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Received:November 30, 2021 Published Online:July 20, 2022
Received:November 30, 2021 Published Online:July 20, 2022
中文摘要: 目的 通过荟萃分析评价中西医结合治疗非增殖期糖尿病视网膜病变（NPDR）的临床疗效，为中西医结合治疗NPDR提供循证依据。
方法 计算机检索中国知网数据库（CNKI）、万方数据库（WanFang Data）、维普中文期刊数据库（VIP），中国生物医学文献数据库（CBM）、PubMed、Cochrane Library，检索近10年运用中西医结合药物治疗NPDR的临床随机对照试验（RCTs），采用RevMan 5.3软件进行Meta分析。
结果 最终纳入19篇中文RCT研究，共1 549例NPDR患者。Meta分析结果示,与单纯西药治疗相比，中西医结合治疗在以下方面效果更优：提高临床疗效［OR=3.98,95%CI（2.93～5.40），P＜0.01］，改善视力［MD=0.11,95%CI（0.09～0.13），P＜0.01］，降低空腹血糖［MD=-0.51,95%CI（-0.92～-0.11）， P＜0.05］，降低高切全血黏度［MD=-0.55,95%CI（-0.86～-0.25），P＜0.01］和血浆黏度［MD=-0.18,95%CI（-0.32～-0.04），P＜0.05］，降低血清VEGF水平［MD=-9.37,95%CI（-11.63～-7.12），P＜0.01］，增加视网膜中央动脉收缩期峰流速（PSV）［MD=0.62，95%CI（0.36～0.88），P＜0.01］和舒张末期流速（EDV）［MD=0.32，95%CI（0.13～0.51），P＜0.01］、降低阻力指数（RI）［MD=-0.04，95%CI（-0.88～-0.01），P＜0.01］，减少眼底微血管瘤个数［MD=-0.96,95%CI（-1.21～-0.71），P＜0.01］、小出血点个数［MD=-1.67,95%CI（-1.90～-1.44），P＜0.01］、棉絮斑个数［MD=-0.91,95%CI（-1.16～-0.67），P＜0.01］和硬性渗出个数［MD=-0.97,95%CI（-1.15～-0.80），P＜0.01］。
结论 中西医结合治疗NPDR优于单纯西药治疗。但由于纳入研究样本量及文献质量的影响，仍需更多RCTs来验证。
中文关键词: 中西医结合 糖尿病视网膜病变，非增殖期 随机对照试验 视网膜中央动脉血流动力学 眼底征象 荟萃分析
Abstract:Objective To evaluate the clinical efficacy of integrated Chinese and Western medicine in the treatment of non-proliferative diabetes retinopathy（NPDR） by Meta-analysis, so as to provide evidence-based consensus for it. Methods The databases of CNKI, WanFang Data, VIP Chinese Journal Database（VIP）, China Biomedical Literature Database（CBM）, PubMed and Cochrane Library were searched by computer. Using RevMan 5.3 software, a Meta-analysis was performed to retrieve clinical randomized controlled trials（RCTs） involving the integrative Chinese and Western medicine in the treatment of NPDR in the last 10 years. Results A total of 1 549 patients with NPDR were included in 19 Chinese RCTs. Meta-analysis showed that， compared with Western medicine alone, integrated Chinese and Western medicine had better effects in the following aspects: improving the clinical efficacy［OR=3.98, 95%CI（2.93-5.40）］ and the visual acuity ［MD=0.11, 95%CI（0.09-0.13）］； reducing fasting blood glucose ［MD=-0.51, 95%CI（-0.92--0.11）］, high shear whole blood viscosity ［MD=-0.55, 95%CI（-0.86--0.25）］ and plasma viscosity ［MD=-0.18, 95%CI（-0.32--0.04）］; reducing the serum levels of VEGF ［MD=-9.37, 95%CI（-11.63--7.12）］； increasing the peak systolic velocity（PSV） ［MD=0.62, 95%CI（0.36-0.88）］ and end-diastolic flow velocity（EDV） ［MD=0.32, 95%CI（0.13～0.51）］ and reducing resistance index（RI） of the central retinal artery ［MD=-0.04, 95%CI（-0.88--0.01）］； improving the fundus condition, including reduction of the number of microvascular tumors ［MD=-0.96, 95%CI（-1.21--0.71）］, small bleeding points ［MD=-1.67, 95%CI（-1.90--1.44）］, cotton wool spots ［MD=-0.91, 95%CI（-1.16--0.67）］ and hard exudation ［MD=-0.97, 95%CI（-1.15--0.80）］ （P＜0.01, P＜0.05）. Conclusion In the treatment of NPDR, integrative medicine is superior to Western medicine alone. However, due to the impact of sample size and the quality of literature, more RCTs are needed to confirm the efficacy of integrated Chinese and Western medicine.
keywords: Integrated Chinese and Western medicine Diabetic retinopathy, non-proliferative Randomized controlled trials Hemodynamics of central retinal artery Fundus signs Meta-analysis
文章编号： 中图分类号：R587.2 R276.7 文献标志码：A
基金项目:财政部中医药专科专病循证能力建设项目（2019XZZX-YK008）
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