【原】【罂粟摘要】痛性糖尿病神经病变介入治疗的研究进展：一项系统性评价

痛性糖尿病神经病变介入治疗的研究进展：一项系统性评价

贵州医科大学           麻醉与心脏电生理课题组

翻译：宋雨婷            编辑：宋雨婷       审校：曹莹

背景

痛性糖尿病神经病变（PDN）是糖尿病的主要并发症之一。它常使人身体虚弱，且对药物治疗无效。此研究目的为系统地回顾和评估PDN介入治疗方案的证据强度，并为临床实践提出循证建议。

方法

本研究检索了PubMed、Scopus、谷歌学术和Cochrane，并系统地评估了PDN介入治疗模式的所有临床研究类型。

结果

本研究确定并分析了10项相关的随机临床试验（RCTs），8项系统性评价/meta分析，以及5项以疼痛为主要结局指标的PDN介入治疗的观察性研究。本研究评估了证据分级的偏倚风险，发现有中高质量证据支持使用脊髓电刺激（SCS，又称脊髓背根电刺激，DCS）治疗下肢PDN（证据水平：1B +），但缺乏其在上肢治疗疗效的研究。现有证据表明，针灸和注射肉毒杆菌毒素-A可以缓解PDN引起的疼痛或肌肉痉挛，且副作用最小（证据水平：2B + / 1B +）。类似的证据水平支持可对难治性PDN伴神经压迫的患者行下肢周围神经减压 术（2B±/1B+）。阻滞交感神经或神经松解术和刺激背根神经节（DRG）的证据仅限于回顾性病例系列研究中（2C+）。

结论

中高质量证据支持可使用SCS治疗PDN常规药物治疗失败患者的下肢痛。针灸或注射肉毒杆菌毒素-A可作为PDN的辅助治疗。对于PDN伴神经压迫的患者，可考虑行周围神经减压术。需要进行高质量的研究，以进一步评估PDN介入治疗的安全性，有效性和成本效益。

原始文献来源

Xu, Li; Sun, Zhuo; Casserly, Elizabethet, et al. Advances in Interventional Therapies for Painful Diabetic Neuropathy: A Systematic Review. Anesthesia & Analgesia: June 2022 - Volume 134 - Issue 6 - p 1215-1228

英文原文

Advances in Interventional Therapies for Painful Diabetic Neuropathy: A Systematic Review

Background  Painful diabetic neuropathy (PDN) is one of the major complications of diabetes mellitus. It is often debilitating and refractory to pharmaceutical therapies. Our goal was to systematically review and evaluate the strength of evidence of interventional management options for PDN and make evidence-based recommendations for clinical practice.

Methods  We searched PubMed, Scopus, Google Scholar, and Cochrane Llibrary and systematically reviewed all types of clinical studies on interventional management modalities for PDN.

Results  We identified and analyzed 10 relevant randomized clinical trials (RCTs), 8 systematic reviews/meta-analyses, and 5 observational studies of interventional modalities for PDN using pain as primary outcome. We assessed the risk of bias in grading of evidence and found that there is moderate to strong evidence to support the use of dorsal column spinal cord stimulation (SCS) in treating PDN in the lower extremities (evidence level: 1B+), while studies investigating its efficacy in the upper extremities are lacking. Evidence exists that acupuncture and injection of botulinum toxin-A provide relief in pain or muscle cramps due to PDN with minimal side effects (2B+/1B+). Similar level of evidence supports surgical decompression of lower limb peripheral nerves in patients with intractable PDN and superimposed nerve compression (2B±/1B+). Evidence for sympathetic blocks or neurolysis and dorsal root ganglion (DRG) stimulation is limited to case series (2C+).

Conclusions  Moderate to strong evidence exists to support the use of SCS in managing lower extremity pain in patients who have failed conventional medical management for PDN. Acupuncture or injection of botulinum toxin-A can be considered as an adjunctive therapy for PDN. Surgical decompression of peripheral nerves may be considered in patients with PDN superimposed with nerve compression. High-quality studies are warranted to further evaluate the safety, efficacy, and cost-effectiveness of interventional therapies for PDN.