Network Meta-analysis Of 5 Kinds Of Salvia Miltiorrhiza Preparations Combined With Mecobalamin In The Treatment Of Diabetic Peripheral Neuropathy

Objective: Through the network meta-analysis method,to rank the clinical effectiveness and the effect on the improvement of nerve conduction velocity of 5 kinds of Danshen preparations(Tanshinone ⅡA Sodium Sulfonate Injection,Salvia Miltiorrhiza Polyphenolate Injection,Danshen Injection,Ligustrazine Injection,Danhong Injection)combined with mecobalamin in the treatment of diabetic peripheral neuropathy in order to provide a reference for clinical medication.Methods: Computer search of CNKI,VIP,CBM,Wanfang,Pub Med,EMbase,CoChrane Library,Web of Science literature database.The search time is from the establishment of each database to December 2020.The included literature was screened strictly according to the preestablished inclusion and exclusion criteria nd assessed their methodological quality according to cochrane risk of bias tool with the basic information and outcomes of included studies were extracted.Meta-analysis was performed by Rev Man5.3 and Network meta-analysis was performed by Stata15.0.Continuous variables were calculated by mean difference and 95%confidence intervals and dichotomous variable were calculated by odds ratio and 95%confidence intervals.Calculating SUCRA and sorting the rank of different outcome indicators.Results :1.A total of 849 relevant documents were retrieved,and there are 53 articles involving4838 patients in this study.2.Meta-analysis showed the results as follows:Compared with mecobalamin alone,Tanshinone Ⅱ-A sodium sulfonate injection combined with mecobalamin,Salvia miltiorrhiza polyphenolate injection combined with mecobalamin,Danhong injection combined with mecobalamin,Danshen injection combined with mecobalamin to improve the clinical efficacy and beter of motor nerve and sensory nerve conduction velocity of amine in the treatment of diabetic peripheral neuropathy,the difference is statistically significant(P<0.05);Compared with mecobalamin alone,Danshen ligustrazine injection combined with mecobalamin to improve the clinical efficacy and beter median nerve motor conduction velocity,common peroneal nerve motor conduction velocity,and common peroneal nerve sensory conduction velocity,the difference was statistically significant(P<0.05);while in median nerve sensory conduction velocity,the difference was not statistically significant(P=0.26).3.Network meta-analysis showed the results as follows:(1)In terms of improving clinical effectiveness,the salvia miltiorrhiza polyphenolate injection group [OR=6.84,95%CI=(4.59,10.21)],the tanshinone Ⅱ-A sodium sulfonate injection group [OR=6.10,95%CI=(4.03,9.21)],Danshen injection group [OR=6.11,95%CI=(2.70,13.80)],Danshen ligustrazine injection group [OR=5.09,95%CI=(2.87,9.00)],Danhong Injection Group [OR=4.42,95%CI=(3.54,5.52)] is better than the methylcobalamin group alone,and the difference is statistically significant.According to the SUCRA value,the Salvia miltiorrhiza polyphenolate injection group(80.2%)ranks first;(2)In terms of the improvement of median nerve motor conduction velocity,the salvia miltiorrhiza polyphenolate injection group [MD=4.67,95%CI=(2.84,6.50)],the tanshinone injection group [MD=2.33,95%CI=(0.03,4.62)],Danshen injection combined group [MD=8.57,95%CI=(6.10,11.04)],Danshen ligustrazine injection group [MD=4.03,95%CI=(2.20,5.85)],Danhong Injection Group [MD=4.86,95%CI=(3.69,6.03)] has advantages compared with methylcobalamin alone,and the difference is statistically significant.SUCRA value ranking,Danshen injection group(99.7%)ranks first;(3)In terms of the improvement of the motor conduction velocity of the common peroneal nerve,the salvia polyphenolate injection group [MD=8.0,95%CI=(6.76,9.24)],the tanshinone sodium injection group [MD=2.86,95%CI=(1.61,4.12)],Danshen injection group [MD=12.23,95%CI=(10.51,13.96)],Danshen ligustrazine injection group [MD=3.28,95%CI=(2.20,4.35)],The Danhong injection group [MD=4.27,95%CI=(3.50,5.03)] is better than that of methylcobalamin alone,and the difference is statistically significant.According to the SUCRA value,the Danshen injection group(100%)ranks first;(4)In terms of the improvement of median nerve sensory conduction velocity,the salvia miltiorrhiza polyphenolate injection group [MD=5.44,95%CI=(4.21,6.67)],the tanshinone injection group [MD=5.04,95%CI=(3.64,6.44)];Danshen injection group [MD=6.61,95%CI=(4.74,8.48)],Danhong injection group [MD=3.81,95%CI=(2.99,4.63)] are better than singleuse methylcobalamin,and the difference is statistically significant.Compared with the salvia and ligustrazine injection group [MD=1.03,95%CI=(-0.21,2.26)],the difference is not statistically significant.According to the SUCRA value,Danshen injection group(94.9%)ranks first;(5)In terms of the improvement of sensory conduction velocity of the common peroneal nerve,the salvia polyphenolate injection group [MD=6.17,95%CI=(5.36,6.98)],the tanshinone injection group [MD=2.86,95%CI=(1.45,4.27)],Danshen injection group [MD=5.87,95%CI=(4.32,7.43)],Danshen ligustrazine injection group [MD=5.78,95%CI=(4.81,6.75)],Danhong injection group [MD=4.48,95%CI=(3.87,5.08)],and the differences is statistically significant.According to the SUCRA value,Salvia miltiorrhiza polyphenolate injection group(87.1%)ranks first.Conclusion:1.Danshen preparation combined with mecobalamin has advantages in improving clinical effectiveness and nerve conduction velocity;2.In terms of improving the clinical effectiveness and the sensory conduction velocity of the common peroneal nerve,the salvia polyphenolate injection combined with mecobalamin is better than other groups;Danshen injection combined with mecobalamin has the best effect in improving the median nerve,common peroneal nerve motor conduction velocity,and median nerve sensory conduction velocity.3.Danshen preparation combined with mecobalamin can be used as a clinical treatment plan for diabetic peripheral neuropathy.