Network Meta-analysis Of Danggui Sini Decoction In The Treatment Of Diabetic Peripheral Neuropathy

Objective: Clinical studies have shown that Danggui Sini Decoction has a significant effect in the treatment of diabetes peripheral neuropathy.Danggui Sini Decoction is widely used in the treatment of diabetes peripheral neuropathy,mainly including oral,external washing,fumigation,sticking,foot bath,etc.Due to the multiple usage methods of Danggui Sini Tang and the lack of direct comparison of therapeutic effects between methods.In this regard,the network meta-analysis was used to evaluate the clinical efficacy,safety and improvement of nerve conduction velocity of diabetes peripheral neuropathy,providing evidence for future clinical treatment.Methods: Randomized controlled trials on the treatment of diabetes peripheral neuropathy with Danggui Sini Decoction were searched in Chinese databases such as CNKI,VIP,Wanfang,Duxiu,Chinese Biomedical Literature,and English databases such as Pub Med,Co Crane Library,Embase,Scopus,Proques,Web of Science,Ovid,etc.The search time is from the establishment of each database to March 1,2022.Two researchers independently completed literature screening,data extraction,and bias risk assessment.The Cochrane bias risk tool was used to evaluate the quality of the literature,and the data was analyzed using Stata 15,Stata 16,and Rev Man 5.4 software.Results:1.Literature search results: A total of 416 articles were included in the relevant content literature,resulting in the inclusion of 59 articles involving 5077 patients.2.Results of traditional meta-analysis:(i)if I2 in the study is <50%,P > 0.1,a fixed-effects model should be used because this indicates low heterogeneity between studies;(ii)if I2 in the study is >50%,P < 0.1,this indicates high heterogeneity between studies,so the reasons for the occurrence of heterogeneity should be identified first and a subgroup analysis should be performed when considering a random-effects model;(iii)the clinical effectiveness rate I2 = 0%,P = 0.999,using a A random-effects model should be used to compare the median nerve motor conduction velocity levels of the two groups in the trial,which were divided into three subgroups to give I2 = 85%,P < 0.00001;a random-effects model should be used to compare the median nerve sensory conduction velocity levels of the two groups in the trial,which were divided into four subgroups to give I2 = 82%,P < 0.00001;a random-effects model should be used to compare the The random effects model should be used to compare the motor conduction velocity levels of the common peroneal nerve in the two groups,which were divided into three subgroups to obtain I2 = 91%,P < 0.00001;the sensory conduction velocity levels of the common peroneal nerve in the two groups in the test,which were divided into three subgroups to obtain I2 = 89%,P < 0.00001;the random effects model should be used to compare the motor conduction velocity levels of the tibial nerve in the two groups in the test The random-effects model should be used to compare the levels of tibial nerve motor conduction velocity in the two groups in the test.3.Results of mesh meta-analysis:(1)In terms of improving clinical efficacy,the top three intervention measures ranked were Western medicine+Danggui Sini Tang external washing,Western medicine+Danggui Sini Tang oral plus external washing,and Western medicine+Danggui Sini Tang foot bath,The cumulative probability ranking of the efficacy of each intervention measure is: Western medicine+Danggui Sini Tang external washing(SUCRA=82.3)>Western medicine+Danggui Sini Tang oral plus external washing(SUCRA=66.8)>Western medicine+Danggui Sini Tang foot bath(SUCRA=66.2)>Western medicine+Danggui Sini Tang oral plus fumigation(SUCRA=65.4)>Western medicine+Danggui Sini Tang application(SUCRA=65.2)>Western medicine+Danggui Sini Tang oral administration(SUCRA=60.2)>Danggui Sini Tang oral administration(SUCRA=50.2)> Western medicine+flour application(SUCRA=25.1)> Western medicine+black Rice noodles application(SUCRA=15.1)> Western medicine(SUCRA=3.5);(2)In terms of improving the motor conduction velocity of the median nerve,the top three interventions are western medicine+angelica sini decoction external washing,angelica sini decoction oral taking,western medicine+angelica sini decoction oral taking.The cumulative probability of the efficacy of each intervention is: western medicine+angelica sini decoction external washing(SUCRA=78.3)>angelica sini decoction oral taking(SUCRA=70.1)>western medicine+angelica sini decoction oral taking(SUCRA=51.4)>western medicine(SUCRA=0.2);(3)In terms of improving the sensory conduction velocity of the median nerve,the top three interventions are western medicine+angelica sini decoction external washing,western medicine+angelica sini decoction oral,western medicine+angelica sini decoction foot bath,The cumulative probability ranking of the efficacy of each intervention measure is: Western medicine+Danggui Sini Tang external washing(SUCRA=88.1)>Western medicine+Danggui Sini Tang oral(SUCRA=70.8)>Western medicine+Danggui Sini Tang foot bath(SUCRA=53.9)>Danggui Sini Tang oral(SUCRA=35.9)>Western medicine(SUCRA=1.3);(4)In terms of improving the motor conduction velocity of the common peroneal nerve,the top ranked intervention measures are Western medicine+Danggui Sini Tang external washing.The cumulative probability of efficacy of each intervention measure is: Western medicine+Danggui Sini Tang external washing(SUCRA=79.8)>Western medicine+Danggui Sini Tang oral washing(SUCRA=77.8)>Danggui Sini Tang oral washing(SUCRA=42.2)>Western medicine(SUCRA=0.2);(5)In terms of improving the sensory conduction velocity of the common peroneal nerve,the top ranked intervention measures are Western medicine+Danggui Sini Tang external washing.The cumulative probability of efficacy of each intervention measure is: Western medicine+Danggui Sini Tang external washing(SUCRA=79.8)>Western medicine+Danggui Sini Tang oral washing(SUCRA=77.8)>Danggui Sini Tang oral washing(SUCRA=42.2)>Western medicine(SUCRA=0.2);(6)In terms of improving tibial nerve motor conduction velocity,the top ranked intervention measure is Danggui Sini Tang oral administration.The cumulative probability of efficacy of each intervention measure is: Danggui Sini Tang oral administration(SUCRA=79.3)>Western medicine+Danggui Sini Tang oral administration(SUCRA=70.6)>Western medicine(SUCRA=0.1);(7)In terms of improving the sensory conduction velocity of the tibial nerve,the top ranked intervention measure is Danggui Sini Tang oral administration.The cumulative probability of efficacy of each intervention measure is: Danggui Sini Tang oral administration(SUCRA=93.4)>Western medicine+Danggui Sini Tang oral administration(SUCRA=56.5)>Western medicine(SUCRA=0.1);(8)In terms of safety,a total of 19 included articles reported adverse reactions,of which 10 did not report the occurrence of specific adverse reactions and 9reported specific adverse reactions,but statistical analysis showed no significant difference.4.Conclusion:1.The treatment of diabetes peripheral neuropathy with Danggui Sini Decoction for internal and external use is better than that with western medicine alone,especially in improving clinical efficacy and nerve conduction velocity;2.The cumulative probability of the efficacy of Western medicine + Danggui Sihui Tang topical treatment was the highest in terms of improvement of median nerve movement,median nerve sensation,common peroneal nerve movement conduction velocity and clinical efficiency;the cumulative probability of the efficacy of Danggui Sihui Tang oral treatment was the highest in terms of improvement of common peroneal nerve sensation,tibial nerve movement and tibial nerve sensation conduction velocity;3.The reticulated Meta-analysis can objectively evaluate and rank the efficacy of internal and external Angelica Sinensis Si-wei Tang on diabetic peripheral neuropathy,providing a basis for further clinical studies.Limitations include the low quality of most studies,the small sample size included,and the fact that most of the pilot studies did not use blinding.