Meta-Analysis On The Treatment Of Diabetic Peripheral Neuropathy With Traditional Chinese Medicine Decoction Of Promoting Blood Circulation And Removing Stasis Combined With Neurotrophic Drugs

Objective: To explore the effectiveness of traditional Chinese medicine decoction of Promoting Blood Circulation and Removing Stasis combined with neurotrophic drugs in the treatment of diabetic peripheral neuropathy,in order to provide a theoretical basis for the treatment of diabetic peripheral neuropathy with traditional Chinese medicine.Methods: In the past 10 years(from January 1,2009 to October 31,2019),CNKI,Wanfang,VIP,CBM,Pub Med,Cochrane Library,embasa and other databases were used to search for the clinical randomized controlled trials related to the treatment of diabetic peripheral neuropathy with traditional Chinese medicine decoction of Promoting Blood Circulation and Removing Stasis combined with neurotrophic drugs,and relevant journals and magazines were searched manually by two independent researchers in strict accordance with the Institute According to the inclusion and exclusion criteria,qualified studies were screened out,and data extraction tables were made by word software to extract relevant data.All the included literatures were assessed by Cochrane bias risk assessment tool and modified Jadad score,and meta analysis was conducted by Revman 5.3 software to systematically evaluate the effectiveness of traditional Chinese medicine decoction of Promoting Blood Circulation and Removing Stasis combined with neurotrophic drugs in the treatment of diabetic peripheral neuropathy.Results: A total of 973 patients were included in 14 articles,including 500 in the treatment group and 473 in the control group.Their baseline level was basically the same,mainly small sample,low-quality clinical randomized control study.The results of meta analysis showed that: compared with treatment with neurotrophic drugs alone,the combination of Huoxue Huayu traditional Chinese medicine decoction and neurotrophic drugs can improve the total effective rate of clinical efficacy[OR=4.68,95%CI(3.25,6.74),Z=8.27,P<0.00001],the difference have statistical sense,indicating that the combination of Huoxue Huayu traditional Chinese medicine decoction and neurotrophic drugs can improve the clinical efficacy of DPN patients Symptom.In terms of improving motor nerve conduction velocity,the combination of Huoxue Huayu traditional Chinese medicine decoction and neurotrophic drugs can improve the MCV of median nerve [combined effect MD=2.73,95%CI(0.84,4.62),Z=2.83,P=0.005],the MCV of common peroneal nerve [combined effect MD=2.18,95%CI(1.54,2.82),Z=6.71,P<0.00001],and the MCV of tibial nerve [combined effect MD=4.04,95%CI(1.17,6.91),Z=2.76,P=0.006],which shows that the combination of Huoxue Huayu traditional Chinese medicine decoction and neurotrophic drugs is better than treatment with neurotrophic drugs alone in improving the motor nerve conduction velocity,the difference have statistical sense.In terms of improving the sensory nerve conduction velocity,the combination of Huoxue Huayu traditional Chinese medicine decoction and neurotrophic drugs can improve the SCV of median nerve [combined effect amount MD=1.17,95%CI(0.37,1.97),Z=2.87,P=0.004],and the SCV of common peroneal nerve [combined effect amount MD=0.55,95%CI(-1.09,2.19),Z=0.66,P=0.51],indicating that the combination of Huoxue Huayu traditional Chinese medicine decoction and neurotrophic drugs can improve the SCV of median nerve,The difference was statistically significant,there was no significant difference in improving the SCV of common peroneal nerve compared with the conventional western medicine treatment.Compared with treatment with neurotrophic drugs alone,the combination of Huoxue Huayu traditional Chinese medicine decoction and neurotrophic drugs treatment can improve the symptom score [the combined effect amount MD=-3.69,95%CI(-4.95,-2.42),Z=5.73,P<0.00001],indicating that the combination of Huoxue Huayu traditional Chinese medicine decoction and neurotrophic drugs treatment can reduce the symptom score of patients,and the difference is statistically significant.In the aspect of improving liver and kidney function,Huoxue Huayu traditional Chinese medicine decoction Combined with neurotrophic drugs improved AST level[combined effect amount MD=-0.54,95%CI(-2.66,1.57),z=0.50,P=0.61],ALT level[combined effect amount MD=0.23,95%CI(-1.43,1.89),z=0.27,P=0.78],creatinine level[combined effect amount MD =-1.43,95%CI(-4.53,1.66),z=0.91](P=0.36),the difference have no statistical sense,expressing that there was no significant effect of Huoxue Huayu traditional Chinese medicine decoction Combined with neurotrophic drugs in reducing the level of glutamic oxaloacetate transaminase,glutamic pyruvate transaminase and serum creatinine.No serious adverse reactions were reported in the experimental group and the control group.Conclusion: Compared with treatment with neurotrophic drugs alone,the combination of Huoxue Huayu traditional Chinese medicine decoction and neurotrophic drugs has obvious advantages in improving the total effective rate of clinical curative effect of diabetic peripheral neuropathy,increasing the motor nerve conduction velocity of median nerve,common peroneal nerve and tibial nerve,increasing the sensory nerve conduction velocity of median nerve,and reducing the symptom score,etc.In improving the conduction velocity of the common peroneal nerve,there is no obvious advantage compared with the treatment of neurotrophic drugs alone;in the aspect of improving liver and kidney function,there is no obvious therapeutic effect.Due to the low quality of the included literature,more high-quality RCT studies are needed to verify the above conclusions.