Table 1_Traditional Chinese medicine for diabetic peripheral neuropathy: a network meta-analysis.docx

BackgroundDiabetic peripheral neuropathy (DPN) is a common complication of diabetes mellitus, characterized by high morbidity and significant disability. Traditional Chinese medicine (TCM) has shown potential in relieving symptoms and improving neurological function through multi-targeted mechanisms; however, the efficacy and safety of different TCM therapies have yet to be systematically evaluated.
ObjectiveThis study aims to provide evidence-based medicine for treating DPN with TCM therapy by network meta-analysis (NMA).
MethodsThis study comprehensively searched nine databases constructed up to November 2024. The quality and evidence of the included RCTs were assessed using the risk of bias assessment tool and GRADE pro, and pairwise meta-analysis and NMA were performed using RevMan, Stata, and R Studio. The results showed that 95 RCTs involving 8194 patients were included, containing 9 TCM therapies.
ResultsTCM Decoration + Acupuncture ranked highest in improving the motor conduction velocity of the common peroneal nerve (SUCRA = 0.81), followed by TCM Decoction + Chinese Herbal Footbath (SUCRA = 0.80), electroacupuncture (SUCRA = 0.75). Regarding the sensory conduction velocity of the common peroneal nerve, TCM Decoration + Chinese Herbal Foot (SUCRA=0.87) ranked first, followed by TCM Decoction + Acupuncture (SUCRA = 0.83), and TCM Decoction (SUCRA = 0.51). Electroacupuncture (SUCRA = 0.83) ranks first in improving median nerve motor conduction velocity, followed by TCM Decoction + Acupuncture (SCURA = 0.98), TCM Decoction (SUCRA = 0.55). TCM Decoration + Acupuncture (SUCRA=0.98) ranks first in improving the sensory conduction velocity of the median nerve, followed by electroacupuncture (SUCRA = 0.51), and Chinese Patent Medicine (SUCRA = 0.51). TCM Decoration + Chinese Herbal Footbath (SUCRA = 0.85) ranked first in improving overall clinical symptoms of DPN.
ConclusionThe effectiveness and safety of traditional Chinese medicine therapy in treating DPN have been preliminarily verified. In clinical practice, conservative clinical stratification selection can be made based on the results of this study and the actual situation. In addition, due to the limited quality of the included studies, larger sample sizes and high-quality research are still needed.
Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/, identifier (CRD42024589159).

背景：糖尿病周围神经病变（Diabetic peripheral neuropathy, DPN）是糖尿病的常见并发症，具有高发病率与显著致残性。中医药（Traditional Chinese medicine, TCM）可通过多靶点作用机制缓解患者症状、改善神经功能，展现出良好应用潜力，但不同中医疗法的疗效与安全性仍有待系统评估。
目的：本研究旨在通过网络meta分析（network meta-analysis, NMA）为中医药治疗糖尿病周围神经病变提供循证医学依据。
方法：本研究全面检索了截至2024年11月的9个数据库。采用偏倚风险评估工具与GRADE pro对纳入的随机对照试验（randomized controlled trial, RCT）的质量及证据等级进行评价，并借助RevMan、Stata及R Studio完成配对meta分析与网络meta分析。最终共纳入95项随机对照试验，涉及8194例患者，涵盖9种中医疗法。
结果：在改善腓总神经运动传导速度方面，中药复方制剂（TCM Decoration）联合针刺疗法的表面下累积排序概率（SUCRA）值为0.81，位列第一；其次为中药汤剂（TCM Decoction）联合中药足浴（SUCRA=0.80）、电针疗法（SUCRA=0.75）。针对腓总神经感觉传导速度，中药复方制剂（TCM Decoration）联合中药足浴（SUCRA=0.87）位居首位，其次为中药汤剂（TCM Decoction）联合针刺疗法（SUCRA=0.83）与单纯中药汤剂（SUCRA=0.51）。在改善正中神经运动传导速度方面，电针疗法（SUCRA=0.83）位列第一，其次为中药汤剂（TCM Decoction）联合针刺疗法（SUCRA=0.98，原文笔误SCURA已修正为SUCRA）、单纯中药汤剂（SUCRA=0.55）。在改善正中神经感觉传导速度方面，中药复方制剂（TCM Decoration）联合针刺疗法（SUCRA=0.98）排名第一，其次为电针疗法（SUCRA=0.51）与中成药（SUCRA=0.51）。在改善糖尿病周围神经病变整体临床症状方面，中药汤剂（TCM Decoction）联合中药足浴（SUCRA=0.85）位居首位。
结论：本研究初步验证了中医药治疗糖尿病周围神经病变的有效性与安全性。临床实践中可结合本研究结果与实际诊疗情况，进行分层个体化保守治疗选择。此外，由于纳入研究的整体质量存在局限，仍需开展大样本量、高质量的相关研究以进一步验证结论。
系统评价注册信息：注册平台：https://www.crd.york.ac.uk/PROSPERO/，注册号：CRD42024589159。