痛性糖尿病周围神经病变下肢周围神经减压术与常规药物疗效的Meta分析

doi:10.3877/cma.j.issn.2095-9605.2022.03.006

目的

通过文献荟萃分析的方式检索、收集并整理国内外近几年的最新研究，分析并总结周围神经减压手术在痛性糖尿病周围性病变（P-DPN）患者中的疗效和安全性。

方法

通过检索国内外综合性文献搜索平台检索P-DPN手术与保守治疗的疗效对比的研究进行荟萃分析。

结果

共检索到679篇文献，6篇文献被纳入其中。一共729名P-DPN患者纳入这次研究。文献报道腓肠神经传导速度（NCV）、腓总NCV、腓浅NCV比较有统计学差异（P<0.00001），手术组NCV均明显好转，两篇文献报道胫NCV比较无统计学差异（P=0.67），但是提示手术组胫NCV与未手术组无明显差异，考虑纳入文献较少导致偏倚，需进一步验证。振动觉阈值和冷热觉阈值均有统计学差异（P<0.00001），提示术后振动觉、冷热觉明显改善。

结论

本研究结果表明，周围神经减压术在治疗P-DPN患者时可以明显改善NCV，改善P-DPN患者神经功能方面有一定的疗效。由于高质量的随机对照试验或精心设计的前瞻性研究较少，需要更多的数据来阐明手术在未来治疗P-DPN中的作用。

关键词: 痛性糖尿病周围性病变, 周围神经减压术, 神经传导速度, Meta分析

Objective

To analyze the efficacy and safety of peripheral nerve decompression in patients with P-DPN by literature meta-analysis.

Methods

A meta-analysis was conducted to compare the efficacy of painful diabetic peripheral neuropathy surgery and conservative treatment by searching comprehensive literature search platforms at home and abroad.

Results

A total of 679 literatures were retrieved, and 6 literatures were included. A total of 729 patients with P-DPN were enrolled in the study. There were statistically significant differences in sural nerve conduction velocity (NCV), total peroneal NCV and superficial peroneal NCV (P<0.00001), and NCV was significantly improved in the surgery group. Tibial NCV was no statistically different in the two literatures (P=0.67), considering the fewer included literatures, bias is required for further verification. There were statistically significant differences in the thresholds of vibration sensation and cold and heat sensation (P<0.00001), indicating significant improvement in vibration sensation and cold and heat sensation after surgery.

Conclusions

The results of our study indicate that peripheral nerve decompression can significantly improve nerve conduction velocity and nerve function in patients with P-DPN. Because there are few high-quality randomized controlled trials or well-designed prospective studies, more data are needed to elucidate the role of surgery in the future treatment of P-DPN.

Key words: Painful diabetic peripheral neuropathy (P-DPN), Peripheral nerve decompression, Nerve conduction velocity, Meta analysis

图1 文献检索流程图

表1 文献基本信息

作者	年份	研究类型	患者数量	手术部位	文献质量a
Macaré van Maurik J Maurik^[6]	2015	随机对照	42	单侧下肢（对侧肢体作为对照）	5
Liao C ^[7]	2014	队列研究	367	双下肢	12
方旭^[8]	2014	队列研究	90	双下肢	10
姚建立^[9]	2014	病例对照	50	双下肢	8
蔡树权^[10]	2017	病例对照	108	双下肢	7
杨晓东^[11]	2021	队列研究	72	双下肢	9

表1 文献基本信息

作者	年份	研究类型	患者数量	手术部位	文献质量a
Macaré van Maurik J Maurik^[6]	2015	随机对照	42	单侧下肢（对侧肢体作为对照）	5
Liao C ^[7]	2014	队列研究	367	双下肢	12
方旭^[8]	2014	队列研究	90	双下肢	10
姚建立^[9]	2014	病例对照	50	双下肢	8
蔡树权^[10]	2017	病例对照	108	双下肢	7
杨晓东^[11]	2021	队列研究	72	双下肢	9

图2 术后手术组与对照组腓肠NCV对比分析森林图

图3 术后手术组与对照组腓总NCV对比分析森林图

图4 术后手术组与对照组腓浅NCV对比分析森林图

图5 术后手术组与对照组胫NCV对比分析森林图

图6 术后手术组与对照组振动觉对比分析森林图

图7 术后手术组与对照组冷感觉对比分析森林图

图8 术后手术组与对照组热感觉对比分析森林图

图9 术后手术组与对照组腓浅NCV对比分析漏斗图

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Meta-analysis of lower extremity peripheral nerve decompression and conventional drugs in patients with painful diabetic peripheral neuropathy

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Meta-analysis of lower extremity peripheral nerve decompression and conventional drugs in patients with painful diabetic peripheral neuropathy