益气化痰活血类中药干预2型糖尿病伴颈动脉病变的Meta分析  

Meta-analysis of Type 2 Diabetes Mellitus with Carotid Artery Lesions Intervened by Qi-benefiting,Phlegm-resolving,and Blood-activating Chinese Medicines

作　　者：肖瑶[1,2] 潘欣渝 徐明君 曾贵兴 魏军平 XIAO Yao;PAN Xin-yu;XU Ming-jun;ZENG Gui-xing;WEI Jun-ping(Beijing University of Chinese Medicine,Beijing 100029;Guang′anmen Hospital,China Academy of Chinese Medical Sciences,Beijing 100053)

机构地区：[1]北京中医药大学,北京100029 [2]中国中医科学院广安门医院,北京100053

出　　处：《世界中西医结合杂志》2025年第1期16-27,共12页World Journal of Integrated Traditional and Western Medicine

基　　金：中央高水平中医医院临床研究和成果转化能力提升项目中医药临床循证研究专项(HLCMHPP2023084);中央高水平中医院医院临床科研业务领军人才培育项目(CZ40905);中国中医科学院科技创新工程项目(CI2021A01617);中国中医科学院中医药循证能力建设项目(60104)。

摘　　要：目的系统评价益气化痰活血类中药治疗2型糖尿病(Type 2 diabetes mellitus,T2DM)伴颈动脉病变的疗效和安全性。方法检索中国知网(CNKI)、万方数据库(Wanfang Data)、维普中文期刊数据库(VIP)、中国生物医学文献数据库(CBM)、PubMed、Web of science、the Cochrane Library建库至2023年9月18日期间,公开发表的中医益气化痰活血类中药治疗T2DM伴颈动脉病变的随机对照试验。由两名评价员独立进行文献筛选和资料提取,并采用Cochrane偏倚风险评估工具对纳入的研究进行文献质量评价。运用RevMan 5.4软件进行Meta分析。结果共纳入27篇研究,2574例受试者。Meta分析结果显示:与对照组相比,益气化痰活血类中药联合西药常规治疗在提高总有效率[OR=2.69,95%CI(2.09,3.46)]、降低颈动脉内膜中层厚度(Carotid intima-media thickness,CIMT)[MD=-0.15,95%CI(-0.20,-0.10)]、斑块面积[MD=-0.25,95%CI(-0.38,-0.12)]、斑块积分[MD=-0.39,95%CI(-0.56,-0.21)]、改善胰岛素抵抗[MD=-0.48,95%CI(-0.59,-0.37)]、糖化血红蛋白[MD=-0.45,95%CI(-0.70,-0.19)]、总胆固醇[MD=-0.43,95%CI(-0.66,-0.21)]、低密度脂蛋白胆固醇[MD=-0.32,95%CI(-0.43,-0.21)]、降低同型半胱氨酸[MD=-2.30,95%CI(-3.15,-1.44)]和高敏C反应蛋白[MD=-1.67,95%CI(-2.38,-0.95)]方面更具优势,差异有统计学意义(P<0.01),且安全性与单纯西药常规治疗无明显差异[MD=0.82,95%CI(0.43,1.55),P=0.53]。结论益气化痰活血类中药可以有效治疗T2DM伴颈动脉病变,且不增加不良反应风险。然而由于所纳入文献质量欠佳,该结论还有待大样本、多中心、高质量的随机对照临床试验进一步证实。Objective To systematically evaluate the efficacy and safety of qi-benefiting,phlegm-resolving,and blood-activating Chinese medicines in the treatment of type 2 diabetes mellitus(T2DM)complicated by carotid artery lesions.Methods Multiple databases including China National Knowledge Infrastructure(CNKI),Wanfang Data,VIP,China Biology Medicine disc(CBMdisc),PubMed,Web of Science,and The Cochrane Library were searched for random⁃ized controlled trials(RCTs)published up to September 18,2023,involving the use of qi-benefiting,phlegm-resolving,and blood-activating Chinese medicines in the treatment of T2DM with carotid artery lesions.Two reviewers independently conducted literature screening and data extraction,and the Cochrane Risk of Bias tool was used for quality assessment.Me⁃ta-analysis was performed using RevMan 5.4 software.Results A total of 27 studies involving 2574 participants were included.The Meta-analysis showed that,compared to the control group,the combination of qi-benefiting,phlegm-re⁃solving,and blood-activating Chinese medicines with conventional Western medication had a significant advantage in im⁃proving the total effective rate[OR=2.69,95%CI(2.09,3.46)],reducing carotid intima-media thickness(CIMT)[MD=-0.15,95%CI(-0.20,-0.10)],plaque area[MD=-0.25,95%CI(-0.38,-0.12)],plaque score[MD=-0.39,95%CI(-0.56,-0.21)],improving insulin resistance[MD=-0.48,95%CI(-0.59,-0.37)],reducing glycated hemoglobin[MD=-0.45,95%CI(-0.70,-0.19)],lowering total cholesterol[MD=-0.43,95%CI(-0.66,-0.21)],lowering low-density lipoprotein cholesterol[MD=-0.32,95%CI(-0.43,-0.21)],reducing homocysteine[MD=-2.30,95%CI(-3.15,-1.44)],and lowering high-sensitivity C-reactive protein[MD=-1.67,95%CI(-2.38,-0.95)],with all differences being statistically significant(P<0.01).The safety of the com⁃bination treatment was similar to that of conventional Western treatment alone[MD=0.82,95%CI(0.43,1.55),P=0.53].Conclusion Qi-benefiting,phlegm-resolving,and blood-activating Chinese medicines can effectively treat T2DM with carotid

关 键 词：益气化痰活血 2型糖尿病 颈动脉硬化 临床疗效 安全性 META分析 

分 类 号：R587.1[医药卫生—内分泌]