■非增生性糖尿病视网膜病变(NPDR),一种常见的糖尿病并发症,发病率高,以视功能受损和眼底病变为特征。据报道,口服中成药(OCPM)可能会改善视力和资金体征。然而,NPDR的最佳OCPM仍然值得怀疑,值得进一步研究。
■从成立到2022年10月20日,在七个数据库中搜索了符合条件的随机对照试验(RCT)。结果为临床有效率,视敏度,视野灰度值,微动脉瘤体积,出血面积,黄斑厚度,和不良事件发生率。使用修订的Cochrane偏倚风险工具(ROB2)评估纳入研究的质量。使用R4.1.3和STATA15.0软件进行网络荟萃分析。
■我们纳入了42个RCTs,有4,858名患者(5,978只眼)。复方丹参滴丸(CDDP)联合羟苯磺酸钙(CD)在临床疗效上提高最大(SUCRA,88.58%)。复方血栓通胶囊(CXC)联合CD可能是最佳干预措施(SUCRA,98.51%)用于改善视力。单用CDDP可能是最有效的治疗选择(SUCRA,91.83%)用于提高视野灰度值。和血明目片(HXMMT)和双丹明目胶囊(SDMMC)联合CD可能是减少微动脉瘤体积和出血面积的最有效治疗方法(SUCRA,94.48%,和86.24%),分别。关于减少黄斑厚度,CXC结合CD排名第一(SUCRA,86.23%)。此外,所有OCPM均未引起严重不良反应.
■OCPM对NPDR有效且安全。仅CDDP,并结合CD,可能是最有效的提高视野灰度值和临床有效率,分别;CXC联合CD可能是增强BCVA和减少黄斑厚度的最佳方法;HXMMT和SDMMC联合CD,可能是最有效的微动脉瘤体积和出血面积,分别。然而,初步研究中的方法论报告很差,在综合证据和解释结果时,可能存在潜在的偏见。目前的发现需要更多的大样本来证实,双盲,未来严格设计和稳健方法的多中心RCT。
■https://www.crd.约克。AC.英国/普华永道/,标识符CRD42022367867。
Non-proliferative diabetic retinopathy (NPDR), a common diabetic complication with high morbidity, is featured by impaired visual function and fundus lesions. It has been reported that oral Chinese patent medicines (OCPMs) may improve visual acuity and fund signs. However, the best possible OCPMs for NPDR remain questionable and merit further investigation.
From inception to October 20, 2022, seven databases were searched for eligible randomized controlled trials (RCTs). The outcomes were clinical effective rate, visual acuity, visual field gray value, microaneurysm volume, hemorrhage area, macular thickness, and adverse events rate. The revised Cochrane risk-of-bias tool (ROB 2) was used to assess the quality of the included studies. Network meta-analysis was performed using R 4.1.3 and STATA 15.0 software.
We included 42 RCTs with 4,858 patients (5,978 eyes). The Compound Danshen Dripping Pill (CDDP) combined with calcium dobesilate (CD) had the most improvement in clinical efficacy rate (SUCRA, 88.58%). The Compound Xueshuantong Capsule (CXC) combined with CD may be the best intervention (SUCRA, 98.51%) for the improvement of visual acuity. CDDP alone may be the most effective treatment option (SUCRA, 91.83%) for improving visual field gray value. The Hexuemingmu Tablet (HXMMT) and Shuangdan Mingmu Capsule (SDMMC) combined with CD may be the most effective treatment for reducing microaneurysm volume and hemorrhage area (SUCRA, 94.48%, and 86.24%), respectively. Referring to reducing macular thickness, CXC combined with CD ranked first (SUCRA, 86.23%). Moreover, all OCPMs did not cause serious adverse reactions.
OCPMs are effective and safe for NPDR. CDDP alone, and combined with CD, may be the most effective in improving visual field gray value and clinical efficacy rate, respectively; CXC combined with CD may be the best in enhancing BCVA and reducing macular thickness; HXMMT and SDMMC combined with CD, maybe the most effective regarding microaneurysm volume and hemorrhage area, respectively. However, the reporting of methodology in the primary study is poor, potential biases may exist when synthesizing evidence and interpreting the results. The current findings need to be confirmed by more large-sample, double-blind, multi-center RCTs of rigorous design and robust methods in the future.
https://www.crd.york.ac.uk/prospero/, identifier CRD42022367867.