■甲钴胺是治疗糖尿病性周围神经病变(DPN)的常用药物。本研究旨在系统评价穴位注射甲钴胺治疗DPN的有效性和安全性。
■在2023年1月31日之前发表的关于穴位注射甲钴胺治疗DPN的相关临床试验在8个常用数据库中进行了检索。在筛选和确认纳入的研究后,进行荟萃分析和试验序贯分析。
■共确认了10项相关研究,总样本量为927例。在疗效终点,荟萃分析表明,与其他给药方法相比,穴位注射甲钴胺可显著提高27%的临床有效率[RR=1.27,95%CI=(1.19,1.36),P<0.00001],运动神经传导速度(正中神经)5.93m/s[MD=5.93,95%CI=(4.79,7.07),P<0.00001],运动神经传导速度(腓总神经)5.66m/s[MD=5.66,95%CI=(2.89,8.43),P<0.0001],感觉神经传导速度(正中神经)4.83m/s[MD=4.83,95%CI=(3.75,5.90),P<0.00001],感觉神经传导速度(腓总神经)为3.60m/s[MD=3.60,95%CI=(2.49,4.71),P<0.00001],试验序贯分析显示这些获益是决定性的.就安全终点而言,荟萃分析表明,穴位注射的总不良事件与其他给药方法相当,试验序贯分析提示,该结果需要更多研究验证.亚组分析表明,穴位注射甲钴胺的益处不受剂量限制,治疗持续时间,或纳入研究报告的穴位数量。Harbord检验显示无显著发表偏倚(P=0.106)。
■穴位注射甲钴胺治疗DPN的疗效明显优于其他给药,其安全性与其他主管部门相当。因此,穴位注射可能是甲钴胺治疗DPN的最佳方法。
■https://www.crd.约克。AC.uk/prospro/display_record.php?RecordID=454120,标识符:CRD42023454120。
UNASSIGNED: Mecobalamin is a commonly used drug in the treatment of diabetic peripheral neuropathy (DPN). This study aimed to systematically evaluate the efficacy and safety of acupoint injection of mecobalamin for DPN.
UNASSIGNED: Relevant clinical trials on acupoint injection of mecobalamin for DPN published before 31 January 2023 were searched in eight commonly used databases. After screening and confirming the included studies, meta-analysis and trial sequential analysis were performed.
UNASSIGNED: A total of 10 relevant studies were confirmed, and the total sample size was 927 cases. On the efficacy endpoints, meta-analysis showed that compared with other administration methods, acupoint injection of mecobalamin significantly increased the clinical effective rate by 27% [RR = 1.27, 95% CI = (1.19, 1.36), P < 0.00001], motor nerve conduction velocity (median nerve) by 5.93 m/s [MD = 5.93, 95% CI = (4.79, 7.07), P < 0.00001], motor nerve conduction velocity (common peroneal nerve) by 5.66 m/s [MD = 5.66, 95% CI = (2.89, 8.43), P < 0.0001], sensory nerve conduction velocity (median nerve) by 4.83 m/s [MD = 4.83, 95% CI = (3.75, 5.90), P < 0.00001], and sensory nerve conduction velocity (common peroneal nerve) by 3.60 m/s [MD = 3.60, 95% CI = (2.49, 4.71), P < 0.00001], and trial sequential analysis showed these benefits were conclusive. In terms of safety endpoints, meta-analysis indicated that the total adverse events for acupoint injection were comparable to other methods of administration, and trial sequential analysis suggested that the results needed to be validated by more studies. Subgroup analysis demonstrated that the benefits of acupoint injections of mecobalamin were not limited by the dose, duration of treatment, or number of acupoints reported in the included studies. Harbord\'s test showed no significant publication bias (P = 0.106).
UNASSIGNED: The efficacy of acupoint injection of mecobalamin for DPN was significantly better than other administrations, and its safety was comparable to other administrations. Therefore, acupoint injection may be the optimal method of mecobalamin for DPN.
UNASSIGNED: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=454120, identifier: CRD42023454120.