中医内服外治综合疗法对糖尿病周围神经病变气虚血瘀证患者疗效的影响及作用机制
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摘要
目的观察中医内服外治综合疗法治疗糖尿病周围神经病变气虚血瘀证患者的临床疗效及对血清胰岛素样生长因子(IGF-1)和脑源性神经营养因子(BNDF)的影响,探讨其可能的作用机制。方法将72例糖尿病周围神经病变气虚血瘀证患者随机分为治疗组和对照组各36例。在西医基础治疗的同时,治疗组采用中药内服联合中药熏蒸、针灸疗法,对照组仅采用中药内服,疗程均为3个月,观察2组患者临床总有效率,以及治疗前后中医证候积分、Toronto临床评分、神经传导速度及血清IGF-1和BNDF的变化。结果治疗组临床总有效率为91.1%,对照组为82.8%,治疗组的疗效优于对照组(P<0.05)。治疗后,治疗组患者正中神经、腓肠神经、胫神经神经传导速度改善均优于对照组(P<0.05);治疗组患者血清IGF-1和BNDF表达优于对照组(P<0.05)。治疗过程中无明显不良反应,无肝肾功能损害。结论中医内服外治综合疗法可明显改善糖尿病周围神经病变患者的临床症状、神经病变积分及神经传导速度,其作用机制可能与提高血清IGF-1和BNDF表达有关。
Objective To observe the clinical efficacy of TCM comprehensive therapy with internal and external methods in treating diabetic peripheral neuropathy with Qi deficiency and blood stasis syndrome and its effect on serum IGF-1 and BNDF in order to explore its possible mechanism.Methods 72 cases of diabetic peripheral neuropathy with Qi deficiency and blood stasis syndrome were randomly divided into treatment group and control group with 36 cases in each group.At the same time of basic treatment of Western medicine,the treatment group was also treated with internal taking of Chinese herbal medicine combined with herbal fumigation and acupuncture,while the control group was treated with Chinese herbal medicine only all for three months.The total clinical effective rate,TCM syndrome score,Toronto clinical score, nerve conduction velocity and serum levels of IGF-1 and BNDF were observed before and after treatment.Results The total clinical effective rate was 91.1 % in the treatment group and 82.8 % in the control group.The curative effect of the treatment group was better than that of the control group(P<0.05).After treatment,the median nerve, sural nerve and tibial nerve conduction velocity in the treatment group were better than those in the control group(P<0.05),and the expression of serum IGF-1 and BNDF in the treatment group was better than that in the control group(P<0.05).There were no obvious adverse reactions,and liver and kidney function damage during the treatment.Conclusion TCM comprehensive therapy of internal and external treatment can significantly improve the clinical symptoms, neuropathy score and nerve conduction velocity of patients with diabetic peripheral neuropathy, and its mechanism may be related to the increase of serum IGF-1 and BNDF expression.
Objective To observe the clinical efficacy of TCM comprehensive therapy with internal and external methods in treating diabetic peripheral neuropathy with Qi deficiency and blood stasis syndrome and its effect on serum IGF-1 and BNDF in order to explore its possible mechanism.Methods 72 cases of diabetic peripheral neuropathy with Qi deficiency and blood stasis syndrome were randomly divided into treatment group and control group with 36 cases in each group.At the same time of basic treatment of Western medicine,the treatment group was also treated with internal taking of Chinese herbal medicine combined with herbal fumigation and acupuncture,while the control group was treated with Chinese herbal medicine only all for three months.The total clinical effective rate,TCM syndrome score,Toronto clinical score, nerve conduction velocity and serum levels of IGF-1 and BNDF were observed before and after treatment.Results The total clinical effective rate was 91.1 % in the treatment group and 82.8 % in the control group.The curative effect of the treatment group was better than that of the control group(P<0.05).After treatment,the median nerve, sural nerve and tibial nerve conduction velocity in the treatment group were better than those in the control group(P<0.05),and the expression of serum IGF-1 and BNDF in the treatment group was better than that in the control group(P<0.05).There were no obvious adverse reactions,and liver and kidney function damage during the treatment.Conclusion TCM comprehensive therapy of internal and external treatment can significantly improve the clinical symptoms, neuropathy score and nerve conduction velocity of patients with diabetic peripheral neuropathy, and its mechanism may be related to the increase of serum IGF-1 and BNDF expression.
引文
[1] 中华中医药学会.糖尿病周围神经病变中医防治指南[J].中国中医药现代远程教育,2011,9(22):119-121.
[2] 吕翠岩,刘铜华.糖尿病周围神经病变发病机制研究进展[J].吉林中医药,2012,32(11):1179-1182.
[3] 卫江丽,冯兴中.中药内服外用治疗糖尿病周围神经病变临床观察[J].山西中医,2015,31(12):11-12.
[4] 蒋雨平,陆费汉倩,郑白帝,等.糖尿病性多发性周围神经病变的WHOPNTF诊断标准和10年随访[J].上海医科大学学报,1993,20(8):9-14.
[5] 中华医学会糖尿病分会.中国2型糖尿病防治指南(2013)[M].北京:北京大学医学出版社,2013:66-128.
[6] 中华中医药学会糖尿病分会.糖尿病中医防治指南(2007)[M].北京:中国中医药出版社,2007:25-27.
[7] 仝小林.糖尿病中医防治指南解读[M].北京:中国中医药出版社,2009:108-120.
[8] Bril V,Perkins BA.Validation of the Toron to clinical scoring system for diabetic polyneuropathy[J].Diabetes Care,2002,25(11):2048-2052.
[9] 高彦彬,周晖,张涛静,等.糖络宁治疗糖尿病周围神经病变临床研究[J].中华中医药杂志,2013,28(6):1673-1677.
[10] Farmer KL,Li C,Dobrowsky RT.Diabetic peripheral neuropathy:should a chaperone accompany our therapeutic approach[J].Pharmacol Rev,2012,64(4):880-900.
[11] 孙盼盼,冯兴中.中医药治疗糖尿病周围神经病变[J].吉林中医药,2015,35(2):156-158.
[12] 张洁,仇盛蕾,梁雅慧,等.木丹颗粒治疗气虚血瘀型糖尿病周围神经病变临床疗效[J].北京中医药,2016,35(12):1166-1168.
[13] 吴群励,梁晓春.糖尿病周围神经病变发病机制及中药复方筋脉通胶囊对其干预作用的研究进展[J].中医杂志,2014,34(11):1401-1404.
[14] 田颖欣.中药内服加外洗治疗糖尿病周围神经病变临床观察[J].北京中医药,2009,28(7):534-535.
[15] 赵红霞,王少杰.补肝肾通络汤治疗2型糖尿病周围神经病变疗效观察[J].北京中医药,2014,33(11):850-851
[16] 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.
[17] 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):434-436,450.
[18] 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.
[19] Tsou RC,Bence KK.Central regulation of metabolism by protein tyrosins phosphatases[J].Front Neuro sci,2012,6:192.
[20] 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] 吕翠岩,刘铜华.糖尿病周围神经病变发病机制研究进展[J].吉林中医药,2012,32(11):1179-1182.
[3] 卫江丽,冯兴中.中药内服外用治疗糖尿病周围神经病变临床观察[J].山西中医,2015,31(12):11-12.
[4] 蒋雨平,陆费汉倩,郑白帝,等.糖尿病性多发性周围神经病变的WHOPNTF诊断标准和10年随访[J].上海医科大学学报,1993,20(8):9-14.
[5] 中华医学会糖尿病分会.中国2型糖尿病防治指南(2013)[M].北京:北京大学医学出版社,2013:66-128.
[6] 中华中医药学会糖尿病分会.糖尿病中医防治指南(2007)[M].北京:中国中医药出版社,2007:25-27.
[7] 仝小林.糖尿病中医防治指南解读[M].北京:中国中医药出版社,2009:108-120.
[8] Bril V,Perkins BA.Validation of the Toron to clinical scoring system for diabetic polyneuropathy[J].Diabetes Care,2002,25(11):2048-2052.
[9] 高彦彬,周晖,张涛静,等.糖络宁治疗糖尿病周围神经病变临床研究[J].中华中医药杂志,2013,28(6):1673-1677.
[10] Farmer KL,Li C,Dobrowsky RT.Diabetic peripheral neuropathy:should a chaperone accompany our therapeutic approach[J].Pharmacol Rev,2012,64(4):880-900.
[11] 孙盼盼,冯兴中.中医药治疗糖尿病周围神经病变[J].吉林中医药,2015,35(2):156-158.
[12] 张洁,仇盛蕾,梁雅慧,等.木丹颗粒治疗气虚血瘀型糖尿病周围神经病变临床疗效[J].北京中医药,2016,35(12):1166-1168.
[13] 吴群励,梁晓春.糖尿病周围神经病变发病机制及中药复方筋脉通胶囊对其干预作用的研究进展[J].中医杂志,2014,34(11):1401-1404.
[14] 田颖欣.中药内服加外洗治疗糖尿病周围神经病变临床观察[J].北京中医药,2009,28(7):534-535.
[15] 赵红霞,王少杰.补肝肾通络汤治疗2型糖尿病周围神经病变疗效观察[J].北京中医药,2014,33(11):850-851
[16] 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.
[17] 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):434-436,450.
[18] 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.
[19] Tsou RC,Bence KK.Central regulation of metabolism by protein tyrosins phosphatases[J].Front Neuro sci,2012,6:192.
[20] 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.
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