糖尿病性末梢神経障害への鍼とビタミンB
Meta-Analysis
Manual Acupuncture or Combination with Vitamin B to Treat Diabetic Peripheral Neuropathy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
糖尿病性末梢神経障害(DPN)に対する鍼治療とビタミンBの単独ないしは組み合わせによる効果をメタ解析したシステマチックレビュー。
解析されたのは18編のRCTが厳選され、
11編は、鍼vsビタミンB
7編は、ビタミンBvs鍼＋ビタミンB
18編中ブラインドされたRCTは1編だけ。
効果判定には、臨床効果判定にはトロント臨床スコアが、神経伝導速度(腓骨神経・脛骨神経・正中神経・尺骨神経)が用いられている。
鍼の方法；15分～60分の範囲で、足三里や合谷、陽陵泉などが使われる頻度が多そう(パッと見た感じの印象です)。
Table 2
The characteristics of manual acupuncture.
| References | Acupoints | Reinforcing and reducing | Needle retaining time |
|---|---|---|---|
| Fei 2011 | Zusanli (ST36), Sanyinjiao (SP6), Pishu (BL20), Shenshu (BL23), Weiwanxiashu (EX-CA) | Mild supplementing and reducing | 30 min |
| Han 2016 | Houxi (SI13), Zhaohai (KI6), Zhaohai (KI6), Neiguan (PC6), Waiguan (TE5), Gongsun (SP4), Lieque (LU7), Lieque (LU7) | Mild supplementing and reducing | 30 min |
| Ji 2010 | Zusanli (ST36), Sanyinjiao (SP6), Quchi (LI11), Yanglingquan (GB34), Hegu (LI4), Zhongwan (RN12), Xuehai (SP10), Diji (SP8), Yinlingquan (SP9), Fenglong (ST40), Taichong (LR3) | Mild supplementing and reducing | 30 min |
| Li 1998 | Zusanli (ST36), Sanyinjiao (SP6), Quchi (LI11), Yanglingquan (GB34), Fenglong (ST40), Taibai (SP3) ⟶ Zutonggu (BL66) | Mild supplementing and reducing | 20 min |
| Li 2005 | Zusanli (ST36), Sanyinjiao (SP6), Quchi (LI11), Yanglingquan (GB34), Pishu (BL20), Hegu (LI4), Dazhui (DU14), Weiwanxiashu (EX-CA), Shenshu (BL23), Neiguan (PC6), Xuanzhong (GB39) | Mild supplementing and reducing | 20-30 min |
| Li 2011 | Quchi (LI11), Pishu (BL20), Hegu (LI4), Houxi (SI13), Shenshu (BL23), Xiawan (RN10), Zhongwan (RN12), Qihai (RN6), Guanyuan (RN4), Ganshu (BL18) | Mild supplementing and reducing | 15 min |
| Lu 2016 | Zusanli (ST36), Pishu (BL20), Shenshu (BL23), Geshu (BL17), Weiwanxiashu (EX-CA), Ganshu (BL18), Taixi (KI3), Ashi point | Mild supplementing and reducing | 30 min |
| Pan 2014 | Zusanli (ST36), Sanyinjiao (SP6), Quchi (LI11), Yanglingquan (GB34), Pishu (BL20), Hegu (LI4), Houxi (SI13), Shenshu (BL23), Ganshu (BL18), Guanyuan (RN4), Qihai (RN6), Zhongwan (RN12), Xiawan (RN10), Yinlingquan (SP9), Diji (SP8), Jiexi (ST41), Yongquan (KI1) | Mild supplementing and reducing | 20 min |
| Ren 2007 | Zusanli (ST36), Sanyinjiao (SP6), Quchi (LI11), Yanglingquan (GB34), Fengchi (G20), Waiguan (TE5), Weizhong (BL40), Fenglong (ST40), Taichong (LR3), Xuehai (SP10) | Mild supplementing and reducing | 20 min |
| Song 2005 | Zusanli (ST36), Sanyinjiao (SP6), Pishu (BL20), Feishu (BL13) | Mild supplementing and reducing | 30 min |
| Wang 2007 | Zusanli (ST36), Quchi (LI11), Yanglingquan (GB34), Hegu (LI4), Neiguan (PC6), Yangchi (TE4), Taichong (LR3), Jiexi (ST41) | / | 40 min |
| Wang 2010 | Zusanli (ST36), Sanyinjiao (SP6), Quchi (LI11), Yanglingquan (GB34), Jiexi (ST41), Neiting (ST44), Taixi (KI3), Guanyuan (RN4), Geshu (BL17), Ashi point | Mild supplementing and reducing | 30 min |
| Wu 2017 | Sanyinjiao (SP6), Taixi (KI3), Weiwanxiashu (EX-CA), Feishu (BL13), Weishu (BL21), Shenshu (BL23) | Mild supplementing and reducing | / |
| Yan 2007 | Zusanli (ST36), Sanyinjiao (SP6), Quchi (LI11), Yanglingquan (GB34), Pishu (BL20), Taichong (LR3), Neiting (ST44), Jiexi (ST41), Xingjian (LR2), Yinlingquan (SP9), Erjian (LI2), Sanjian (LI3), Yangxi (LI5), Yemen (TE2), Zhongzhu (TE3), Qiangu (SI2), Houxi (SI13), Daling (PC7), Weiwanxiashu (EX-CA) | Mild supplementing and reducing | 20 min |
| Yao 2012 | Houxi (SI13), Neiguan (PC6), Gongsun (SP4), Waiguan (TE5), Lieque (LU7), Zhaohai (KI6), Lieque (LU7), Zhaohai (KI6) | Mild supplementing and reducing | 30 min |
| Zhao 2007 | Zusanli (ST36), Sanyinjiao (SP6), Quchi (LI11), Yanglingquan (GB34), Pishu (BL20), Hegu (LI4), Weiwanxiashu (EX-CA), Shenshu (BL23), Feishu (BL13), Taixi (KI3), Ganshu (BL18) | Mild supplementing and reducing | 30 min |
| Zhao 2016 | Houxi (SI13), Zhaohai (KI6), Zhaohai (KI6), Waiguan (TE5), Neiguan (PC6), Lieque (LU7), Gongsun (SP4), Lieque (LU7) | Mild supplementing and reducing | 30 min |
| Zuo 2010 | Zusanli (ST36), Sanyinjiao (SP6), Quchi (LI11), Hegu (LI4), Taixi (KI3), Waiguan (TE5), Guanyuan (CV4), Qihai (CV6) | Mild supplementing and reducing | 60 min |
結果；
ビタミンBvs鍼治療
トロント臨床判定スコアは鍼治療に有意な改善が認められ、
神経伝導速度は、正中神経の感覚神経伝導以外は、鍼に有意な改善が認められた。
ビタミンBvs鍼＋ビタミンB；
いずれの項目も鍼＋ビタミンBに有意な改善
サンプルサイズが小さいことなどから、大規模な研究が必要とされているようですが、
ビタミンBよりも鍼治療の方がDPNの改善寄与率は高そうです。
