【晨读】糖尿病周围神经病变的非药物治疗：综述（一）

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本次文献选自Suzanne, Amato, Nesbit, et al. Non-pharmacologic treatments for symptoms of diabetic peripheral neuropathy: a systematic review.[J]. Current Medical Research & Opinion, 2018.35(1)：15-25

ABSTRACT

Objective: To systematically assess benefits and harm of non-pharmacologic interventions for diabetic peripheral neuropathy (DPN) symptoms.

Methods: MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were searched from 1966 to May 24, 2016 for randomized controlled trials. Two reviewers evaluated studies for eligibility, serially abstracted data, evaluated risk of bias, and graded strength of evidence (SOE) for critical outcomes (pain and quality-of-life).

Results: Twenty-three trials were included. For pain, alpha-lipoic acid was more effective than placebo (moderate SOE) and frequency-modulated electromagnetic stimulation was more effective than sham (low SOE) in the short-term but not the long-term. Electrical stimulation (including transcutaneous) was not effective for pain (low SOE). Spinal cord stimulation was more effective than usual care for pain (low SOE), but had serious complications, and studies had no sham arm. Evidence for cognitive behavioral therapy and acupuncture was insufficient; no exercise or physical therapy trials met inclusion criteria. No interventions reported sufficient evidence on quality-of-life. Most studies were shortterm with unclear risk of bias.

Conclusions: Alpha-lipoic acid and spinal cord stimulation were effective for pain; studies were short term with quality deficits. Spinal cord stimulation had serious adverse events. Further research should address long-term outcomes and other non-pharmacologic treatments.

摘要

目的：系统评价糖尿病周围神经病变(DPN)非药物治疗的有效性和安全性。

方法：检索从1966年到2016年5月24日，MEDLINE、Embase和Cochrane临床对照试验中心注册数据库的随机对照试验。研究者评估了研究的可信度、提取数据的连续性、评估的偏倚风险和关键结果(疼痛和生活质量)的证据强度分级（SOE）。

结果:该研究包括23项试验。对于疼痛的缓解，α-硫辛酸比安慰剂(中度SOE)有效，调频电刺激在短期内比对照组(低SOE)有效，但在长期内无效。电刺激(包括经皮)对疼痛缓解无效。脊髓电刺激比通常的疼痛护理(低SOE)有效，但有严重的并发症，并且研究缺乏假手术对照。认知行为疗法和针灸的疗效缺乏论证；没有运动或物理治疗试验符合纳入标准。目前还没有关于治疗措施对于生活质量影响的研究。大多数研究都是短期的，偏倚风险不明。

结论:α-硫辛酸和脊髓刺激对缓解疼痛有效；但研究追踪时间较短，有质量缺陷。脊髓刺激有严重的不良事件。进一步的研究应该延长随访时间，并关注其他非药物治疗方案。

KEYWORDS

Diabetic peripheral neuropathy; Pain; Diabetes

关键词：糖尿病周围神经病变；疼痛；糖尿病

Introduction

Peripheral neuropathy affects 30–50% of patients with diabetes, but the impact may be even higher due to underdiagnosis. Common symptoms of diabetic peripheral neuropathy include pain, numbness, and paresthesia, and the impact on quality-of-life is substantial, including sleep disturbances and symptoms of anxiety and depression 2. Pharmacologic agents may be helpful in prevention and management of patients with diabetic peripheral neuropathy(DPN) , but these treatments often have significant side effects, making non-pharmacologic approaches potentially desirable options.

引言

30-50%的糖尿病患者可能会出现周围神经病变，由于部分漏诊，其影响可能更大。糖尿病周围神经病变的常见症状包括疼痛、麻木和感觉异常，对生活质量的影响很大，包括睡眠障碍以及焦虑和抑郁症状。药物可能有助于糖尿病周围神经病变患者的预防和管理，但这些治疗通常有显著的副作用，使非药物方法成为潜在的理想选择。

Dietary supplements, acupuncture, physical therapy and exercise, electrical stimulation and spinal cord stimulation are non-pharmacologic strategies used to alleviate symptoms from DPN. However, the last comprehensive review and guideline including non-pharmacologic treatments addressed literature through August 2008, and concluded that there were no effective treatments. Specifically, the review concluded that evidence was insufficient for alphalipoic acid or other supplements, that percutaneous electrical nerve stimulation should be considered, and that other approaches should not be considered or had insufficient evidence. A large number of studies have been published since this review, but no recent reviews have comprehensively assessed non-pharmacologic interventions, with recent reviews of treatments for DPN focusing only on pharmacologic options.

DPN的非药物治疗方案包括膳食补充剂、针灸、物理治疗和锻炼、电刺激和脊髓刺激。然而，最近一次对DPN非药物治疗方案的总结是，2008年8月的文献，当时的结论是没有有效的非药物治疗方案。文章认为，α硫辛酸或其他补充剂的治疗效果不确定，经皮神经电刺激可以考虑，其他方法证据不足。自该文献以来，又发表了大量研究，但最近的综述没有总结非药物治疗，目前的文献还是侧重于药物治疗。

We, therefore, conducted a comprehensive systematic review to address the benefits and harms of nonpharmacologic approaches to improve symptoms of diabetic peripheral neuropathy and health-related quality-of-life.

因此，我们对可以改善糖尿病周围神经病变症状和改善相关生活质量的非药物治疗方案进行了一项全面的系统综述，探讨非药物治疗方案的有效性和安全性。