王世娇 徐连杰 张如意 李梦莎 张秀梅

【摘 要】

目的：系統评价针刺结合中药治疗糖尿病胃轻瘫（DGP）的有效性和安全性，并评价结局指标的证据质量，为临床提供循证医学证据。方法：计算机检索中国生物医学（CBM）、中国知网（CNKI）、万方数据库、重庆维普，检索时限为建库以来至2020年11月;按照纳入与排除标准，由两名研究者独立进行文献筛选，数据提取和偏倚风险评价，采用RevMan 5.3进行Meta分析，运用GRADEproGDT系统工具进行证据级别评价。结果：共纳入22篇文献，共计1581名患者，Meta分析结果显示：针刺结合中药在改善DGP患者总有效率、痊愈率以及胃排空功能方面优于西药治疗，且不增加不良反应的发生，疗效更加安全、可靠，GRADE证据质量评价结果显示，总有效率、痊愈率、胃排空时间、不良反应为低质量证据，胃排空率为极低质量证据。结论：当前证据显示，针刺结合中药治疗糖尿病胃轻瘫（DGP）的疗效优于西药治疗，但纳入文献的质量较低，研究结果需要开展更加严格的高质量随机对照试验来验证。

【关键词】

针刺;中药;糖尿病胃轻瘫;Meta分析;GRADE

【中图分类号】R246.1   【文献标志码】 A    【文章编号】1007-8517（2021）24-0071-10

Meta Analysis and GRADE Evidence Evaluation of Acupuncture Combined with Chinese Herbology for Diabetic Gastroparesis

WANG Shijiao1 XU Lianjie1 ZHANG Ruyi2 LI Mengsha1 ZHANG Xiumei1*

1.Honghe Hani and Yi Autonomous Prefecture Hospital of Traditional Chinese Medicine，Honghe  654399，China;

2.Chongqing University Three Gorges Hospital，Chongqing 404000，China

Abstract：

Objective To evaluate the efficacy and safety of acupuncture combined with Chinese herbology in the treatment of diabetic gastroparesis （DGP），and evaluate the quality of evidence for outcome indicators，to provide evidence-based medical evidence for clinical practice. Methods Computer search for Chinese Biomedical （CBM），China Zhiwang （CNKI），Wanfang Database，Chongqing Weipu，The retrieval time was limited since the establishment of the database to November 2020; According to inclusion and exclusion criteria，iterature screening，data extraction and bias risk assessment were conducted independently by two researcherst.After，using RevMan 5.3 for Meta analysis，Application of GR ADEproGDT system tools for evidence level evaluation. Results A total of 1581 patients were included in 22 articles. The Meta analysis showed that acupuncture combined withChinese herbology was superior to western medicine in improving the total effective rate，recovery rate and gastric emptying function of DGP patients，and did not increase the occurrence of adverse reactions. The results of quality evaluation of GRADE evidence showed that total effective rate，recovery rate，gastric emptying time，adverse reactions were low quality evidence，gastric emptying rate was extremely low quality evidence. Conclusion Current evidence shows that acupuncture combined withChinese herbology for treatment diabetic Gastroparesis （DGP） is superior to western medicine，but the quality of the literature is low，the results need to be validated by more rigorous，high-quality randomized controlled trials.

Key words：

Acupuncture; Traditional Chinese Medicine; Diabetic Gastroparesis; Meta Analysis; GRADE

糖尿病性胃轻瘫（Diabetic gastroparesis，DGP）是继发于糖尿病（Diabetes mellitus，DM）基础上出现的常见的并发症之一[1]，最早由Kassander于1958年提出[2]，主要表现为上腹部饱胀感，恶心，呕吐，厌食，腹泻或便秘等[3]，有关研究[4]调查发现该病发病率可达50%以上，且临床上该病具有较高的误诊和漏诊率[5]，随着生活方式的改变，近年来该病具有逐渐增多的趋势，约占糖尿病患者的5%[6]，患者因胃动力不足，胃排空率下降，可影响食物，药物吸收，出现营养失衡，血糖大幅波动等[7-8]，严重影响患者的生活质量[9]。……