一例糖尿病外周神经病变患者的循证治疗_李俊峰.pdfVIP

实 践 与 交 流 2009, 9(1): 107 112 中国循证医学杂志 ～ 一例糖尿病外周神经病变患者的循证治疗 李俊峰 文重远* 武汉大学人民医院内分泌科 摘要 目的 针对一例糖尿病外周神经病变患者，检索当前最佳证据，为患者选择药物治疗方案提供依据，减 轻患者症状，提高生活质量。方法 根据循证临床实践的方法，提出问题，检索证据，对所获证据进行评价，并结合患 者意愿制定治疗方案。结果 共纳入 15 个随机对照试验，14 个系统评价 /Meta 分析和 1 个临床指南。证据结果表 明：① 稳定而良好的血糖控制是治疗糖尿病神经病变的基础；② 不推荐醛糖还原酶抑制剂、神经生长因子用于治疗 糖尿病神经病变；③ α- 硫辛酸能改善糖尿病神经病变患者症状；④ 三环类抗抑郁药，抗惊厥药，5- 羟色胺和去甲肾 上腺素摄取抑制剂可减轻糖尿病神经病变患者疼痛；⑤ B 族维生素与复方辣椒碱乳膏可用于治疗糖尿病神经病变。 结合患者情况，应用证据治疗 3 月后，患者血糖水平保持正常，症状缓解。结论 采用循证治疗的方法，为糖尿病外 周神经病变患者制定合理的治疗方案，可有效提高治疗效果。 关键词 糖尿病外周神经病变；醛糖还原酶抑制剂；神经生长因子；α- 硫辛酸；三环类抗抑郁药；复方辣椒碱乳 膏；循证治疗 Evidence-based Clinical Treatment of diabetic peripheral neuropathy LI Jun-feng, WEN Chong-yuan* Department of Endocrinology,Renmin Hospital of Wuhan University Abstract Objective To make individualized evidence-based treatment for patients with diabetic peripheral neuropathy. Methods Based on the clinical questions we raised, evidence was collected and critically assessed. Patients’ preferences was also taken into consideration in the decision-making treatment. Results 157 studies were retrieved and fi nally 15 randomized controlled trials, 14 systematic reviews and meta-analyses, and 1 clinical guidelines were considered eligible. The evidence indicated that the fi rst step in management of patients with diabetic peripheral neuropathy should aim for stable and optimal glycemic control; there was no statistically significant difference between aldose reductase inhibitors and placebo in the treatment of diabetic polyneuropathy, the same to nerve growth factor; alpha-lipoic acid is superior to placebo in reducing symptoms of diabetic peripheral neuropathy; 5-hydroxytryptamine and norepinephrine uptake inhibitor, tricyclic antidepressants and anticonvulsants might alleviate the pain in patients with diabetic peri