基于Meta分析和数据挖掘的糖尿病肾病针灸治疗策略研究
A strategic study of acupuncture for diabetic kidney disease based on meta-analysis and data mining.
作者信息
Yu Yunfeng, Hu Gang, Yang Xinyu, Yin Yuman, Tong Keke, Yu Rong
机构信息
Department of Endocrinology, The First Hospital of Hunan University of Chinese Medicine, Changsha, Hunan, China.
College of Chinese Medicine, Hunan University of Chinese Medicine, Changsha, Hunan, China.
出版信息
Front Endocrinol (Lausanne). 2024 Feb 26;15:1273265. doi: 10.3389/fendo.2024.1273265. eCollection 2024.
OBJECTIVE
The specific benefit and selection of acupoints in acupuncture for diabetic kidney disease (DKD) remains controversial. This study aims to explore the specific benefits and acupoints selection of acupuncture for DKD through meta-analysis and data mining.
METHODS
Clinical trials of acupuncture for DKD were searched in eight common databases. Meta-analysis was used to evaluate its efficacy and safety, and data mining was used to explore its acupoints selection.
RESULTS
Meta-analysis displayed that compared with the conventional drug group, the combined acupuncture group significantly increased the clinical effective rate (risk ratio [RR] 1.35, 95% confidence interval [CI] 1.20 to 1.51, P < 0.00001) and high-density lipoprotein cholesterol (mean difference [MD] 0.36, 95% CI 0.27 to 0.46, P < 0.00001), significantly reduced the urinary albumin (MD -0.39, 95% CI -0.42 to -0.36, P < 0.00001), urinary microalbumin (MD -32.63, 95% CI -42.47 to -22.79, P < 0.00001), urine β2-microglobulin (MD -0.45, 95% CI -0.66 to -0.24, P < 0.0001), serum creatinine (MD -15.36, 95% CI -21.69 to -9.03, P < 0.00001), glycated hemoglobin A1c (MD -0.69, 95% CI -1.18 to -0.19, P = 0.006), fasting blood glucose (MD -0.86, 95% CI -0.90 to -0.82, P < 0.00001), 2h postprandial plasma glucose (MD -0.87, 95% CI -0.92 to -0.82, P < 0.00001), total cholesterol (MD -1.23, 95% CI -2.05 to -0.40, P = 0.003), triglyceride (MD -0.69, 95% CI -1.23 to -0.15, P = 0.01), while adverse events were comparable. Data mining revealed that CV12, SP8, SP10, ST36, SP6, BL20, BL23, and SP9 were the core acupoints for DKD treated by acupuncture.
CONCLUSION
Acupuncture improved clinical symptoms, renal function indices such as uALB, umALB, uβ2-MG, and SCR, as well as blood glucose and blood lipid in patients with DKD, and has a favorable safety profile. CV12, SP8, SP10, ST36, SP6, BL20, BL23, and SP9 are the core acupoints for acupuncture in DKD, and this program is expected to become a supplementary treatment for DKD.
目的
针刺治疗糖尿病肾病（DKD）的具体疗效及穴位选择仍存在争议。本研究旨在通过荟萃分析和数据挖掘探讨针刺治疗DKD的具体疗效及穴位选择。
方法
在八个常见数据库中检索针刺治疗DKD的临床试验。采用荟萃分析评估其疗效和安全性，采用数据挖掘探索其穴位选择。
结果
荟萃分析显示，与传统药物组相比，针刺联合治疗组显著提高了临床有效率（风险比[RR]1.35，95%置信区间[CI]1.20至1.51，P<0.00001）和高密度脂蛋白胆固醇（平均差[MD]0.36，95%CI0.27至0.46，P<0.00001），显著降低了尿白蛋白（MD -0.39，95%CI -0.42至-0.36，P<0.00001）、尿微量白蛋白（MD -32.63，95%CI -42.47至-22.79，P<0.00001）、尿β2-微球蛋白（MD -0.45，95%CI -0.66至-0.24，P<0.0001）、血清肌酐（MD -15.36，95%CI -21.69至-9.03，P<0.00001）、糖化血红蛋白A1c（MD -0.69，95%CI -1.18至-0.19，P = 0.006）、空腹血糖（MD -0.86，95%CI -0.90至-0.82，P<0.00001）、餐后2小时血糖（MD -0.87，95%CI -0.92至-0.82，P<0.00001）、总胆固醇（MD -1.23，95%CI -2.05至-0.40，P = 0.003）、甘油三酯（MD -0.69，95%CI -1.23至-0.15，P = 0.01），而不良事件相当。数据挖掘显示，中脘（CV12）、血海（SP8）、三阴交（SP10）、足三里（ST36）、脾俞（SP6）、肾俞（BL20）、气海俞（BL23）和阴陵泉（SP9）是针刺治疗DKD的核心穴位。
结论
针刺改善了DKD患者的临床症状、肾功能指标如尿白蛋白、尿微量白蛋白、尿β2-微球蛋白和血清肌酐，以及血糖和血脂，且具有良好的安全性。中脘（CV12）、血海（SP8）、三阴交（SP10）、足三里（ST36）、脾俞（SP6）、肾俞（BL20）、气海俞（BL23）和阴陵泉（SP9）是DKD针刺治疗的核心穴位，该方案有望成为DKD的辅助治疗方法。
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