醛糖还原酶抑制剂治疗糖尿病多神经病。

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粉笔C、F Benstead TJ,摩尔

醛糖还原酶抑制剂治疗糖尿病多神经病。

科克伦数据库系统启2007年10月17日;(4):CD004572。

PubMed ID

17943821 (在PubMed

]

文摘

背景:多神经病,一个糖尿病患者的常见合并症,导致疼痛,肢体感觉和运动的赤字,和足部溃疡也是一个重要的独立预测指标。抑制葡萄糖的新陈代谢的多元醇通路使用醛糖还原酶抑制剂是一个潜在的机制来减缓或逆转神经病变的进展。目的:评估的影响醛糖还原酶抑制剂对症状的恶化,或功能障碍在糖尿病性多神经病迹象。必威国际app搜索策略:我们搜查了Cochrane神经肌肉疾病组试验注册,MEDLINE(1966年1月至2007年5月)、EMBASE(从1980年1月到2007年5月)和紫丁香(从1982年到2007年5月)。我们回顾了随机试验确定的书目,联系作者和该领域的专家。选择标准:我们包括随机对照试验比较醛糖还原酶抑制剂和控制,并持续至少六个月。主要结果测量指标是神经系统功能的变化,以各种方式,包括强度测试、感官检查,和神经系统检查的综合得分。次要结果措施神经传导研究中,神经性症状、生活质量,发生足溃疡和不利影响。数据收集和分析:试验包括在审查由至少两个独立选择和评估。方法标准及研究结果记录在数据提取形式。 MAIN RESULTS: Thirty-two randomized controlled trials meeting the inclusion criteria were identified. Many had significant methodological flaws. Change in neurological function, our primary outcome measure, was assessed in 29 trials, but sufficient data for meta-analysis were only available in 13 studies, involving 879 treated participants and 909 controls. There was no overall significant difference between the treated and control groups (SMD -0.25, 95% CI -0.56 to 0.05), although one subgroup analysis (four trials using tolrestat) favored treatment. A benefit for neuropathic symptoms was suggested by a group of trials using a dichotomized endpoint (improvement or not), but this was contradicted by another group of trials which measured symptoms on a continuous scale. There was no overall benefit on nerve conduction parameters (27 studies) or foot ulceration (one study). Quality of life was not assessed in any of the studies. While most adverse events were infrequent and minor, three compounds had dose limiting adverse events that lead to their withdrawal from human use: severe hypersensitivity reactions with sorbinil, elevation of creatinine with zenarestat, and alteration of liver function with tolrestat. AUTHORS' CONCLUSIONS: We found no statistically significant difference between aldose reductase inhibitors and placebo in the treatment of diabetic polyneuropathy. Any future clinical trials of aldose reductase inhibitors should be restricted to compounds proven to have substantial biological or preclinical advantages over previously tested agents.

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药物

Zenarestat