益气温阳活血汤治疗糖尿病周围神经病变的研究
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摘要
目的:观察以益气温阳活血法为治则的中药对改善糖尿病周围神经病变(DPN)的临床疗效并探讨其作用机制。方法:所有患者60名均确诊为糖尿病周围神经病变。将病例随机分为2组,治疗组(30例)服用益气温阳活血汤,对照组(30例)在同样条件下给予甲钴胺胶囊0.5mg,每天3次,口服。两组均以40天为1个疗程,共治2个疗程,然后评价两组神经传导速度。结果:经临床观察,治疗组有效率为80%,对照组的有效率为63.3%。治疗组在治疗前和治疗后的神经传导速度有显著差异(p<0.05),说明此法治疗是有效的。对照组治疗前和治疗后的神经传导速度有显著差异(p<0.01),说明西药治疗也是有效的。治疗后治疗组与对照组比较神经传导速度也有显著差异(p<0.01)。说明中药与西药治疗不尽相同。治疗组对改善临床症状,提高神经传导速度方面优于对照组(p<0.05)。结论:益气温阳活血汤对治疗糖尿病周围神经病变效果优于甲钴胺胶囊。同时证明以阳虚寒凝血瘀为糖尿病周围神经病变的病机,利用益气温阳活血法治疗糖尿病周围神经病变具有可行性。
Object:To observe the therapeutic efficacy of Yiqiwenyanghuoxue decoction in treating Diabetic Peripheral Neuropathy(DPN).Methods: 60 patients diagnosed DPN were randomly classified into two groups .30 patients in treated group were treated with Yiqiwenyanghuoxue decoction,others in control group were treated with Jiaguan grannules.Eighty days were a course of treatment. Result:Through observtion,there are significant effects of treatment on nerve conduction between pre-treatment and post-treatment in both TCM group(p<0.05) and WM group(p<0.01).In addition,there are also obvious difference between TCM and WM,indicating that the effects of TCM and WM were different.Conclusion:Yiqiwenyanghuoxue decoction has more curative effect than Jiaguan grannules in treating DPN,and it can prove that the freezing coldness from deficiency of yang and blood stasis is pathogenesis of DPN.To treat DPN with method of Yiqiwenyanghuoxue is feasibility.
Object:To observe the therapeutic efficacy of Yiqiwenyanghuoxue decoction in treating Diabetic Peripheral Neuropathy(DPN).Methods: 60 patients diagnosed DPN were randomly classified into two groups .30 patients in treated group were treated with Yiqiwenyanghuoxue decoction,others in control group were treated with Jiaguan grannules.Eighty days were a course of treatment. Result:Through observtion,there are significant effects of treatment on nerve conduction between pre-treatment and post-treatment in both TCM group(p<0.05) and WM group(p<0.01).In addition,there are also obvious difference between TCM and WM,indicating that the effects of TCM and WM were different.Conclusion:Yiqiwenyanghuoxue decoction has more curative effect than Jiaguan grannules in treating DPN,and it can prove that the freezing coldness from deficiency of yang and blood stasis is pathogenesis of DPN.To treat DPN with method of Yiqiwenyanghuoxue is feasibility.
引文
[1] Chung S,Ho C,Lam KS,et a1.Contribution ofpolyol—path—way to diabetes-induced oxidative stress[J].Am SocNephrol,2003,14(3):233-236.
[2] Zochodne DW.Neurotrophins and other growth factors in diabetic neuropathy[J].Semin Neurol,1996,16:153-161
[3] Younger DS,Rosookli,ja G,Hays AP.Diabetic peripheral neuropathy[J]. Semin Neurol,1998,18(1):95-104
[4] Vnik A.Diabetic neuroPathy:pathogenesis and therapy[J].AmJMed,1999,107(2):17-26.
[5] King RHM . The role of g1ucution in the pathogenesis of diabetic polyneuroPathy[J].Clim Pathol Mol Patl1oL2001,54(6):400-408.
[6] Yangihashi S.Pathology of diabetic neuropathy,a revewfrom the updated literature oflast 10 yearIJ],Nippon Rinsho,2002.60(10):204.
[7]屈传强,郭洪志.糖尿病神经病变发病机制研究进展[J].山东医药,2003,43(1):59-60.
[8] Zhu XP,Zhou ZG.Clinical observation ofcombined therapeutic effect of prostaglandin E1 and mecobalamin on diabetic per ipheralneuropathy[J].Hunan Yi Ke Da Xue XueBao,2001.26(4):343.
[9] Delva P,Pastori C,Montesi G.Intralymphocyte free mag—nesium and insulin tolerance test in a group of essential hypertensivepatients[J].LifeScience,1998,63:1405.
[10] Craner MJ,Klein JP,Black JA,et a1.Preferential expression of IGF—I in small DRG neurons and down-regulation followinginjury[II.Neuroreport,2002,13(13):1649-1652.
[11] I VinikAL。Leichter SB,Pittenger GL,et a1.Phospholipid and glutamic acid decarboxylase ancibodies in diabetic nearopathy[J].DiabetesCare,1995,18(9):1255-1231.
[12]姜文字.粘附分子与糖尿病慢性并发症[J]学一内科学分册,1999,26(7):294-296.
[13] mbrosch A,Dierkes J,Cobmann R,et a1.Hyperhomecysteinemia and endothetial dysfunction in IDDM[J].DiabetMed,2001,18(3):185-192.
[14]成夫,卢学勉.2型糖尿病患者血浆Hcy水平与糖尿病周围神经病变的关系[J]临床医学,2005,25(9):29-31.
[15] Nathan DM,Cleary PA,Backlund JY,et al.Intensive diabetes treatment and cardiovascular disease in patients with type I diabetes [J].N Engl J Med,2005,353:2643-2653.
[16] The Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Research Group.Retinopathy and nephropathy in patients with type I diabetes four years after a trial of intensive therapy[J]。N Engl J Med,2000,342:381-389.
[17] Ziegler D Nowak H,Kempler P,et al.Treatment of symptomatic diabetic polyneuropathy with the antioxidant aa-lipoic acid:a metaanalysis[J],Diabetic Med,2004,21:114-121.
[18] ZhuangHX,SnyderCK,Pu SF,etal.Znsulin like growth factors reverse or arrest diabetic neuropathy:effects on hyperalgesia and impaired nerve regeneration in rats[J].ExpNeurol.1996,140(2):198.
[19] TsaiSC,Bumakis TG Aldosereductaseinhibitors:anupdate.AnnPharmacother,1993,27:751-752
[20]易小玲,李军,徐涟等。金纳多治疗糖尿病周围神经病变48例临床观察,基层中药杂志,2002,16(3):59-59.
[21]曹海平,李冉,郭景红等。金纳多联合甲钴胺治疗糖尿病周围神经病变36例临床观察,实用中西医结合临床,2004,4(3):44-45
[22]秦伯未.秦伯未医学名著全书[M].北京:中医古籍出版社,2003:166-167.
[23]杨铁虹,贾敏,梅其炳等。当归多糖对凝血和血小板聚集的影响[J].中药材,2002,25(5):344-345
[24]何丽娜,何素冰等。赤芍总甙对大脑皮层神经Ca超载损伤的保护作用。中药新药与临床药理。2001,12(3):212-216.
[25]唐刚华,唐小兰,姜国辉.川芎嗪及其类似物对血小板聚集和实验性血栓形成的影响。中国药理学通报,2001;17(3):33
[26]徐凤彩,高向阳,王炜军等.蚯蚓体内营养和药物有效成分的研究进展.华南农业大学学报,2001:;22(3):86-89
[27]刘青云.中药药理学[M].人民出版社,1997,1:563
[28]丁学屏.糖尿病中医研究进展[M].上海科技教育出版社,2000,1:153
[29]张树虎,徐贵军.胰岛素抵抗的中医药治疗进展[J].新中医,2006,38(9):20-21
[1]钟玲,吴世和,郭常辉等,尼莫通治疗糖尿病周围神经病变疗效观察,中国糖尿病杂志,1999;(1):48
[2]刘嵋,张金辉,糖尿病性神经病变的药物治疗现状。中华内分泌代谢杂志,1996,12(1):37-38
[3]许成群.糖尿病周围神经病变的中医病机探讨.现代中医药,2003,(4):55-57
[4]曹莹,王立琴,张金梅.糖尿病周围神经病变的中医药研究近况[J].中西医结合心脑血管病杂志,1672-1349(2006)05-0427-02.
[5]张苗海.糖尿病周围神经病变的病机及辨证治疗[J].光明中医,2003,18(5):11
[6]瞿伟,通络汤治疗糖尿病周围神经病变69例[J].实用中医药杂志,2002,18(10):61
[7]周铭.行气化浊活血法治疗糖尿病周围神经病变73例.中医药信息,2002,19(4):47-48
[8]倪青,起病隐匿易漏诊误诊辩证施治宜标本兼顾-治疗糖尿病周围神经病变经验[J].辽宁中医杂志,2001,28(8):451
[9]肖昌庆,吕仁和.治疗糖尿病周围神经病变的经验[J].中国中医药信息杂志.2001;8(9):86
[10]刘红英,邢占敏,刘学兰.抑消通络汤治疗糖尿病周围神经病变43例[J].四川中医,2003,21(3):27-28
[11]刘江华,李柳哲.以黄芪桂枝五物汤为主治疗糖尿病周围神经病变的临床研究.衡阳医学院学报,1998,26(1):47-48
[12]周法根,补阳还五治疗2型糖尿病周围神经病变疗效观察[J].浙江中西医结合杂志,2005,6(7):425.
[13]辛莉,童文新,张汝菁等.血塞通注射液辅助治疗糖尿病周围神经病变31例[J].中西医结合杂志,2003,23(3):230.
[14]张英来,谢富明.川芎嗪在2型糖尿病周围神经病变的作用[J].中华实用中西医杂志,2004,4(17):864
[15]赵昌盛.刺五加浸液离子导入治疗糖尿病周围神经病变临床观察.河南中医,2006,26(8):30-32
[16]于世家.唐末宁对糖尿病周围神经病变血浆β2内啡肽水平和神经电生理影响的研究.中医药学刊2002;20(3):270-272
[17]衡先培.糖络通治疗糖尿病性周围神经疼痛机理研究.中国中医急症,2002,11(6):480-481
[18]衡先培.糖络通对糖尿病周围神经病变大鼠血液流变性的影响.安徽中医学院学报,2002,21(5):42-44
[19]朱章志,熊曼琪.学生思想及临床经验.新中医,1996,(3),12-14
[20]卜献春等.足浴法治疗糖尿病周围神经病变18例.福建中医药,2001,32(4):22
[21]冯新送,伦新.针刺治疗糖尿病周围神经病变35例临床观察.江苏中医药,2002,(23):30-31
[22]李永方,郑惠田,康尔竹.电针治疗糖尿病周围神经病变临床研究.针灸临床杂志,2000,16(10):13-16
[23]杨明丽,路波,沈路.电针治疗糖尿病周围神经病变的临床观察.陕西中医.2002,23(3):162
[2] Zochodne DW.Neurotrophins and other growth factors in diabetic neuropathy[J].Semin Neurol,1996,16:153-161
[3] Younger DS,Rosookli,ja G,Hays AP.Diabetic peripheral neuropathy[J]. Semin Neurol,1998,18(1):95-104
[4] Vnik A.Diabetic neuroPathy:pathogenesis and therapy[J].AmJMed,1999,107(2):17-26.
[5] King RHM . The role of g1ucution in the pathogenesis of diabetic polyneuroPathy[J].Clim Pathol Mol Patl1oL2001,54(6):400-408.
[6] Yangihashi S.Pathology of diabetic neuropathy,a revewfrom the updated literature oflast 10 yearIJ],Nippon Rinsho,2002.60(10):204.
[7]屈传强,郭洪志.糖尿病神经病变发病机制研究进展[J].山东医药,2003,43(1):59-60.
[8] Zhu XP,Zhou ZG.Clinical observation ofcombined therapeutic effect of prostaglandin E1 and mecobalamin on diabetic per ipheralneuropathy[J].Hunan Yi Ke Da Xue XueBao,2001.26(4):343.
[9] Delva P,Pastori C,Montesi G.Intralymphocyte free mag—nesium and insulin tolerance test in a group of essential hypertensivepatients[J].LifeScience,1998,63:1405.
[10] Craner MJ,Klein JP,Black JA,et a1.Preferential expression of IGF—I in small DRG neurons and down-regulation followinginjury[II.Neuroreport,2002,13(13):1649-1652.
[11] I VinikAL。Leichter SB,Pittenger GL,et a1.Phospholipid and glutamic acid decarboxylase ancibodies in diabetic nearopathy[J].DiabetesCare,1995,18(9):1255-1231.
[12]姜文字.粘附分子与糖尿病慢性并发症[J]学一内科学分册,1999,26(7):294-296.
[13] mbrosch A,Dierkes J,Cobmann R,et a1.Hyperhomecysteinemia and endothetial dysfunction in IDDM[J].DiabetMed,2001,18(3):185-192.
[14]成夫,卢学勉.2型糖尿病患者血浆Hcy水平与糖尿病周围神经病变的关系[J]临床医学,2005,25(9):29-31.
[15] Nathan DM,Cleary PA,Backlund JY,et al.Intensive diabetes treatment and cardiovascular disease in patients with type I diabetes [J].N Engl J Med,2005,353:2643-2653.
[16] The Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Research Group.Retinopathy and nephropathy in patients with type I diabetes four years after a trial of intensive therapy[J]。N Engl J Med,2000,342:381-389.
[17] Ziegler D Nowak H,Kempler P,et al.Treatment of symptomatic diabetic polyneuropathy with the antioxidant aa-lipoic acid:a metaanalysis[J],Diabetic Med,2004,21:114-121.
[18] ZhuangHX,SnyderCK,Pu SF,etal.Znsulin like growth factors reverse or arrest diabetic neuropathy:effects on hyperalgesia and impaired nerve regeneration in rats[J].ExpNeurol.1996,140(2):198.
[19] TsaiSC,Bumakis TG Aldosereductaseinhibitors:anupdate.AnnPharmacother,1993,27:751-752
[20]易小玲,李军,徐涟等。金纳多治疗糖尿病周围神经病变48例临床观察,基层中药杂志,2002,16(3):59-59.
[21]曹海平,李冉,郭景红等。金纳多联合甲钴胺治疗糖尿病周围神经病变36例临床观察,实用中西医结合临床,2004,4(3):44-45
[22]秦伯未.秦伯未医学名著全书[M].北京:中医古籍出版社,2003:166-167.
[23]杨铁虹,贾敏,梅其炳等。当归多糖对凝血和血小板聚集的影响[J].中药材,2002,25(5):344-345
[24]何丽娜,何素冰等。赤芍总甙对大脑皮层神经Ca超载损伤的保护作用。中药新药与临床药理。2001,12(3):212-216.
[25]唐刚华,唐小兰,姜国辉.川芎嗪及其类似物对血小板聚集和实验性血栓形成的影响。中国药理学通报,2001;17(3):33
[26]徐凤彩,高向阳,王炜军等.蚯蚓体内营养和药物有效成分的研究进展.华南农业大学学报,2001:;22(3):86-89
[27]刘青云.中药药理学[M].人民出版社,1997,1:563
[28]丁学屏.糖尿病中医研究进展[M].上海科技教育出版社,2000,1:153
[29]张树虎,徐贵军.胰岛素抵抗的中医药治疗进展[J].新中医,2006,38(9):20-21
[1]钟玲,吴世和,郭常辉等,尼莫通治疗糖尿病周围神经病变疗效观察,中国糖尿病杂志,1999;(1):48
[2]刘嵋,张金辉,糖尿病性神经病变的药物治疗现状。中华内分泌代谢杂志,1996,12(1):37-38
[3]许成群.糖尿病周围神经病变的中医病机探讨.现代中医药,2003,(4):55-57
[4]曹莹,王立琴,张金梅.糖尿病周围神经病变的中医药研究近况[J].中西医结合心脑血管病杂志,1672-1349(2006)05-0427-02.
[5]张苗海.糖尿病周围神经病变的病机及辨证治疗[J].光明中医,2003,18(5):11
[6]瞿伟,通络汤治疗糖尿病周围神经病变69例[J].实用中医药杂志,2002,18(10):61
[7]周铭.行气化浊活血法治疗糖尿病周围神经病变73例.中医药信息,2002,19(4):47-48
[8]倪青,起病隐匿易漏诊误诊辩证施治宜标本兼顾-治疗糖尿病周围神经病变经验[J].辽宁中医杂志,2001,28(8):451
[9]肖昌庆,吕仁和.治疗糖尿病周围神经病变的经验[J].中国中医药信息杂志.2001;8(9):86
[10]刘红英,邢占敏,刘学兰.抑消通络汤治疗糖尿病周围神经病变43例[J].四川中医,2003,21(3):27-28
[11]刘江华,李柳哲.以黄芪桂枝五物汤为主治疗糖尿病周围神经病变的临床研究.衡阳医学院学报,1998,26(1):47-48
[12]周法根,补阳还五治疗2型糖尿病周围神经病变疗效观察[J].浙江中西医结合杂志,2005,6(7):425.
[13]辛莉,童文新,张汝菁等.血塞通注射液辅助治疗糖尿病周围神经病变31例[J].中西医结合杂志,2003,23(3):230.
[14]张英来,谢富明.川芎嗪在2型糖尿病周围神经病变的作用[J].中华实用中西医杂志,2004,4(17):864
[15]赵昌盛.刺五加浸液离子导入治疗糖尿病周围神经病变临床观察.河南中医,2006,26(8):30-32
[16]于世家.唐末宁对糖尿病周围神经病变血浆β2内啡肽水平和神经电生理影响的研究.中医药学刊2002;20(3):270-272
[17]衡先培.糖络通治疗糖尿病性周围神经疼痛机理研究.中国中医急症,2002,11(6):480-481
[18]衡先培.糖络通对糖尿病周围神经病变大鼠血液流变性的影响.安徽中医学院学报,2002,21(5):42-44
[19]朱章志,熊曼琪.学生思想及临床经验.新中医,1996,(3),12-14
[20]卜献春等.足浴法治疗糖尿病周围神经病变18例.福建中医药,2001,32(4):22
[21]冯新送,伦新.针刺治疗糖尿病周围神经病变35例临床观察.江苏中医药,2002,(23):30-31
[22]李永方,郑惠田,康尔竹.电针治疗糖尿病周围神经病变临床研究.针灸临床杂志,2000,16(10):13-16
[23]杨明丽,路波,沈路.电针治疗糖尿病周围神经病变的临床观察.陕西中医.2002,23(3):162