapy in the 36 cases of diabetic peripheral neuropathy [J]. Journal ofLinyi Medical Academy, 1999; 21(1): 48-49.
8. 黃玉芬,王鳳菊.山莨菪堿、TMP聯(lián)合治療糖尿病性周圍神經(jīng)病變36例療效觀察[J].臨沂醫(yī)專學(xué)報,1999;21(1):48～49.
9. ［6］Zhang MH. Tetramethylpyrazine combinated with Xiaoshuanling for the treatment of diabetic peripheral neuropathy: Report of 50 cases [J]. San Dong Medical Journal, 1995; 35(9): 32.
10. 張曼華.中藥TMP合并消栓靈治療糖尿病性周圍神經(jīng)病變50例體會[J].山東醫(yī)藥,1995;35(9):32.
11. ［7］Weng XG, Fan DF, Dou JF. The clinical efficacy of Tetramethylpyrazine therapy in the 105 cases of diabetic peripheral neuropathy [J]. New Chinese Medicine, 1998; 29(10): 533-534.
12. 翁孝剛,樊東方,竇敬芳.TMP治療糖尿病周圍神經(jīng)病變105例臨床療效觀察[J].新醫(yī)學(xué),1998;29(10):533～534.
13. ［8］Yan SQ. The clinical efficacy of Tetramethylpyrazine combinated with antihyperglycemic therapy in the 40 cases of diabetic peripheral neuropathy [ J ]. Research of Traditional Chinese Medicine, 1998; 14(4): 28-29.
14. 閻淑琴.TMP聯(lián)合降糖藥治療糖尿病周圍神經(jīng)病變40例療效觀察[J].中醫(yī)藥研究,1998;14(4):28～29.
15. ［9］Juni P, Altman DG, Egger M. Assessing the quality of controlled clinical trials [J]. BMJ, 2001; 323(7 303): 42-46.
16. ［10］Ran XW, Li N, Liu Y. Methodological evaluation of randomized controlled trials of diabetic peripheral neuropathy treatment by Chinese medicine herb [J]. West China Medical Journal, 2003; 18(3) : 299-300.
17. 冉興無,李寧,劉雅.中醫(yī)藥治療糖尿病患者周圍神經(jīng)病變臨床隨機(jī)對照試驗(yàn)的方法學(xué)質(zhì)量評估[J].華西醫(yī)學(xué),2003;18(3):299～300.
  1. 1. ［1］Tesfaye S, Stevens LK, Stephenson JM, FullerJH, Plater M,Ionescu-Tirgoviste C, Nuber A, Pozza G, WardJD. Prevalence of diabetic peripheral neuropathy and its relation to glycaemic control and potential risk factors: the EUR ODIAB IDDM Complications Study [J]. Diabetologia, 1996; 39( 11 ):1 377-1 384.
  2. 2. ［2］Partanen J, Niskanen L, Lehtinen J, Mervaala E, Siitonen O,Uusitupa M. Natural history of peripheral neuropathy in patients with non-insulin-dependent diabetes mellitus [J]. N Engl JMed, 1995; 333(2): 89-94.
  3. 3. ［3］Cai YQ, Du JH. Observation of the result of Tetramethylpyrazine for the treaunent of 50 cases of diabetic peripheral neuropathy [J]. Chinese Journal of Traditional Science and Technology, 2000; 7(6): 415-416.
  4. 4. 蔡英奇,杜積慧.TMP注射液治療糖尿病周圍神經(jīng)病變50例[J].中國中醫(yī)藥科技,2000;7(6):415～416.
  5. 5. ［4］Fan DF, Weng XG, Dou JF. The clinical observation of Tetramethylpyrazine for diabetic peripheral neuropathy [J ]. Chinese Journal of Integrated Traditional and Western Medicine,1999; 19(9): 550-551.
  6. 6. 樊東方,翁孝剛,竇敬芳.TMP治療糖尿病周圍神經(jīng)病變的臨床觀察[J].中國中西醫(yī)結(jié)合雜志,1999;19(9):550～551.
  7. 7. ［5］Huang YF, Wang FJ. The clinical efficacy of Tetramethylpyrazine combinated with Raceanisodamine Hydrochloride therapy in the 36 cases of diabetic peripheral neuropathy [J]. Journal ofLinyi Medical Academy, 1999; 21(1): 48-49.
  8. 8. 黃玉芬,王鳳菊.山莨菪堿、TMP聯(lián)合治療糖尿病性周圍神經(jīng)病變36例療效觀察[J].臨沂醫(yī)專學(xué)報,1999;21(1):48～49.
  9. 9. ［6］Zhang MH. Tetramethylpyrazine combinated with Xiaoshuanling for the treatment of diabetic peripheral neuropathy: Report of 50 cases [J]. San Dong Medical Journal, 1995; 35(9): 32.
  10. 10. 張曼華.中藥TMP合并消栓靈治療糖尿病性周圍神經(jīng)病變50例體會[J].山東醫(yī)藥,1995;35(9):32.
  11. 11. ［7］Weng XG, Fan DF, Dou JF. The clinical efficacy of Tetramethylpyrazine therapy in the 105 cases of diabetic peripheral neuropathy [J]. New Chinese Medicine, 1998; 29(10): 533-534.
  12. 12. 翁孝剛,樊東方,竇敬芳.TMP治療糖尿病周圍神經(jīng)病變105例臨床療效觀察[J].新醫(yī)學(xué),1998;29(10):533～534.
  13. 13. ［8］Yan SQ. The clinical efficacy of Tetramethylpyrazine combinated with antihyperglycemic therapy in the 40 cases of diabetic peripheral neuropathy [ J ]. Research of Traditional Chinese Medicine, 1998; 14(4): 28-29.
  14. 14. 閻淑琴.TMP聯(lián)合降糖藥治療糖尿病周圍神經(jīng)病變40例療效觀察[J].中醫(yī)藥研究,1998;14(4):28～29.
  15. 15. ［9］Juni P, Altman DG, Egger M. Assessing the quality of controlled clinical trials [J]. BMJ, 2001; 323(7 303): 42-46.
  16. 16. ［10］Ran XW, Li N, Liu Y. Methodological evaluation of randomized controlled trials of diabetic peripheral neuropathy treatment by Chinese medicine herb [J]. West China Medical Journal, 2003; 18(3) : 299-300.
  17. 17. 冉興無,李寧,劉雅.中醫(yī)藥治療糖尿病患者周圍神經(jīng)病變臨床隨機(jī)對照試驗(yàn)的方法學(xué)質(zhì)量評估[J].華西醫(yī)學(xué),2003;18(3):299～300.