College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China.
Department of Vertigo, Jinan Shizhong People's Hospital, Jinan, Shandong, China.
Pharm Biol. 2024 Dec;62(1):833-852. doi: 10.1080/13880209.2024.2422084. Epub 2024 Nov 4.
Diabetic peripheral neuropathy (DPN) is the most common complication of diabetes mellitus. Chinese patent medicines (CPMs) are widely used in clinical practice to treat DPN.
This study aims to summarize the latest evidence on the harms and benefits of CPMs as adjunctive therapy for DPN.
We conducted searches for randomized controlled trials (RCTs) evaluating CPMs in conjunction with mecobalamin (Mec) or alpha-lipoic acid (αLA) across eight databases up to July 2024. The surface under the cumulative ranking area (SUCRA) was utilized to assess the clinical efficacy rate (CER), the peroneal motor nerve conduction velocity (pMNCV), the peroneal sensory nerve conduction velocity (pSNCV), the median motor nerve conduction velocity (mMNCV), and the median sensory nerve conduction velocity (mSNCV).
The search yielded 128 eligible studies with 31 CPMs with Mec and 39 eligible studies with 17 CPMs with αLA. SUCRA rankings indicated that, when combined with Mec, liquid (lMLN) was the most effective regimen for CER, injection (iHH) for pMNCV, capsule (cMXK) for pSNCV, injection (iDZXX) for mMNCV, and capsule (cTXL) for mSNCV. Combined with αLA, injection (iDH) showed the highest efficacy for CER, pSNCV, and mSNCV, while injection (iXShT) was the most effective for pMNCV and mMNCV.
This network meta-analysis confirms the efficacy and safety of 37 CPMs combined with Mec or αLA for treating DPN. However, given the potential risk of bias and the very low certainty of the evidence, these recommendations should be adopted with caution.
糖尿病周围神经病变（DPN）是糖尿病最常见的并发症。中药（CPMs）广泛用于临床治疗 DPN。
本研究旨在总结 CPMs 联合甲钴胺（Mec）或α-硫辛酸（αLA）辅助治疗 DPN 的最新疗效和安全性证据。
我们在 2024 年 7 月之前，对 8 个数据库中的评估 CPMs 联合 Mec 或 αLA 的随机对照试验（RCTs）进行了检索。采用累积排序曲线下面积（SUCRA）评估临床疗效（CER）、腓总运动神经传导速度（pMNCV）、腓浅感觉神经传导速度（pSNCV）、正中运动神经传导速度（mMNCV）和正中感觉神经传导速度（mSNCV）。
检索得到 128 项研究，其中 31 项研究采用 CPMs 联合 Mec，39 项研究采用 CPMs 联合 αLA。SUCRA 评分显示，与 Mec 联合使用时，液体（lMLN）对 CER 的疗效最佳，注射（iHH）对 pMNCV 的疗效最佳，胶囊（cMXK）对 pSNCV 的疗效最佳，注射（iDZXX）对 mMNCV 的疗效最佳，胶囊（cTXL）对 mSNCV 的疗效最佳。与 αLA 联合使用时，注射（iDH）对 CER、pSNCV 和 mSNCV 的疗效最高，而注射（iXShT）对 pMNCV 和 mMNCV 的疗效最高。
本网络荟萃分析证实了 37 种 CPMs 联合 Mec 或 αLA 治疗 DPN 的疗效和安全性。然而，鉴于潜在的偏倚风险和证据的极低确定性，这些建议应谨慎采用。
