System Evaluation And Meta Analysis Of Mudan Granule Combined With Methylcobalamin In Treatment Of Diabetic Peripheral Neuropathy

Objective:To evaluate the clinical effects of Mudan granule and Mecobalamin resisting diabetic peripheral neuropathy systemically using meta analysis method by collecting relevant literature from home and abroad, in the hope of serving as a guidance in medication and providing a new way for integrative treatment on diabetic peripheral neuropathy.Methods:Apply "Mudan granule、Mecobalamin、Diabetic peripheral neuropathy" as keywords, searching for concerned RCT literatures published between 2006.1 and 2016.3 on CNKI, CAJD, VIP, Wan Fang data, CBM, PubMed and Web of science. The experimental group uses Mudan granule and Mecobalamin while the control group uses Mecobalamin to treat the disease. To evaluate the quality of the RCTs, exclude those unqualified and low-level publications. The difference of average±standard deviation before and after treatment both in the experimental and control group was calculated. Then the selected data was analyzed with software RevMan 5.3.Results:11 qualified literatures were selected from 20 chinese publications by preliminary searching, all in Chinese, since no English publications were found. All literatures have recorded the cases of both experimental and control group in detail, and the quality of the majority was evaluated as B level.All research mentioned that there was no difference in the two groups before treatment(P>0.05).1237 DPN patients are included,there are 603 and 634 cases in control group and experimental group respectively.Each research has 240 cases at most and 54 cases at least.The result shows clear effect in experimental group. As for the effective rate,the experimental group is higher than control group[RR=1.41,95%CI(1.30,1.52), Z=8.70, P<0.00001].The improvement of median nerve motor conduction velocity[MD=3.59,95% CI(0.44,6.75), Z=2.23, P=0.03] and sensory nerves conduction velocity [MD=3.80,95% CI(1.64,5.95), Z=3.45, P=0.0006] is greater than control group.The common peroneal nerve motor conduction velocity[MD=4.05,95%CI(1.00,7.10), Z=2.60, P=0.009] and sensory nerve conduction velocity [MD=3.52,95%CI(1.96,5.09), Z=4.42, P<0.00001] also show greater improvement than contol group.Conclusion:There is advantage in treating DPN by using Mudan granule and Mecobalamin at the same time,it can alleviate the clinical symptoms effectively and improve the indicators of related nerve function compared with using Mecobalamin only. There has already been lots of literatures on the greater effectiveness of combined treatment,however,the result may not be accurate because of the difference in collecting literatures. Rigorously-designed and large sample RCT is needed.