益气养阴活血法治疗非增殖期糖尿病视网膜病变疗效的Meta分析  

A Meta-analysis on the effect of the invigorating Qi,nourishing Yin and promoting blood circulation method on non-proliferative diabetic retinopathy

作　　者：高珂 温静 郭丛丛 廖琳 GAO Ke

机构地区：[1]山东中医药大学,山东济南250014 [2]山东省中医院,山东济南250014 [3]山东第一医科大学第一附属医院,山东济南250014

出　　处：《中医临床研究》2023年第5期52-64,共13页Clinical Journal Of Chinese Medicine

基　　金：山东省自然科学基金青年项目(ZR2020QH310)。

摘　　要：目的:系统评价益气养阴活血法治疗非增殖期糖尿病视网膜病变的有效性。方法:检索中国知网、万方、维普中文科技期刊数据库、中国生物医学文献数据库、Cochrane library、EMbase、PubMed等数据库,查找所有比较具有益气养阴活血功效的中药或联合西药治疗非增殖期糖尿病视网膜病变的临床随机对照试验。利用RevMan 5.3软件进行数据分析,使用偏倚风险表对文章进行质量评估。结果:共纳入42篇随机对照试验,包括3 532例患者。结果:采用益气养阴活血法治疗非增殖期糖尿病视网膜病变能够明显提高临床总有效率(OR=3.62,95%CI[3.02, 4.34],Z=13.95,P <0.000 01);改善血液流变情况,包括全血高切黏度(SMD=-1.14,95%CI [-1.85,-0.44],Z=3.18,P=0.001)及全血低切黏度(SMD=-1.10,95%CI [-2.20,0.00],Z=1.95,P=0.05);降低糖化血红蛋白(Glycosylated Hemoglobin,HbA1c)(SMD=-0.43,95%CI[-0.72,-0.14],Z=2.91,P=0.004)以及三酰甘油(SMD=-0.24,95%CI [-0.43,-0.05], Z=2.50,P=0.01)和胆固醇(SMD=-0.46,95%CI [-0.65,-0.27],Z=4.64,P <0.000 01)水平;还可以降低血管内皮生长因子(Vascular Endothelial Growth Factor,VEGF)(SMD=-1.11,95%CI[-1.62,-0.61],Z=4.32,P <0.000 1)、胰岛素生长因子-1(Insulin-like Growth Factor 1,IGF-1)(SMD=-1.11,95%CI[-1.46,0.75],Z=6.11,P <0.000 01)等炎症细胞因子水平;同时改善血管瘤体积(SMD=-1.11,95%CI [-1.30,-0.92],Z=11.28,P <0.000 01)和眼底出血面积(SMD=-1.54,95%CI[-1.85,-1.22],Z=9.52,P <0.000 01)。9项研究描述了不良反应的发生,表明益气活血养阴法并不会增加临床不良反应发生率。结论:益气养阴活血治疗非增殖期糖尿病视网膜病变,可提高临床疗效,调节血液流变、血糖血脂代谢,降低炎症因子水平以及改善眼底病变。但因纳入研究的文献质量较低,今后还需更多高质量的随机对照试验加以证实。Objective:To systematically evaluate the effectiveness of the invigorating Qi(气),nourishing Yin(阴)and promoting blood circulation method in the treatment of non-proliferative diabetic retinopathy.Methods:CNKI,Wanfang,VIP and CBM were retrieved.Cochrane library,EMbase,PubMed and other databases were searched for all clinical randomized controlled trials comparing the effects of TCM medicine or the integrative medicine on non-proliferative diabetic retinopathy.RevMan 5.3 software was used for data analysis and risk of bias table was used to evaluate the quality of the paper.Results:The treatment of non-proliferative diabetic retinopathy by the invigorating Qi,nourishing Yin and promoting blood circulation method could significantly improve the total clinical efficiency,ameliorate blood rheology,including whole blood high shear viscosity(SMD=-1.14,95%CI[-1.85,-0.44],Z=3.18,P=0.001)and whole blood low shear viscosity decrease HbA1 c,triglycerides(SMD=0.24,95%CI(0.43,0.05),Z=2.50,P=0.01)and cholesterol,VEGF(SMD=-1.11,95%CI[-1.62,-0.61],Z=4.32,P<0.0001),IGF-1(SMD=-1.11,95%CI[-1.46,0.75],Z=6.11,P<0.00001)and other inflammatory cytokines;meanwhile,hemangioma volume(SMD=-1.11,95%CI[-1.30,-0.92],Z=11.28,P<0.00001)and fundus hemorrhage area(SMD=-1.54,95%CI[-1.85,-1.22],Z=9.52,P<0.00001)were ameliorated.Nine studies described the occurrence of adverse reactions,indicating that supplementing Qi,promoting blood circulation and nourishing Yin did method not increase the incidence of clinical adverse reactions.Conclusion:The treatment of non-proliferative diabetic retinopathy by the nourishing Qi,nourishing Yin and promoting blood circulation method can improve clinical efficacy,regulate blood rheology,blood glucose and lipid metabolism,reduce the level of inflammatory factors,and improve fundus lesions.However,due to the low quality of the literature included in the study,more high-quality randomized controlled trials are needed to confirm it in the future.

关 键 词：益气养阴活血 非增殖期糖尿病视网膜病变 随机对照试验 META分析 

分 类 号：R587.1[医药卫生—内分泌]