针药并用治疗糖尿病足的临床疗效Meta分析  

Meta-Analysis of Clinical Efficacy of Acupuncture Combined with Traditional Chinese Medicine in Treatment of Diabetic Foot

作　　者：罗明辉 徐浩然 张鑫 郭勇 杨颇 邸铁涛 张永祥 LUO Ming-hui;XU Hao-ran;ZHANG Xin;CUO Yong;YANG Po;DI Tie-tao;ZHANG Yong-xiang(Guizhou University of Traditional Chinese Medicine,Guiyang Guizhou 550000;The Second Affiliated Hospital of Guizhou University of Traditional Chinese Medicine,Guiyang Guizhou 550000)

机构地区：[1]贵州中医药大学,贵州贵阳550000 [2]贵州中医药大学第二附属医院,贵州贵阳550000

出　　处：《世界中西医结合杂志》2025年第2期274-282,共9页World Journal of Integrated Traditional and Western Medicine

基　　金：中国康复医学会科技发展项目(KFKT-2023-023)。

摘　　要：目的评估针药并用治疗糖尿病足(Diabetic foot,DF)的临床疗效及安全性。方法计算机检索Cochrane、EMBASE、PubMed、中国知网(CNKI)、万方数据库(Wanfang Data)和维普数据库(VIP)建库至2024年4月期间发表的针灸结合中药治疗DF的随机对照试验(Randomized controlled trial,RCT)中英文文献。由2名研究员独立筛选文献、提取文献资料并对纳入的研究进行偏倚风险评价。使用Revman 5.4软件进行Meta分析。结果共纳入17篇文献,涉及1723例患者。与对照组相比,针药并用治疗DF在提高临床有效率[OR=3.83,95%CI(2.87,5.11),P<0.00001]及腓总神经、感觉神经、正中神经传导速度[MD=3.90,95%CI(2.17,5.63)P<0.00001;MD=1.11,95%CI(0.88,1.33),P<0.00001;MD=7.70,95%CI(6.13,9.27),P<0.00001]方面均优于对照组;在降低疼痛[MD=-0.78,95%CI(-1.11,-0.44),P<0.0001]、无力[MD=-0.67,95%CI(-0.81,-0.53),P<0.00001]、麻木[MD=-0.81,95%CI(-0.87,-0.75),P<0.00001]、皮肤紫红[MD=-1.17,95%CI(-1.49,-0.86),P<0.00001]、嗜睡倦怠[MD=-0.46,95%CI(-0.48,-0.44),P<0.00001]、全血高切黏度程度[MD=-0.67,95%CI(-0.93,-0.40),P<0.00001]方面明显优于对照组;在改善创面情况方面:创面灰暗[MD=-0.87,95%CI(-0.99,-0.74),P<0.00001]、创口难敛情况[MD=-0.98,95%CI(-1.14,-0.82),P<0.00001]、创面深度[MD=-1.40,95%CI(-1.66,-1.14),P<0.00001]、创面分泌物[MD=-0.90,95%CI(-1.32,-0.47),P<0.0001]、创面红肿[MD=-1.88,95%CI(-2.14,-1.62),P<0.00001]、腐肉覆盖[MD=-1.49,95%CI(-1.75,-1.23),P<0.00001]、肉芽增生[MD=-1.41,95%CI(-1.61,-1.21),P<0.00001]、创面疼痛[MD=-1.05,95%CI(-1.20,-0.90),P<0.00001]同样优于对照组。亚组分析表明:在疼痛程度评分方面,各亚组间存在一定异质性(I2=30.10%),针刺结合中药外用组亚组内异质性较大(I2=97.00%),针刺结合中药内服组通过敏感性分析明确异质性来源后异质性消除(I2=0);无力程度评分方面,各亚组间异质性检验较大(I2=95.50%),气虚血瘀和湿热血瘀亚组组内不存在异质性(I2=0�Objective To evaluate the clinical efficacy and safety of acupuncture combined with traditional Chinese medicine in the treatment of diabetic foot(DF).Methods Literature published until April 2024 in Cochrane,EMBASE,PubMed,China National Knowledge Infrastructure(CNKI),Wanfang Database(WF Data),and China Science and Technology Journal Database(VIP Data)was searched by computer.Chinese and English literature of randomized controlled trials(RCTs)of acupuncture combined with traditional Chinese medicine in the treatment of DF was collected.Two authors independently screened and extracted the literature and assessed the bias risk of the included study.Revman 5.4 software was used for Meta-analysis.Results A total of 17 articles were included,involving 1723 patients.Compared with the control group,acupuncture combined with traditional Chinese medicine could improve the clinical effective rate of DF[OR=3.83,95%CI(2.87,5.11),P<0.00001],and the conduction velocity of common peroneal nerve,sensory nerve,and median nerve[MD=3.90,95%CI(2.17,5.63),P<0.00001;MD=1.11,95%CI(0.88,1.33),P<0.00001;MD=7.70,95%CI(6.13,9.27),P<0.00001]were better than those in the control group.The acupuncture combined with traditional Chinese medicine group was superior to the control group in reducing pain[MD=-0.78,95%CI(-1.11,-0.44),P<0.0001],weakness[MD=-0.67,95%CI(-0.81,-0.53),P<0.00001],numbness[MD=-0.81,95%CI(-0.87,-0.75),P<0.00001],purplish skin[MD=-1.17,95%CI(-1.49,-0.86),P<0.00001],lethargy[MD=-0.46,95%CI(-0.48,-0.44),P<0.00001],and high shear viscosity of whole blood[MD=-0.67,95%CI(-0.93,-0.40),P<0.00001].It was also superior to the control group in improving gray wound[MD=-0.87,95%CI(-0.99,-0.74),P<0.00001],difficult wound healing[MD=-0.98,95%CI(-1.14,-0.82),P<0.00001],wound depth[MD=-1.40,95%CI(-1.66,-1.14),P<0.00001],wound secretion[MD=-0.90,95%CI(-1.32,-0.47),P<0.0001],wound redness and swelling[MD=-1.88,95%CI(-2.14,-1.62),P<0.00001],carrion cover[MD=-1.49,95%CI(-1.75,-1.23),P<0.00001],granulation hyperplasia[MD=-1.41,95%CI(-1,61,-1.21)

关 键 词：糖尿病足 针药并用 随机对照试验 META分析 

分 类 号：R245.3[医药卫生—针灸推拿学] R587.2[医药卫生—中医临床基础]