前列腺素E_1治疗糖尿病周围神经病变的系统评价  

Prostaglandin E_1 for Diabetic Peripheral Neuropathy:A Systematic Review

作　　者：李亚[1] 方弟晋[2] 高霞[2] 田浩明[1] 吴泰相[3] 

机构地区：[1]四川大学华西医院内分泌科,成都610041 [2]延安大学附属医院,陕西延安716000 [3]四川大学华西医院中国循证医学中心,成都610041

出　　处：《中国循证医学杂志》2006年第6期404-415,共12页Chinese Journal of Evidence-based Medicine

摘　　要：目的系统评价前列腺素E1(PGE1)治疗糖尿病周围神经病变(DPN)的疗效与安全性。方法计算机检索Cochrane图书馆2006年第1期、PubMed、EMbase、CNKI、VIP,手工检索《中华内分泌代谢杂志》、《中华糖尿病杂志》、《新医学》,收集以PGE1为干预措施治疗DPN的随机对照试验(RCT),按Cochrane系统评价方法,评价纳入研究的方法学质量并提取有效数据进行Meta分析。结果共纳入了31个RCT,包括2497例DPN患者。Meta分析结果显示,PGE1改善DPN症状及体征均优于B族维生素、安慰剂及其它改善微循环药物,其RR(95%CI)分别为[RR=1.75,95%CI(1.54,2.00)]、[RR合并=1.57,95%CI(1.42,1.74)]及[RR=1.31,95%CI(1.19,1.45)]。PGE1对DPN神经传导速度的改善亦优于B族维生素、安慰剂以及其它改善微循环药物。PGE1不同剂型间比较,前列腺素E1脂微球载体制剂(Lipo-PGE1)较PGE1粉针剂(PGE1-CD)改善自发性疼痛和感觉异常等症状更有效[RR=1.43,95%CI(1.16,1.76)]。有16个研究报道了不良反应,结果显示大多较轻微。结论本系统评价结果显示,较之B族维生素、安慰剂及其他微循环改善药物,PGE1对改善糖尿病周围神经病变症状、体征及神经传导速度均有较好疗效。在PGE1的剂型选择上倾向于Lipo-PGE1。但目前收集到的文献质量较低,若有高质量、大样本、长期随访的研究进一步证实其有效性和安全性,该结论将更可信。Objective To evaluate the efficacy and safety ofprostaglandin E1 （PGE1） for diabetic peripheral neuropathy （DPN）. Methods We searched the Cochrane Library, PubMed, EMbase, CNKI, VIP and handsearched Chinese Journal of Metabolism, Chinese Journal of Diabetes and New Chinese Medicine. Randomized controlled trials of clinical therapeutic studies on PGE1 for DPN were included. The quality of included studies was evaluated and Meta-analysis was performed. Results Thirty-one trials involving 2 497 participants were included. Meta-analysis indicated that PGE1 was more effective than Vitamin B, Placebo and other microcirculation improving drugs in improving symptoms and signs of DPN. The RR （95%CI） were [ RR=1.75, 95%CI （1.54, 2.00） ] , [ RRpooled=1.57, 95%CI （1.42, 1.74） ] and [ RR=1.31, 95%CI （1.19, 1.45） ] respectively. PGE1 was more effective than Vitamin B, Placebo and other microcirculation improving drugs in improving nerve conduction velocity （NCV） of DPN patients. For spontaneous pain and hypesthesia of DPN patients, Lipo-PGE1 was more effective compared with PGE1-CD and the RR （95%CI） was [ RR=1.43, 95%CI （1.16, 1.76） ] . Slight adverse effects were reported in 16 studies. Conclusion Based on this review, PGE1 is effective for DPN. However, the evidence is not strong enough due to the low quality of included trials. Further large-sample and multi-center studies are needed.

关 键 词：糖尿病 周围神经病变 前列腺素E1 系统评价 

分 类 号：R587.2[医药卫生—内分泌]