评估糖尿病患者心血管自主神经病变的治疗方案：一项系统综述。

Evaluating treatment options for cardiovascular autonomic neuropathy in patients with diabetes mellitus: a systematic review.

作者信息

Goh Jasmine KaiLi, Koh Leroy

机构信息

Department of Pharmacy, National University of Singapore, 18 Science Drive 4, Singapore, 117559 Singapore.

出版信息

Diabetol Int. 2023 Apr 25;14(3):224-242. doi: 10.1007/s13340-023-00629-x. eCollection 2023 Jul.

DOI:10.1007/s13340-023-00629-x

PMID:37397902

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10307756/

Abstract

BACKGROUND

Cardiovascular autonomic neuropathy (CAN) is a debilitating complication of diabetes mellitus. To date, there is no systematic review on all the available drug treatments for CAN in diabetic patients, except for one review focusing on aldose reductase inhibitors.

OBJECTIVE

To evaluate available drug treatment options for CAN in diabetic patients.

METHODS

A systematic review was conducted with a search of CENTRAL, Embase, PubMed and Scopus from database inception till 14th May 2022. Randomised controlled trials (RCTs) of diabetic patients with CAN that investigated the effect of treatment on blood pressure, heart rate variability, heart rate or QT interval were included.

RESULTS

Thirteen RCTs with a total of 724 diabetic patients with CAN were selected. There was a significant improvement in the autonomic indices of diabetic patients with CAN given angiotensin-converting enzyme inhibitor (ACEI) for 24 weeks (<0.05) to two years (<0.001), angiotensin-receptor blocker (ARB) for one year (<0.05), single dose of beta blocker (BB) (<0.05), omega-3 polyunsaturated fatty acids (PUFAs) for three months (<0.05), alpha-lipoic acid (ALA) for four months ( < 0.05) to six months (=0.048), vitamin B12 in combination with ALA, acetyl L‑carnitine (ALC), superoxide dismutase (SOD) for one year (=0.001) and near significant improvement in the autonomic indices of diabetic patients with CAN given vitamin E for four months ( = 0.05) compared to the control group. However, there was no significant improvement in the autonomic indices of patients given vitamin B12 monotherapy ( ≥ 0.05).

CONCLUSION

ACEI, ARB, BB, ALA, omega-3 PUFAs, vitamin E, vitamin B12 in combination with ALA, ALC and SOD could be effective treatment options for CAN, while vitamin B12 monotherapy might be unlikely to be recommended for the treatment of CAN due to its lack of efficacy.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s13340-023-00629-x.

摘要

背景

心血管自主神经病变（CAN）是糖尿病的一种使人衰弱的并发症。迄今为止，除了一项聚焦于醛糖还原酶抑制剂的综述外，尚无对糖尿病患者CAN所有可用药物治疗的系统评价。

目的

评估糖尿病患者CAN的可用药物治疗选择。

方法

进行了一项系统评价，检索了从数据库建立至2022年5月14日的Cochrane系统评价数据库（CENTRAL）、Embase、PubMed和Scopus。纳入了调查治疗对血压、心率变异性、心率或QT间期影响的CAN糖尿病患者随机对照试验（RCT）。

结果

选择了13项RCT，共724例CAN糖尿病患者。与对照组相比，给予血管紧张素转换酶抑制剂（ACEI）治疗24周（<0.05）至两年（<0.001）、血管紧张素受体阻滞剂（ARB）治疗一年（<0.05）、单剂量β受体阻滞剂（BB）（<0.05）、ω-3多不饱和脂肪酸（PUFA）治疗三个月（<0.05）、α-硫辛酸（ALA）治疗四个月（<0.05）至六个月（=0.048）、维生素B12联合ALA、乙酰左旋肉碱（ALC）、超氧化物歧化酶（SOD）治疗一年（=0.001）以及给予维生素E治疗四个月（=0.05）的CAN糖尿病患者的自主神经指标有显著改善。然而，给予维生素B12单一疗法的患者自主神经指标无显著改善（≥0.05）。