中药复方治疗非增殖期糖尿病视网膜病变的Meta分析  

Meta-analysis on Effect of Traditional Chinese Medicine Compound on Proliferative Diabetic Retinopathy

作　　者：王凤[1] 宋花玲[1] 马燕云[2] 汤晶晶[1] 章怡祎[2] 周典[1] 曾觐 施榕[1] WANG Feng SONG Hua-ling MA Yan-yun TANG Jing-jing ZHANG Yi-yi ZHOU Dian ZENG Jin SHI Rong(School of Public Health, Shanghai University of Traditional Chinese Medicine （ TCM）, Shanghai 201203, China Longhua Hospital Affiliated to Shanghai University of TCM , Shanghai 200032, China)

机构地区：[1]上海中医药大学公共健康学院,上海201203 [2]上海中医药大学附属龙华医院,上海200032

出　　处：《中国实验方剂学杂志》2017年第15期202-210,共9页Chinese Journal of Experimental Traditional Medical Formulae

基　　金：公共卫生三年行动计划项目(15GWZK1002)

摘　　要：目的:运用Meta分析方法比较中药复方治疗与单纯西医治疗对糖尿病性视网膜病变患者各项指标的影响。方法:根据糖尿病性视网膜病变(DR)发病机制有高血糖、血管内皮细胞功能紊乱、生长因子、血液流变学改变、炎症等方面,全面收集治疗DR的临床研究文献,并按照文献选择标准进行筛选,比较中药复方治疗与单纯西医疗法对糖化血红蛋白(HbA1c),血浆内皮素(ET),一氧化氮(NO),血管内皮生长因子(VEGF),血清高敏C反应蛋白(hs CRP),肿瘤坏死因子-α(TNF-α),全血黏度(高切、低切),血浆黏度,眼底改变疗效,视力疗效,中医证候疗效的影响,并进行Meta分析。结果:本次研究共收集3 526篇文献,62篇符合纳入标准。其中27篇文献观察了HbA1c,反映近8周的血糖控制;8篇观察了ET,4篇观察了NO,反映血管内皮细胞功能紊乱;8篇观察了VEGF,是在视网膜微血管增生中,发挥主要作用的生长因子;8篇观察了全血黏度(高切、低切),9篇观察了血浆黏度,6篇观察了纤维蛋白原,用以反映血液流变学的改变;3篇观察了CRP,4篇观察了TNF-α,探讨对炎症的影响;39篇观察了临床疗效,23篇观察了眼底改变疗效,20篇观察了视力疗效,29篇观察了中医证候疗效。结论:与单纯西药治疗组相比,中药复方治疗对DR患者NO的改变作用与其效果相当,对HbA1c,ET,TNF-α,hs CRP,VEGF,全血黏度(高切),全血黏度(低切),血浆黏度,纤维蛋白原,临床疗效,眼底改变疗效,视力疗效,中医证候疗效的作用均优于单纯西药治疗组,提示中药复方治疗方法比单纯西医治疗方法作用更加明显。受纳入研究的数量和质量限制,中药复方治疗对DR患者的作用需要更多高质量的随机双盲对照试验加以证实。Objective：To compare the effects of traditional Chinese medicine（TCM） compound and western medicine in treating diabetic retinopathy by Meta-analysis.Method：According to pathogenesis of diabetic retinopathy（DR） in high blood sugar,blood vessel endothelial cell dysfunction,growth factors,changes in blood rheology and inflammation,clinical research literatures for treatment of diabetic retinopathy were collected and screened according to the literature selection criteria,in order to compare the effects of TCM and western medicine on glycosylated hemoglobin（HbA1c）,endothelin（ET） and nitric oxide（NO）,vascular endothelial growth factor（VEGF） and serum high-sensitivity C-reactive protein（hs CRP） and tumor necrosis factor-α（TNF-α）,whole blood viscosity（high shear）,whole blood viscosity（low shear）,plasma viscosity,fundus change,vision and TCM syndrome,and the meta-analysis was made.Result：This study collected 3 526 literatures,including 62 literatures up to standards.Among them,27 literatures recorded observation of Hb A1 c,reflecting nearly eight weeks of glucose control;8 literatures recorded observation of ET,and 4 literatures recorded observation of NO,reflecting the vascular endothelial cell function disorder;8 literatures recorded observation of VEGF,proving that it is the growth factor playing a major role in the retinal micro-vascular proliferation;8 literatures recorded observation of the whole blood viscosity（high shear）,8 literatures recorded observation of the whole blood viscosity（low shear）,9 literatures recorded observation of the plasma viscosity,6 literatures recorded observation of fibrinogen,so as to reflect the change in blood rheology;3 literatures recorded observation of hs CRP,4 literatures recorded observation of TNF-α,discussing the effects on inflammation;39 literatures recorded observation of the clinical efficacy,23 literatures recorded observation of the efficacy in changing fundus,20 literatures recorded observation of the efficacy in

关 键 词：糖尿病视网膜病变 中药复方 META分析 糖化血红蛋白 血浆内皮素 一氧化氮 血管内皮生长因子 血清高敏C反应蛋白 肿瘤坏死因子-α 

分 类 号：R287.6[医药卫生—中药学]