α-硫辛酸联合前列地尔对糖尿病周围神经病变患者血清炎症因子及神经传导速度的影响
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摘要
目的:探讨α-硫辛酸联合前列地尔对糖尿病周围神经病变患者的疗效及对血清炎症因子、神经传导速度的影响。方法:选取我院2015年6月-2017年6月治疗的130例糖尿病周围神经病变患者,随机分为观察组(n=65)和对照组(n=65)。其中对照组患者采用前列地尔治疗,观察组患者在此基础上联合α-硫辛酸治疗,两组患者均连续治疗2周。对两组患者的临床疗效、治疗前后的神经传导速度、血清炎症因子水平、多伦多临床神经病变评分系统(TCSS)、视觉模拟评分(VAS)、不良反应发生率等指标进行综合评价对比。结果:观察组临床总有效率为93.85%(61/65),高于对照组的78.46%(51/65),(P<0.05)。治疗后,两组患者腓总神经、正中神经的运动神经传导速度(MNCV)、感觉神经传导速度(SNCV)均高于治疗前,观察组高于对照组,组间比较差异显著(P<0.05)。治疗后,两组患者TCSS、VAS评分、肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)、C-反应蛋白(CRP)低于治疗前,观察组低于对照组,组间比较差异明显(P<0.05)。观察组不良反应发生率为13.85%(9/65),对照组为7.69%(5/65),组间相比差异不明显(P>0.05)。结论:α-硫辛酸与前列地尔联合治疗糖尿病周围神经病变,疗效满意,可显著改善患者的神经症状,降低炎症因子水平,且用药安全性好,值得在临床上进一步推广使用。
Objective: To investigate the curative effect of α-lipoic acid and alprostadil on patients with diabetic peripheral neuropathy and its effect on serum inflammatory factors and nerve conduction velocity. Methods: 130 patients with diabetic peripheral neuropathy who were treated in our hospital from June 2015 to June 2017 were selected, and they were randomly divided into the observation group and the control group according to the random digital table method, 65 cases in each group. The patients in the control group were treated with alprostadil, and the patients in the observation group were treated with α-lipoic acid on the basis of control group, and all patients of two groups were treated for 2 weeks. The clinical efficacy, nerve conduction velocity before and after treatment, serum inflammatory factor levels, Toronto clinical neuropathy score system(TCSS), visual analogue scale(VAS) and incidence of adverse reactions were compared and evaluated between the two groups. Results: The total effective rate of the observation group was 93.85%(61/65), which was higher than 78.46% of the control group(51/65)(P<0.05). After treatment, motor nerve conduction velocity(MNCV)and sensory nerve conduction velocity(SNCV) of common peroneal nerve and median nerve in two groups were all higher than those before treatment, and the observation group was higher than that in the control group, and the difference between the two groups was statistically significant(P<0.05). After treatment, the scores of TCSS, VAS and levels TNF-α(TNF-α), interleukin-6(IL-6) and C-reactive protein(CRP) in the two groups were all lower than those before treatment, and the observation group was lower than that in the control group, the difference between the two groups was statistically significant(P<0.05). The incidence of adverse reactions in the observation group was 13.85%(9/65), and there was no significant difference compared with the control group 7.69%(5/65), the difference between the groups was not obvious(P>0.05). Conclusion: α-lipoic acid combined with alprostadil is effective in the treatment of diabetic peripheral neuropathy. It can significantly improve the neurological symptoms and reduce the levels of inflammatory factors, and the safety of drug use is good, which is worthy of further promotion in clinical practice.
Objective: To investigate the curative effect of α-lipoic acid and alprostadil on patients with diabetic peripheral neuropathy and its effect on serum inflammatory factors and nerve conduction velocity. Methods: 130 patients with diabetic peripheral neuropathy who were treated in our hospital from June 2015 to June 2017 were selected, and they were randomly divided into the observation group and the control group according to the random digital table method, 65 cases in each group. The patients in the control group were treated with alprostadil, and the patients in the observation group were treated with α-lipoic acid on the basis of control group, and all patients of two groups were treated for 2 weeks. The clinical efficacy, nerve conduction velocity before and after treatment, serum inflammatory factor levels, Toronto clinical neuropathy score system(TCSS), visual analogue scale(VAS) and incidence of adverse reactions were compared and evaluated between the two groups. Results: The total effective rate of the observation group was 93.85%(61/65), which was higher than 78.46% of the control group(51/65)(P<0.05). After treatment, motor nerve conduction velocity(MNCV)and sensory nerve conduction velocity(SNCV) of common peroneal nerve and median nerve in two groups were all higher than those before treatment, and the observation group was higher than that in the control group, and the difference between the two groups was statistically significant(P<0.05). After treatment, the scores of TCSS, VAS and levels TNF-α(TNF-α), interleukin-6(IL-6) and C-reactive protein(CRP) in the two groups were all lower than those before treatment, and the observation group was lower than that in the control group, the difference between the two groups was statistically significant(P<0.05). The incidence of adverse reactions in the observation group was 13.85%(9/65), and there was no significant difference compared with the control group 7.69%(5/65), the difference between the groups was not obvious(P>0.05). Conclusion: α-lipoic acid combined with alprostadil is effective in the treatment of diabetic peripheral neuropathy. It can significantly improve the neurological symptoms and reduce the levels of inflammatory factors, and the safety of drug use is good, which is worthy of further promotion in clinical practice.
引文
[1]Li B,Yang H,Zhang W,et al.Fatty acid-binding protein 4 predicts gestational hypertension and preeclampsia in women with gestational diabetes mellitus[J].PLo S One,2018,13(2):e0192347
[2]Gong J,Du X,Li Z,et al.Differential expression of genes identified by suppression subtractive hybridization in liver and adipose tissue of gerbils with diabetes[J].PLoS One,2018,13(2):e0191212
[3]Kuo CL,Lu CL,Chang YH,et al.Population-Based Cohort Study on Dementia Risk in Patients with Type 1 Diabetes Mellitus[J].Neuroepidemiology,2018,50(1-2):57-62
[4]聂发传,石英.糖尿病周围神经病变发生机制研究进展[J].重庆医学,2015,44(1):122-125Nie Fa-chuan,Shi Ying.Progress in the mechanism of diabetic peripheral neuropathy[J].Chongqing Medicine,2015,44(1):122-125
[5]Li P,Zhang C,Gao P,et al.Metformin use and its effect on gastric cancer in patients with type 2 diabetes:A systematic review of observational studies[J].Oncol Lett,2018,15(1):1191-1199
[6]Gupta S,Nayak MT,Sunitha JD,et al.Correlation of salivary glucose level with blood glucose level in diabetes mellitus[J].J Oral Maxillofac Pathol,2017,21(3):334-339
[7]Kim ES,Lee SW,Mo EY,et al.Inverse association between serum total bilirubin levels and diabetic peripheral neuropathy in patients with type 2 diabetes[J].Endocrine,2015,50(2):405-412
[8]Pareja-Ríos A,Ruiz-de la Fuente-Rodríguez P,Bonaque-González S,et al.Intravitreal dexamethasone implants for diabetic macular edema[J].Int J Ophthalmol,2018,11(1):77-82
[9]Volpe CMO,Villar-Delfino PH,Dos Anjos PMF,et al.Cellular death,reactive oxygen species(ROS)and diabetic complications[J].Cell Death Dis,2018,9(2):119
[10]高鹏举,罗国刚,李强,等.不同剂量甲钴胺联合GM1治疗糖尿病周围神经病变疗效观察[J].现代生物医学进展,2017,17(21):4108-4111Gao Peng-ju,Luo Guo-gang,Li Qiang,et al.Clinical Effect of Different Dose of Methyl Cobalamin Combined GM1 in Treatment of Diabetic Peripheral Neuropathy Patients[J].Progress in Modern Biomedicine,2017,17(21):4108-4111
[11]Algeffari MA.Painful Diabetic Peripheral Neuropathy among Saudi Diabetic Patients is Common but Under-recognized:Multicenter Cross-sectional study at primary health care setting[J].J Family Community Med,2018,25(1):43-47
[12]Almuhannadi H,Ponirakis G,Khan A,et al.Diabetic neuropathy and painful diabetic neuropathy:Cinderella complications in South East Asia[J].J Pak Med Assoc,2018,68(1):85-89
[13]Ghelani H,Razmovski-Naumovski V,et al.(R)-α-Lipoic acid inhibits fructose-induced myoglobin fructation and the formation of advanced glycation end products(AGEs)in vitro[J].BMC Complement Altern Med,2018,18(1):13
[14]宋春宇,王中京,赵湜,等.甲钴胺联合α-硫辛酸治疗糖尿病周围神经病变对神经电生理的影响[J].广东医学,2015,(11):1754-1756,1757Song Chun-yu,Wang Zhong-jing,Zhao Shi,et al.Effect of Mecobalamin Combined with alpha lipoic acid in the treatment of diabetic peripheral neuropathy of electrophysiology[J].Guangdong Medical Journal,2015,(11):1754-1756,1757
[15]中华医学会糖尿病学分会.中国2型糖尿病防治指南(2013年版)[J].中华糖尿病杂志,2014,22(7):447-498Chinese Diabetes Society.Guidelines for the prevention and control of type 2 diabetes in China(2013 Edition)[J].Chinese Journal of Diabetes Mellitus,2014,22(7):447-498
[16]罗君华.α硫辛酸联合单唾液酸四己糖神经节苷脂治疗糖尿病周围神经病变患者的效果及对相关神经传导速度的影响[J].中国综合临床,2016,32(3):231-234Luo Jun-hua.The therapeutic effect and effects on nerve conduction velocity ofα-lipoic acid combined with monosialoteterahexosyl ganglioside sodium on diabetic peripheral neuropathy[J].Clinical Medicine of China,2016,32(3):231-234
[17]Olt S,Oznas O.Investigation of the vitamin B12 deficiency with peripheral neuropathy in patients with type 2 diabetes mellitus treated using metformin[J].North Clin Istanb,2017,4(3):233-236
[18]Nathan HJ,Poulin P,Wozny D,et al.Randomized Trial of the Effect of Mindfulness-Based Stress Reduction on Pain-Related Disability,Pain Intensity,Health-Related Quality of Life,and A1C in Patients With Painful Diabetic Peripheral Neuropathy[J].Clin Diabetes,2017,35(5):294-304
[19]Danjo J,Sawada H,Uchida K,et al.Efficacy of a new microvibration sensation measurement device at detecting diabetic periph eral neuropathy using a newly devised finger method[J].J Gen Fam Med,2017,18(4):155-161
[20]杨秀颖,张莉,陈熙,等.2型糖尿病周围神经病变机制研究进展[J].中国药理学通报,2016,32(5):598-602Yang Xiu-ying,Zhang Li,Chen Xi,et al.Research progress of diabetic peripheral neuropathy mechanisms in type 2 diabetes[J].Chinese Pharmacological Bulletin,2016,32(5):598-602
[21]Sun J,Zheng H,Qin X,et al.Effects of Immunocytokine Combined with Cattle Encephalon Glycoside and Ignotin on CTGF,HO-1 and NT-3 in Patients with Type 2 Diabetic Peripheral Neuropathy[J].Iran J Public Health,2017,46(12):1632-1638
[22]Sztanek F,MolnárnéMolnár魣,Balogh Z.The role of oxidative stress in the development of diabetic neuropathy[J].Orv Hetil,2016,157(49):1939-1946
[23]Kluding PM,Pasnoor M,Singh R,et al.Safety of Aerobic Exercise in People With Diabetic Peripheral Neuropathy[J].Phys Ther,2015,95(2):223-234
[24]吴志英.硫辛酸联合前列地尔治疗糖尿病周围神经病变的疗效观察[J].中国医院用药评价与分析,2016,16(6):788-789,790Wu Zhi-ying.Clinical Study on Lipoic Acid Combined Alprostadil in Treatment of Diabetic Peripheral Neuropathy[J].Evaluation and Analysis of Drug-Use in Hospitals of China,2016,16(6):788-789,790
[25]褚莉茗.α-硫辛酸联合前列地尔治疗糖尿病周围神经病变的效果分析[J].中国综合临床,2016,32(1):57-60Chu Li-ming.Effect analysis ofα-lipoic acid combined with alprostadil in patients with diabetic peripheral neuropathy[J].Clinical Medicine of China,2016,32(1):57-60
[26]官常荣,朱英标,丁莉,等.鼠神经生长因子联合α-硫辛酸治疗糖尿病周围神经病变的临床观察[J].中国临床药理学杂志,2014,30(10):892-894,900Guan Chang-rong,Zhu Ying-biao,Ding Li,et al.Clinical observation of rat nerve growth factor combined withαlipoic acid for treatment of diabetic peripheral neuropathy[J].The Chinese Jour nal of Clinical Pharmacology,2014,30(10):892-894,900
[27]Bartkoski S,Day M.Alpha-Lipoic Acid for Treatment of Diabetic Peripheral Neuropathy[J].Am Fam Physician,2016,93(9):786
[28]侯瑞华,吕麦扣,张建军,等.前列地尔联合腺苷钴胺治疗老年2型糖尿病周围神经病变的疗效[J].中国老年学杂志,2015,35(17):4858-4859Hou Rui-hua,LV Mai-kou,Zhang Jian-jun,et al.The therapeutic effect of alprostadil combined with adenosine and cobalamin in the treatment of senile type 2 diabetic peripheral neuropathy[J].Chinese Journal of Gerontology,2015,35(17):4858-4859
[29]罗卓章,刘红霞,吴沛锵,等.α-硫辛酸联合甲钴胺、前列地尔对糖尿病周围神经病变的治疗疗效观察[J].实用糖尿病杂志,2014,10(4):53-55Luo Zhuo-zhang,Liu Hong-xia,Wu Pei-qiang,et al.Alpha lipoic acid combined with mecobalamin and alprostadil treatment of diabetic peripheral neuropathy[J].Journal of Practical Diabetology,2014,10(4):53-55
[30]高洁,张艳锋,黄连铭,等.α-硫辛酸联合前列地尔、甲钴胺治疗老年糖尿病周围神经病变的临床疗效研究[J].实用心脑肺血管病杂志,2015,23(12):59-61Gao Jie,Zhang Yan-feng,Huang Lian-ming,et al.Clinical Effect ofα-lipoic Acid Combined with Alprostadil and Mecobalamin on Aged Diabetic Peripheral Neuropathy[J].Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease,2015,23(12):59-61
[2]Gong J,Du X,Li Z,et al.Differential expression of genes identified by suppression subtractive hybridization in liver and adipose tissue of gerbils with diabetes[J].PLoS One,2018,13(2):e0191212
[3]Kuo CL,Lu CL,Chang YH,et al.Population-Based Cohort Study on Dementia Risk in Patients with Type 1 Diabetes Mellitus[J].Neuroepidemiology,2018,50(1-2):57-62
[4]聂发传,石英.糖尿病周围神经病变发生机制研究进展[J].重庆医学,2015,44(1):122-125Nie Fa-chuan,Shi Ying.Progress in the mechanism of diabetic peripheral neuropathy[J].Chongqing Medicine,2015,44(1):122-125
[5]Li P,Zhang C,Gao P,et al.Metformin use and its effect on gastric cancer in patients with type 2 diabetes:A systematic review of observational studies[J].Oncol Lett,2018,15(1):1191-1199
[6]Gupta S,Nayak MT,Sunitha JD,et al.Correlation of salivary glucose level with blood glucose level in diabetes mellitus[J].J Oral Maxillofac Pathol,2017,21(3):334-339
[7]Kim ES,Lee SW,Mo EY,et al.Inverse association between serum total bilirubin levels and diabetic peripheral neuropathy in patients with type 2 diabetes[J].Endocrine,2015,50(2):405-412
[8]Pareja-Ríos A,Ruiz-de la Fuente-Rodríguez P,Bonaque-González S,et al.Intravitreal dexamethasone implants for diabetic macular edema[J].Int J Ophthalmol,2018,11(1):77-82
[9]Volpe CMO,Villar-Delfino PH,Dos Anjos PMF,et al.Cellular death,reactive oxygen species(ROS)and diabetic complications[J].Cell Death Dis,2018,9(2):119
[10]高鹏举,罗国刚,李强,等.不同剂量甲钴胺联合GM1治疗糖尿病周围神经病变疗效观察[J].现代生物医学进展,2017,17(21):4108-4111Gao Peng-ju,Luo Guo-gang,Li Qiang,et al.Clinical Effect of Different Dose of Methyl Cobalamin Combined GM1 in Treatment of Diabetic Peripheral Neuropathy Patients[J].Progress in Modern Biomedicine,2017,17(21):4108-4111
[11]Algeffari MA.Painful Diabetic Peripheral Neuropathy among Saudi Diabetic Patients is Common but Under-recognized:Multicenter Cross-sectional study at primary health care setting[J].J Family Community Med,2018,25(1):43-47
[12]Almuhannadi H,Ponirakis G,Khan A,et al.Diabetic neuropathy and painful diabetic neuropathy:Cinderella complications in South East Asia[J].J Pak Med Assoc,2018,68(1):85-89
[13]Ghelani H,Razmovski-Naumovski V,et al.(R)-α-Lipoic acid inhibits fructose-induced myoglobin fructation and the formation of advanced glycation end products(AGEs)in vitro[J].BMC Complement Altern Med,2018,18(1):13
[14]宋春宇,王中京,赵湜,等.甲钴胺联合α-硫辛酸治疗糖尿病周围神经病变对神经电生理的影响[J].广东医学,2015,(11):1754-1756,1757Song Chun-yu,Wang Zhong-jing,Zhao Shi,et al.Effect of Mecobalamin Combined with alpha lipoic acid in the treatment of diabetic peripheral neuropathy of electrophysiology[J].Guangdong Medical Journal,2015,(11):1754-1756,1757
[15]中华医学会糖尿病学分会.中国2型糖尿病防治指南(2013年版)[J].中华糖尿病杂志,2014,22(7):447-498Chinese Diabetes Society.Guidelines for the prevention and control of type 2 diabetes in China(2013 Edition)[J].Chinese Journal of Diabetes Mellitus,2014,22(7):447-498
[16]罗君华.α硫辛酸联合单唾液酸四己糖神经节苷脂治疗糖尿病周围神经病变患者的效果及对相关神经传导速度的影响[J].中国综合临床,2016,32(3):231-234Luo Jun-hua.The therapeutic effect and effects on nerve conduction velocity ofα-lipoic acid combined with monosialoteterahexosyl ganglioside sodium on diabetic peripheral neuropathy[J].Clinical Medicine of China,2016,32(3):231-234
[17]Olt S,Oznas O.Investigation of the vitamin B12 deficiency with peripheral neuropathy in patients with type 2 diabetes mellitus treated using metformin[J].North Clin Istanb,2017,4(3):233-236
[18]Nathan HJ,Poulin P,Wozny D,et al.Randomized Trial of the Effect of Mindfulness-Based Stress Reduction on Pain-Related Disability,Pain Intensity,Health-Related Quality of Life,and A1C in Patients With Painful Diabetic Peripheral Neuropathy[J].Clin Diabetes,2017,35(5):294-304
[19]Danjo J,Sawada H,Uchida K,et al.Efficacy of a new microvibration sensation measurement device at detecting diabetic periph eral neuropathy using a newly devised finger method[J].J Gen Fam Med,2017,18(4):155-161
[20]杨秀颖,张莉,陈熙,等.2型糖尿病周围神经病变机制研究进展[J].中国药理学通报,2016,32(5):598-602Yang Xiu-ying,Zhang Li,Chen Xi,et al.Research progress of diabetic peripheral neuropathy mechanisms in type 2 diabetes[J].Chinese Pharmacological Bulletin,2016,32(5):598-602
[21]Sun J,Zheng H,Qin X,et al.Effects of Immunocytokine Combined with Cattle Encephalon Glycoside and Ignotin on CTGF,HO-1 and NT-3 in Patients with Type 2 Diabetic Peripheral Neuropathy[J].Iran J Public Health,2017,46(12):1632-1638
[22]Sztanek F,MolnárnéMolnár魣,Balogh Z.The role of oxidative stress in the development of diabetic neuropathy[J].Orv Hetil,2016,157(49):1939-1946
[23]Kluding PM,Pasnoor M,Singh R,et al.Safety of Aerobic Exercise in People With Diabetic Peripheral Neuropathy[J].Phys Ther,2015,95(2):223-234
[24]吴志英.硫辛酸联合前列地尔治疗糖尿病周围神经病变的疗效观察[J].中国医院用药评价与分析,2016,16(6):788-789,790Wu Zhi-ying.Clinical Study on Lipoic Acid Combined Alprostadil in Treatment of Diabetic Peripheral Neuropathy[J].Evaluation and Analysis of Drug-Use in Hospitals of China,2016,16(6):788-789,790
[25]褚莉茗.α-硫辛酸联合前列地尔治疗糖尿病周围神经病变的效果分析[J].中国综合临床,2016,32(1):57-60Chu Li-ming.Effect analysis ofα-lipoic acid combined with alprostadil in patients with diabetic peripheral neuropathy[J].Clinical Medicine of China,2016,32(1):57-60
[26]官常荣,朱英标,丁莉,等.鼠神经生长因子联合α-硫辛酸治疗糖尿病周围神经病变的临床观察[J].中国临床药理学杂志,2014,30(10):892-894,900Guan Chang-rong,Zhu Ying-biao,Ding Li,et al.Clinical observation of rat nerve growth factor combined withαlipoic acid for treatment of diabetic peripheral neuropathy[J].The Chinese Jour nal of Clinical Pharmacology,2014,30(10):892-894,900
[27]Bartkoski S,Day M.Alpha-Lipoic Acid for Treatment of Diabetic Peripheral Neuropathy[J].Am Fam Physician,2016,93(9):786
[28]侯瑞华,吕麦扣,张建军,等.前列地尔联合腺苷钴胺治疗老年2型糖尿病周围神经病变的疗效[J].中国老年学杂志,2015,35(17):4858-4859Hou Rui-hua,LV Mai-kou,Zhang Jian-jun,et al.The therapeutic effect of alprostadil combined with adenosine and cobalamin in the treatment of senile type 2 diabetic peripheral neuropathy[J].Chinese Journal of Gerontology,2015,35(17):4858-4859
[29]罗卓章,刘红霞,吴沛锵,等.α-硫辛酸联合甲钴胺、前列地尔对糖尿病周围神经病变的治疗疗效观察[J].实用糖尿病杂志,2014,10(4):53-55Luo Zhuo-zhang,Liu Hong-xia,Wu Pei-qiang,et al.Alpha lipoic acid combined with mecobalamin and alprostadil treatment of diabetic peripheral neuropathy[J].Journal of Practical Diabetology,2014,10(4):53-55
[30]高洁,张艳锋,黄连铭,等.α-硫辛酸联合前列地尔、甲钴胺治疗老年糖尿病周围神经病变的临床疗效研究[J].实用心脑肺血管病杂志,2015,23(12):59-61Gao Jie,Zhang Yan-feng,Huang Lian-ming,et al.Clinical Effect ofα-lipoic Acid Combined with Alprostadil and Mecobalamin on Aged Diabetic Peripheral Neuropathy[J].Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease,2015,23(12):59-61