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目的系统评价α-硫辛酸联合依帕司他治疗糖尿病周围神经病变(Diabetic peripheral neuropathy DPN)的疗效。方法检索中国学术期刊全文数据库(Pub Med、Cochrane、EMbase、CNKI)、中国生物医学文献数据库(CBM)、维普期刊全文数据库(VIP)、万方数据库(Wan Fang)中的关于α-硫辛酸联合依帕司他治疗糖尿病周围神经病变的随机对照试验(自建库至2016年12月)。根据Cochrane系统评价手册,由2名研究者独立筛选文献、评价质量和提取数据后,采用Review Manager 5.3软件对数据进行分析。结果共13个随机对照试验(RCTs)(包括1 196例患者)纳入研究。对照组:依帕司他(A组)/α-硫辛酸(B组);试验组:α-硫辛酸联合依帕司他。从提高正中神经感觉、运动速度的角度看,试验组胜过对照组,差异有统计学意义,感觉(A组:SMD=1.97,95%CI:0.55~3.39,P<0.01;B组:SMD=1.39,95%CI:0.88~1.91,P<0.01),运动(A组:SMD=1.76,95%CI:0.52~3.01,P<0.01;B组:SMD=1.58;95%CI:0.88~2.28,P<0.01)。就提高腓总神经感觉(B组)、运动传导速度而言,试验组亦胜过对照组,差异有统计学意义,感觉(B组:SMD=1.15,95%CI:0.79~1.52,P<0.01),运动(A组:SMD=2.07,95%CI:0.66~3.48,P<0.01;B组:SMD=1.18,95%CI:0.88~2.67,P<0.01);在提高腓总神经感觉(A组)传导速度方面,差异无统计学(SMD=0.61,95%CI:-0.44~1.66,P>0.05)。结论与单独用药相比,α-硫辛酸联合依帕司他治疗糖尿病周围神经病变的疗效更胜一筹。
Objective To evaluate the efficacy of α-lipoic acid combined with epalrestat in the treatment of diabetic peripheral neuropathy (DPN). Methods We searched the Chinese Journal of Medicine (Cochrane Database), PubMed (Cochrane Database), China Biomedical Literature Database (CBM), VIP Library and Wan Fang database for the identification of α-lipoic acid Randomized controlled trial of epalrestat for the treatment of diabetic peripheral neuropathy (self-built to December 2016). According to the Cochrane systematic review manual, two researchers independently screened the literature, evaluated the quality and extracted the data and analyzed the data using Review Manager 5.3 software. Results A total of 13 randomized controlled trials (RCTs) (including 1,196 patients) were included in the study. Control group: Epalrestat (group A) / α-lipoic acid (group B); Test group: α-lipoic acid combined with epalrestat. From the perspective of improving median nerve sensory and motor speed, the experimental group was better than the control group, the difference was statistically significant (A group: SMD = 1.97, 95% CI: 0.55-3.39, P <0.01; (Group A: SMD = 1.76, 95% CI: 0.52-3.01, P <0.01; group B: SMD = 1.58; 95% CI: 0.88 ~ 2.28, P <0.01). The experimental group also outperformed the control group in terms of sensory enhancement of the common peroneal nerve (group B) and motor conduction velocity (group B: SMD = 1.15, 95% CI: 0.79-1.52, P < 0.01), exercise (group A: SMD = 2.07, 95% CI: 0.66-3.48, P <0.01; group B: SMD = 1.18, 95% CI: 0.88-2.67, P <0.01) (Group A), the difference was not statistically significant (SMD = 0.61, 95% CI: -0.44-1.66, P> 0.05). Conclusion Compared with the drug alone, α-lipoic acid combined with epalrestat treatment of diabetic peripheral neuropathy better.