重庆快乐十分

针灸治疗糖尿病周围神经病变的临床证据_贾蓝羽

3552 中华中医药杂志(原中国医药学报)2013年 12 月第28卷第12期 CJTCMP ,December 2013,Vol .28,No.12

针灸治疗糖尿病周围神经病变的临床证据

贾蓝羽1,杜元灏2,黎波1,王栩1,李海双1

(1天津中医药大学,天津 300193;2天津中医药大学第一附属医院,天津 300193)

摘要:目的:通过对针灸治疗糖尿病周围神经病变(DPN)的临床证据的整理评价,为临床决策提供参考依据。方法:围绕常见的针灸治疗临床问题,全面检索文献,按照循证医学5级标准选用能够回答对应临床问题的证据,结局指标的统计采用RevMan 5.0 软件进行计算。结果:1项B级证据支持针灸的有效性;1项A级证据,6项B级证据支持针灸很可能优于西药;2项B级证据支持针刺结合西药很可能优于单用西药;2项B级证据表明温针灸与针刺以及梅花针叩刺与针刺之间可能没有疗效差异。结论:弱中证据支持针灸治疗DPN可能有效,强中证据支持针灸或针灸配合药物很可能优于单用西药,弱中证据支持温针灸与针刺以及梅花针叩刺与针刺之间可能疗效相当,梅花针叩刺在改善神经传导速度方面可能有治疗优势。

关键词:针灸;糖尿病周围神经病变;临床证据;循证医学

Survey on clinical evidence of acupuncture therapy for diabetic peripheral neuropathy

重庆快乐十分JIA Lan-yu 1, DU Yuan-hao 2, LI Bo 1, WANG Xu 1, LI Hai-shuang 1

( 1Tianjin University of Chinese Medicine, Tianjin 300193, China; 2First Affi liated Hospital of Tianjin University of Chinese

重庆快乐十分Medicine, Tianjin 300193, China )

Abstract: Objective: To evaluate the clinical evidencet of acupuncture therapy for diabetic peripheral neuropathy (DPN) by analyzing the available studies so as to provide clinical decision-making reference。 Methods: The document of clinical study were comprehensively retrieved on the common questions of acupuncture clinical practice。 According to 5-grade criterion of evidence-based medicine, the evidence from high to low level were selected to answer conrresponding clincal questions, and RevMan 5。0 was used to analyze the fi nal results。 Results: One level-B study supported the eff ectiveness of acupuncture。 One level-A and six level-B studies supported that acupuncture might probably be superior to western medicine。 Two level-B studies supported that the eff ect of acupuncture combined with western medicine might probably be superior to that of medicine alone。 Two level-B studies showed that mild-warm moxibustion combined with acupuncture and tapping with plum-blossom needle combined with acupuncture probably had no eff ect diff erence。 Conclusion: Weak-medium powerful evidence supports that acupuncture for DPN might has a positive eff ect。 Strong-medium powerful evidence supports that acupuncture or acupuncture combined with western medicine probably be superior to medicine alone。 Weak-medium powerful evidence supports that mild-warm moxibustion combined with acupuncture and tapping with plum-blossom needle combined with acupuncture might has no eff ect diff erence。 Tapping with plum-blossom needle might be eff ective for treating DPN。

重庆快乐十分Key words: Acupuncture-moxibustion; Diabetic peripheral neuropathy; Clinical evidence; Evidence-based medicine

糖尿病周围神经病变(d ia bet ic p er iphera l

neuropathy,DPN )是糖尿病主要的慢性并发症之一,

也是糖尿病患者致残的主要原因,是在排除其他原

因的情况下,糖尿病患者出现周围神经功能障碍相关

重庆快乐十分的症状和/或体征表现的病变,主要表现为肢体麻木

重庆快乐十分疼痛。罗彻斯特DPN研究显示2型糖尿病患者周围神

经病变的患病率为45%[1]。

目前西医治疗DPN在控制血糖的基础上,常采用通讯作者:杜元灏,天津市南开区鞍山西道314号天津中医药大学第一附属医院C座针灸科,邮编:300193,电话:022-********E -mail:jpjs_cn@http://www。360docs。net/doc/info-ee9eb4a40740be1e640e9a43。html B族维生素、血管扩张剂、镇痛药等对症治疗,而现今大量临床报道显示针灸治疗本病疗效较好,但针对性的临床证据尚缺乏有效提炼和总结。针灸治疗DPN是否有效?针灸与西药相比是否有治疗优势?针灸结合西药能否提高疗效?针灸与其他疗法相比是否有治疗优势?不同刺灸法或不同刺灸方案之间是否存在疗效差异?本研究以上述临床问题为基础,广泛收集现有证据,而后按照循证医学方法提炼高・论著・

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