中医综合疗法治疗气阴两虚血瘀型糖尿病周围神经病变的临床疗效
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摘要
目的研究中医综合疗法治疗气阴两虚血瘀型糖尿病周围神经病变(DPN)的临床疗效及作用机制。方法将110例气阴两虚血瘀型DPN患者随机分为对照组和治疗组,每组55例。对照组和治疗组分别给予口服甲钴胺片和益气养阴活血解毒方联合通络外洗方浴足治疗。对比两组治疗后临床疗效,多伦多临床评分系统(TCSS)评分,右下肢腓总神经和胫神经的运动神经传导速度(MNCV)、感觉神经传导速度(SNCV)及神经营养因子[血清胰岛素样生长因子(IGF-1)和脑源性营养因子(BNDF)]改善情况。结果治疗组和对照组总有效率分别为94. 0%和74. 0%,两组比较差异有统计学意义(P <0. 05)。治疗组各神经传导速度较对照组显著加快,TCSS评分较对照组明显降低(P <0. 05),差异有统计学意义。治疗组IGF-1、BNDF均较对照组有大幅度的增加(P <0. 05),差异有统计学意义。结论中医综合疗法可明显改善DPN患者的临床症状,加快神经传导速度,疗效优于单纯口服甲钴胺片,其作用机制可能与增加DPN患者的IGF-1和BNDF表达,从而修复受损神经有关。
Objective To explore the clinical effects of the comprehensive therapy with traditional Chinese medicine on diabetic peripheral neuropathy( DPN) and the effect mechanism. Methods A total of 110 DPN patients with qi and yin deficiency and blood stagnation were randomized into a control group and a treatment group,55 cases in each one.In the control group,mecobalamine tablets were prescribed for oral administration. In the treatment group,the oral administration of yiqi yangyin huoxue jiedu formula and the foot bath with tongluo formula were used. After treatment,the clinical effects,TCSS score,MNCV,SNCV and neurotrophic factors( IGF-1 and BNDF) were compared between the two groups.Results The total effective rate was 94. 0% in the treatment group and was 74. 0% in the control group,indicating the significant difference( P < 0. 05). IGF-1 and BNDF were increased in large amplitude in the treatment group as compared with the control group( P < 0. 05). Conclusion The comprehensive therapy with traditional Chinese medicine obviously relieves the clinical symptoms of DPN and accelerates nerve conduction velocity. The effects are better than the simple oral administration with mecobalamine tablets. The effect mechanism is probably related to the increased expressions of IGF-1 and BNDF and the repair of damaged nerves in the patients with DPN.
Objective To explore the clinical effects of the comprehensive therapy with traditional Chinese medicine on diabetic peripheral neuropathy( DPN) and the effect mechanism. Methods A total of 110 DPN patients with qi and yin deficiency and blood stagnation were randomized into a control group and a treatment group,55 cases in each one.In the control group,mecobalamine tablets were prescribed for oral administration. In the treatment group,the oral administration of yiqi yangyin huoxue jiedu formula and the foot bath with tongluo formula were used. After treatment,the clinical effects,TCSS score,MNCV,SNCV and neurotrophic factors( IGF-1 and BNDF) were compared between the two groups.Results The total effective rate was 94. 0% in the treatment group and was 74. 0% in the control group,indicating the significant difference( P < 0. 05). IGF-1 and BNDF were increased in large amplitude in the treatment group as compared with the control group( P < 0. 05). Conclusion The comprehensive therapy with traditional Chinese medicine obviously relieves the clinical symptoms of DPN and accelerates nerve conduction velocity. The effects are better than the simple oral administration with mecobalamine tablets. The effect mechanism is probably related to the increased expressions of IGF-1 and BNDF and the repair of damaged nerves in the patients with DPN.
引文
[1]中华人民共和国卫生部.中药新药临床研究指导原则(试行)[M].北京:中国医药科技出版社,2002:233-237.
[2]冯兴中.基于“气虚生毒”学说论糖尿病的防治[J].中医杂志,2016,57(12):1023-1026.
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[5]侯英,史清爽,梅艳,等.益气养阴活血法对2型糖尿病周围神经病变患者胰岛素抵抗的影响[J].中国中医药科技,2012,19(4):367.
[6]刘毅,李志樑,江腾春,等.黄芪多糖对2型糖尿病患者外周血内皮祖细胞数量和功能的影响[J].中国医药导报,2014,11(34):8-10.
[7]刘毅,江腾春,傅强,等.黄芪对糖尿病患者血清胰岛素样生长因子-1、颈动脉内膜中层厚度的影响[J].实用医学杂志,2015,31(17):2907-2909.
[8]宋郁珍,李琳,杜鸿瑶,等.黄连及其复方治疗糖尿病的研究进展[J].中西医结合心脑血管病杂志,2017,15(13):1583-1585.
[9]张美双,李志成,田淋淋,等.人参、黄连及其药对治疗糖尿病研究进展[J].长春中医药大学学报,2016,32(3):656-658.
[10]谷淑敬.从“瘀"论治糖尿病周围神经病变的临床研究现状[J].实用中医内科杂志2011,25(8):22-24.
[11]庞国明,闫镛,朱璞,等.糖尿病周围神经病变中医诊疗规范(初稿)[J].中华中医药杂志,2010,25(2):260-264.
[12]中华中医药学会糖尿病分会.糖尿病周围神经病变中医临床诊疗指南(2016年版)[J].中医杂志,2017,58(7):625-629.
[13]徐静,张春虹,王俊宏,等.胰岛素样生长因子-1与糖尿病下肢血管病变的关系[J].西安交通大学学报:医学版,2007,28(4):434-436.
[14]吴国柱,郭跃先,杨士杰.胰岛素样生长因子-1(IGF-1)的临床应用进展[J].河北医药,2015,37(9):1398-1400.
[15]刘祥秀,孔德明,代方,等.益气养阴活血通络法对糖尿病周围神经病变患者神经传导速度及神经相关生长因子的影响[J].辽宁中医杂志,2017,44(7):1439-1441.
[16]葛丹,任建功,陈白帆,等. 2型糖尿病周围神经病变患者血清脑源性神经营养因子水平的变化及临床意义[J].中国糖尿病杂志,2014,22(8):704-706.
[2]冯兴中.基于“气虚生毒”学说论糖尿病的防治[J].中医杂志,2016,57(12):1023-1026.
[3]冯兴中,姜敏,卢伟,等.益气活血解毒法治疗糖尿病周围神经病变的临床研究[J].中华中医药杂志,2009,24(8):1094-1096.
[4]曹雯,王琦威,喻嵘,等.基于文献调查研究分析中医治疗糖尿病周围神经病变的用药规律[J].辽宁中医杂志,2017,44(6):1221-1223.
[5]侯英,史清爽,梅艳,等.益气养阴活血法对2型糖尿病周围神经病变患者胰岛素抵抗的影响[J].中国中医药科技,2012,19(4):367.
[6]刘毅,李志樑,江腾春,等.黄芪多糖对2型糖尿病患者外周血内皮祖细胞数量和功能的影响[J].中国医药导报,2014,11(34):8-10.
[7]刘毅,江腾春,傅强,等.黄芪对糖尿病患者血清胰岛素样生长因子-1、颈动脉内膜中层厚度的影响[J].实用医学杂志,2015,31(17):2907-2909.
[8]宋郁珍,李琳,杜鸿瑶,等.黄连及其复方治疗糖尿病的研究进展[J].中西医结合心脑血管病杂志,2017,15(13):1583-1585.
[9]张美双,李志成,田淋淋,等.人参、黄连及其药对治疗糖尿病研究进展[J].长春中医药大学学报,2016,32(3):656-658.
[10]谷淑敬.从“瘀"论治糖尿病周围神经病变的临床研究现状[J].实用中医内科杂志2011,25(8):22-24.
[11]庞国明,闫镛,朱璞,等.糖尿病周围神经病变中医诊疗规范(初稿)[J].中华中医药杂志,2010,25(2):260-264.
[12]中华中医药学会糖尿病分会.糖尿病周围神经病变中医临床诊疗指南(2016年版)[J].中医杂志,2017,58(7):625-629.
[13]徐静,张春虹,王俊宏,等.胰岛素样生长因子-1与糖尿病下肢血管病变的关系[J].西安交通大学学报:医学版,2007,28(4):434-436.
[14]吴国柱,郭跃先,杨士杰.胰岛素样生长因子-1(IGF-1)的临床应用进展[J].河北医药,2015,37(9):1398-1400.
[15]刘祥秀,孔德明,代方,等.益气养阴活血通络法对糖尿病周围神经病变患者神经传导速度及神经相关生长因子的影响[J].辽宁中医杂志,2017,44(7):1439-1441.
[16]葛丹,任建功,陈白帆,等. 2型糖尿病周围神经病变患者血清脑源性神经营养因子水平的变化及临床意义[J].中国糖尿病杂志,2014,22(8):704-706.