摘要
随着近年来不断上升的糖尿病前期人数,非药物综合干预已成为糖尿病前期人群的主流治疗方法,而所纳入研究的试验也存在许多不足之处,主要体现在:糖尿病前期的诊断标准不统一,大多选用美国糖尿病协会诊断标准;随机对照试验的随机方法和盲法描述质量不高;提及脱落病例的仅4篇,其中1篇详细说明了脱落原因;疗效评价指标糖代谢、脂代谢指标居多;疗程长短不一,最短的仅1月,非药物干预的疗效很难完全体现;描述干预后随访追踪者较少,难以明确治疗后的效应;干预方法的不良反应评价不够充分;针刺疗法及耳穴贴压的穴位选择没有较为统一国际标准,以个人经验取穴为多;中医干预方式的试验中涉及具体中医辨证分型及对应的个体化治疗方案较少;自身治疗前后对照的试验未设立空白或阳性对照组,缺乏一定的客观性和可信度。上述不足之处可能造成临床试验的偏倚,影响疗效的客观评价,可重复性不强,难以积累足够的数据形成可推广的综合干预方案,同时也不利于学术交流和降低糖尿病前期人群的糖尿病发生率。目前针对中医非药物干预治疗糖尿病前期的机制研究非常少,难以明确其临床疗效的科学客观性,今后亟待进一步深入开展中医非药物疗法的机制研究,为中医特色治疗提供客观依据。
With the increasing number of impaired glucose regulation（ IGR） in recent years,the non drug comprehensive intervention has become the mainstream treatment for people with IGR. However,there are many shortcomings in the trials included.The main findings are as follows： The diagnostic criteria of IGR is not uniform,most of them are diagnosed by the American Diabetes Association diagnostic criteria. The randomness and blindness of the randomized controlled trial were not high in quality. Only4 dropped cases were mentioned,one of them was explained the cause of dropping. Among the indexes of curative effect evaluation,there were many indexes of glucose metabolism and lipid metabolism. The course of treatment is different in length,the shortest course lasts for just one month,and the effect of non drug intervention is difficult to fully reflect. After the description of the intervention,the follow-up is few,which leads to difficulty in clarifying efficacy. Evaluating the adverse reactions of intervention is inadequate. In terms of acupuncture therapy and auricular acupoint selection,there is no uniform international standards,and most is based on personal experiences. The experiment of TCM intervention involves less specific TCM syndrome differentiation and individualized treatment plan. There is no blank control group or positive control group before and after the treatment,lacking a certain degree of objectivity and credibility. These shortcomings may cause bias in clinical trials,influence the objective evaluation of the efficacy,and repeatability is not strong. It is difficult to accumulate enough data to form a comprehensive intervention. At the same time,it is not conducive to academic exchanges and reduce the incidence of IGR. At present,the study on the mechanism of non-drug intervention in the treatment of IGR is very few,and it is difficult to clarify the scientific objectivity of its clinical effect.In the future,the research on the mechanism of non drug therapy of traditional Chinese medicine should be further carried out in order to provide an objective basis for the treatment of traditional Chinese medicine.
作者
王莹
朱蕴华
张晓天
程芳
WANG Ying1,ZHU Yun-hua1,ZHANG Xiao-tian2,CHENG Fang2(1.Affiliated Shuguang Hospital of Shanghai University of TCM, Shanghai, China, 201203;2.Pudong Jinyang Community Health Service Center of Shanghai, Shanghai, China, 20013)
出处
《河南中医》
2018年第3期479-483,共5页
Henan Traditional Chinese Medicine
基金
上海市"治未病"预防保健服务体系建设子项目(编号:ZY3-FWMS-1-1001-KYJS-08)
关键词
糖尿病前期
中医非药物干预
综述
impaired glucose regulation（IGR）
Non drug intervention in traditional Chinese medicine
a review
