Wang Ke-Yi, Ou Yi, Liu Chun-Xiang, Zhang Jun-Hua, Dai Xin-Yue, Gao Rui
Center of Evidence-based Medicine, Tianjin University of Traditional Chinese Medicine Tianjin 301617, China.
Xiyuan Hospital, Chinese Academy of Chinese Medical Sciences Beijing 100091, China.
Zhongguo Zhong Yao Za Zhi. 2021 Aug;46(15):4008-4015. doi: 10.19540/j.cnki.cjcmm.20201218.501.
To analyze the outcome indicators from the randomized controlled trials(RCTs) on traditional Chinese medicine(TCM) treatment for diabetic foot, and to lay a foundation for the establishment of the core index set of the clinical trials on TCM treatment of diabetic foot. Computer retrieval of RCTs on TCM treatment of diabetic foot was performed in CNKI, Wanfang, SinoMed, PubMed, Cochrane Library, EMbase and Web of Science databases. Literature screening and data extraction were conducted independently by two researchers in strict accordance with inclusion and exclusion criteria. Any difference was resolved through discussion. A total of 72 RCTs involving 5 791 patients were included and 204 indicators were used. The number of indicators used in a single study was 2-22, with an average of 3 indicators used for each RCT. The indicators with top 16 frequency were clinical total effective rate, ankle brachial index(ABI), ulcer area, TCM syndrome integral, fibrinogen(FIB), fasting blood glucose(FBG), plasma viscosity(PV), c-reactive protein(CRP), saccharification blood of eggs(HbAlc), 2 h postprandial blood glucose(2 hPG), wound healing time, triglyce-rides(TC), TCM efficacy for syndromes, total cholesterol(TG), percutaneous oxygen partial pressure(TCPO2) and TCM symptom scores. The difference in selection of RCT indicators was large among TCM treatment methods for diabetic foot, and the combination of outcome indicators was arbitrary. The description on indexes was not standardized. Some non-laboratory examination indicators, some indicators not recommended in guidelines or not recognized in clinical practice, and some self-made indicators were not explained in detail. There was a lack of standardized evaluation criteria for indicators. The indicators had large time-point difference in measurement, and the time points were not distinguished in the measurement for diabetic foot patients with different degrees of severity. In addition, the patients with long course of treatment weren't timely measured. The characteristics of TCM or significant endpoint indicators were insufficient. It was urgent to establish the core index set of TCM in treating diabetic foot.
分析中医药治疗糖尿病足随机对照试验(RCT)的结局指标,为建立中医药治疗糖尿病足临床试验核心指标集奠定基础。通过计算机检索中国知网、万方、中国生物医学文献数据库、PubMed、Cochrane图书馆、EMbase及Web of Science数据库中中医药治疗糖尿病足的RCT。由两名研究者严格按照纳入与排除标准独立进行文献筛选和数据提取。如有分歧通过讨论解决。共纳入72项RCT,涉及5791例患者,使用了204个指标。单个研究使用的指标数为2 - 22个,平均每项RCT使用3个指标。使用频率排名前16位的指标为临床总有效率、踝肱指数(ABI)、溃疡面积、中医证候积分、纤维蛋白原(FIB)、空腹血糖(FBG)、血浆黏度(PV)、C反应蛋白(CRP)、糖化血红蛋白(HbAlc)、餐后2小时血糖(2hPG)、伤口愈合时间、甘油三酯(TC)、中医证候疗效、总胆固醇(TG)、经皮氧分压(TCPO2)及中医症状评分。糖尿病足中医治疗方法间RCT指标选择差异较大,结局指标组合随意。指标描述不规范。部分非实验室检查指标、部分指南未推荐或临床实践未认可的指标以及部分自制指标未详细说明。缺乏指标的标准化评价标准。指标测量的时间点差异较大,不同严重程度糖尿病足患者测量时未区分时间点。此外,病程长的患者未及时测量。中医特色或重要终点指标体现不足。迫切需要建立中医药治疗糖尿病足的核心指标集。