背景:糖尿病周围神经病变(DPN)主要以糖尿病作为一个整体来治疗,没有针对性的治疗。有研究报道,高压氧辅助治疗(HBOT)对DPN有较好的疗效,本研究旨在通过系统评价和荟萃分析评价HBOT治疗DPN的临床疗效和安全性,为临床提供参考。
方法:对多个数据库进行了全面搜索,包括PubMed,Embase,科克伦图书馆,WebofScience,中国国家知识互联网数据库,中国生物医学数据库,中国科学期刊数据库,和万方数据库,对于2022年7月之前发表的相关随机对照试验.人口,干预,比较,结果,研究设计标准用于指导研究的选择.使用RevMan5.4和STATA14.0进行荟萃分析,比值比和平均差以及95%置信区间作为效应大小的量度。
结果:14项随机对照试验纳入最终分析,包括HBOT组675例患者和标准治疗(ST)组648例患者。HBOT组治疗有效率明显高于ST组(P<0.001)。此外,HBOT组显示出跨多个神经的运动神经传导速度(MNCV)和感觉神经传导速度(SNVC)显著改善:正中神经(PMNCV<0.001,PSNCV=0.001),尺神经(PMNCV=0.02,PSNCV<0.001),腓骨神经(PMNCV<0.001,PSNCV<0.001),和胫神经(PMNCV=0.001,PSNCV=0.008)。HBOT组报告了6起不良事件,而ST组无不良事件发生,2组间无显著差异。通过漏斗图在一些结果变量中识别出出版偏差,乞丐测试,和Egger测试。
结论:HBOT能显著提高DPN患者的治疗效果和神经传导速度,很少有不良事件,使其成为DPN安全有效的辅助治疗方法。
BACKGROUND: Diabetes peripheral neuropathy (DPN) is mainly treated with diabetes as a whole, and there is no targeted treatment. Some studies have reported that adjuvant hyperbaric oxygen therapy (HBOT) for DPN has achieved a good effect, our study aimed to evaluate the clinical efficacy and safety of HBOT for DPN and provide reference for the clinic by using a systematic review and meta-analysis.
METHODS: A comprehensive search was conducted across several databases, including PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Internet Database, Chinese BioMedical Database, China Scientific Journal Database, and Wanfang Database, for relevant randomized controlled trials published before July 2022. The population, intervention, comparison, outcomes, study design criteria were used to guide the selection of studies. Meta-analysis was performed using RevMan 5.4 and STATA 14.0, with odds ratios and mean differences along with 95% confidence intervals serving as measures of effect size.
RESULTS: Fourteen randomized controlled trials were included in the final analysis, comprising 675 patients in the HBOT group and 648 in the standard therapy (ST) group. The HBOT group demonstrated a significantly higher effective treatment rate compared to the ST group (P < .001). Additionally, the HBOT group showed significant improvements in motor nerve conduction velocity (MNCV) and sensory nerve conduction velocity (SNVC) across multiple nerves: median nerve (PMNCV < 0.001, PSNCV = 0.001), ulnar nerve (PMNCV = 0.02, PSNCV < 0.001), peroneal nerve (PMNCV < 0.001, PSNCV < 0.001), and tibial nerve (PMNCV = 0.001, PSNCV = 0.008). Six adverse events were reported in the HBOT group, while no adverse events occurred in the ST group, with no significant difference between the 2 groups. Publication bias was identified in some outcome variables through funnel plots, Begger test, and Egger test.
CONCLUSIONS: HBOT significantly enhances treatment efficacy and nerve conduction velocity in patients with DPN, with few adverse events, making it a safe and effective adjunctive therapy for DPN.