Tetramethylpyrazine for Diabetic Peripheral Neuropathy: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

RAN Xingwu ¹ , LI Ning ² , LIU Ya ³

1. Department of Endocrinology and Metabolism; West China Hospital; Sichuan University; Chengdu 610041; China2. Department of Acupuncture; West China Hospital; Sichuan University; Chengdu 610041; China3. Department of Internal Medicine; Chengdu Second Hospital; Chengdu 610041; China;

Corresponding author：

Keywords：

Diabetes; Diabetic peripheral neuropathy; Tetramethylpyrazine; Systematic review

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Objective 　To evaluate the efficacy and safety of tetramethylpyrazine (TMP) for diabetic peripheral neuropathy (DPN).
Methods 　Randomized controlled trials were identified from CBM (1978-2003.3), TCMLRS (1980-2003.3), Medline (1970-2003.3), EMbase (1970-2003.3) and Cochrane Library (issue 3, 2003). We handsearched Journal of Traditional Chinese Medicine (1990-2002), New Chinese Medicine (1990-2002), Chinese Journal of Integrated Traditional and Western Medicine (1990-2002) and Research of Traditional Chinese Medicine (1990-2002). Papers of the controlled trials of clinical therapeutic studies on DPN treatment by Chinese medicine herb TMP were included and analyzed according to the criteria of the Cochrane Handbook in 1997.
Results 　Six RCTs involving 669 patients were included, with all trials of low methodological quality. Meta-analysis indicated TMP was more effective than western medicine on pain or numbness of extremities of DPN [The pooled OR = 10.12, 95%CI (6.70 to15.28), P=0.000] and motor nerve conduction velocity change of common peroneal nerves and median nerves . Only one trial reported the side effects of TMP, such as dizziness and headache.
Conclusions 　Based on the review, TMP infusion may have positive effect on DPN. However, the evidence is not b enough due to the general low methodological quality, so we can’t draw a reliable conclusion about the effects of TMP for DPN at the moment. Further large randomized, double blind, placebo-controlled trial are needed.

Citation： RAN Xingwu,LI Ning,LIU Ya. Tetramethylpyrazine for Diabetic Peripheral Neuropathy: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2004, 04(6): 393-397. doi: Copy

1.	［1］Tesfaye S, Stevens LK, Stephenson JM, FullerJH, Plater M,Ionescu-Tirgoviste C, Nuber A, Pozza G, WardJD. Prevalence of diabetic peripheral neuropathy and its relation to glycaemic control and potential risk factors: the EUR ODIAB IDDM Complications Study [J]. Diabetologia, 1996; 39( 11 ):1 377-1 384.
2.	［2］Partanen J, Niskanen L, Lehtinen J, Mervaala E, Siitonen O,Uusitupa M. Natural history of peripheral neuropathy in patients with non-insulin-dependent diabetes mellitus [J]. N Engl JMed, 1995; 333(2): 89-94.
3.	［3］Cai YQ, Du JH. Observation of the result of Tetramethylpyrazine for the treaunent of 50 cases of diabetic peripheral neuropathy [J]. Chinese Journal of Traditional Science and Technology, 2000; 7(6): 415-416.
4.	蔡英奇,杜积慧.TMP注射液治疗糖尿病周围神经病变50例[J].中国中医药科技,2000;7(6):415～416.
5.	［4］Fan DF, Weng XG, Dou JF. The clinical observation of Tetramethylpyrazine for diabetic peripheral neuropathy [J ]. Chinese Journal of Integrated Traditional and Western Medicine,1999; 19(9): 550-551.
6.	樊东方,翁孝刚,窦敬芳.TMP治疗糖尿病周围神经病变的临床观察[J].中国中西医结合杂志,1999;19(9):550～551.
7.	［5］Huang YF, Wang FJ. The clinical efficacy of Tetramethylpyrazine combinated with Raceanisodamine Hydrochloride therapy in the 36 cases of diabetic peripheral neuropathy [J]. Journal ofLinyi Medical Academy, 1999; 21(1): 48-49.
8.	黄玉芬,王凤菊.山莨菪碱、TMP联合治疗糖尿病性周围神经病变36例疗效观察[J].临沂医专学报,1999;21(1):48～49.
9.	［6］Zhang MH. Tetramethylpyrazine combinated with Xiaoshuanling for the treatment of diabetic peripheral neuropathy: Report of 50 cases [J]. San Dong Medical Journal, 1995; 35(9): 32.
10.	张曼华.中药TMP合并消栓灵治疗糖尿病性周围神经病变50例体会[J].山东医药,1995;35(9):32.
11.	［7］Weng XG, Fan DF, Dou JF. The clinical efficacy of Tetramethylpyrazine therapy in the 105 cases of diabetic peripheral neuropathy [J]. New Chinese Medicine, 1998; 29(10): 533-534.
12.	翁孝刚,樊东方,窦敬芳.TMP治疗糖尿病周围神经病变105例临床疗效观察[J].新医学,1998;29(10):533～534.
13.	［8］Yan SQ. The clinical efficacy of Tetramethylpyrazine combinated with antihyperglycemic therapy in the 40 cases of diabetic peripheral neuropathy [ J ]. Research of Traditional Chinese Medicine, 1998; 14(4): 28-29.
14.	阎淑琴.TMP联合降糖药治疗糖尿病周围神经病变40例疗效观察[J].中医药研究,1998;14(4):28～29.
15.	［9］Juni P, Altman DG, Egger M. Assessing the quality of controlled clinical trials [J]. BMJ, 2001; 323(7 303): 42-46.
16.	［10］Ran XW, Li N, Liu Y. Methodological evaluation of randomized controlled trials of diabetic peripheral neuropathy treatment by Chinese medicine herb [J]. West China Medical Journal, 2003; 18(3) : 299-300.
17.	冉兴无,李宁,刘雅.中医药治疗糖尿病患者周围神经病变临床随机对照试验的方法学质量评估[J].华西医学,2003;18(3):299～300.

1. ［1］Tesfaye S, Stevens LK, Stephenson JM, FullerJH, Plater M,Ionescu-Tirgoviste C, Nuber A, Pozza G, WardJD. Prevalence of diabetic peripheral neuropathy and its relation to glycaemic control and potential risk factors: the EUR ODIAB IDDM Complications Study [J]. Diabetologia, 1996; 39( 11 ):1 377-1 384.
2. ［2］Partanen J, Niskanen L, Lehtinen J, Mervaala E, Siitonen O,Uusitupa M. Natural history of peripheral neuropathy in patients with non-insulin-dependent diabetes mellitus [J]. N Engl JMed, 1995; 333(2): 89-94.
3. ［3］Cai YQ, Du JH. Observation of the result of Tetramethylpyrazine for the treaunent of 50 cases of diabetic peripheral neuropathy [J]. Chinese Journal of Traditional Science and Technology, 2000; 7(6): 415-416.
4. 蔡英奇,杜积慧.TMP注射液治疗糖尿病周围神经病变50例[J].中国中医药科技,2000;7(6):415～416.
5. ［4］Fan DF, Weng XG, Dou JF. The clinical observation of Tetramethylpyrazine for diabetic peripheral neuropathy [J ]. Chinese Journal of Integrated Traditional and Western Medicine,1999; 19(9): 550-551.
6. 樊东方,翁孝刚,窦敬芳.TMP治疗糖尿病周围神经病变的临床观察[J].中国中西医结合杂志,1999;19(9):550～551.
7. ［5］Huang YF, Wang FJ. The clinical efficacy of Tetramethylpyrazine combinated with Raceanisodamine Hydrochloride therapy in the 36 cases of diabetic peripheral neuropathy [J]. Journal ofLinyi Medical Academy, 1999; 21(1): 48-49.
8. 黄玉芬,王凤菊.山莨菪碱、TMP联合治疗糖尿病性周围神经病变36例疗效观察[J].临沂医专学报,1999;21(1):48～49.
9. ［6］Zhang MH. Tetramethylpyrazine combinated with Xiaoshuanling for the treatment of diabetic peripheral neuropathy: Report of 50 cases [J]. San Dong Medical Journal, 1995; 35(9): 32.
10. 张曼华.中药TMP合并消栓灵治疗糖尿病性周围神经病变50例体会[J].山东医药,1995;35(9):32.
11. ［7］Weng XG, Fan DF, Dou JF. The clinical efficacy of Tetramethylpyrazine therapy in the 105 cases of diabetic peripheral neuropathy [J]. New Chinese Medicine, 1998; 29(10): 533-534.
12. 翁孝刚,樊东方,窦敬芳.TMP治疗糖尿病周围神经病变105例临床疗效观察[J].新医学,1998;29(10):533～534.
13. ［8］Yan SQ. The clinical efficacy of Tetramethylpyrazine combinated with antihyperglycemic therapy in the 40 cases of diabetic peripheral neuropathy [ J ]. Research of Traditional Chinese Medicine, 1998; 14(4): 28-29.
14. 阎淑琴.TMP联合降糖药治疗糖尿病周围神经病变40例疗效观察[J].中医药研究,1998;14(4):28～29.
15. ［9］Juni P, Altman DG, Egger M. Assessing the quality of controlled clinical trials [J]. BMJ, 2001; 323(7 303): 42-46.
16. ［10］Ran XW, Li N, Liu Y. Methodological evaluation of randomized controlled trials of diabetic peripheral neuropathy treatment by Chinese medicine herb [J]. West China Medical Journal, 2003; 18(3) : 299-300.
17. 冉兴无,李宁,刘雅.中医药治疗糖尿病患者周围神经病变临床随机对照试验的方法学质量评估[J].华西医学,2003;18(3):299～300.

Chinese Journal of Evidence-Based Medicine

Tetramethylpyrazine for Diabetic Peripheral Neuropathy: A Systematic Review

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