桃红四物汤加味治疗糖尿病周围神经病变的疗效观察
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摘要
【目的】探讨桃红四物汤加味内服、外用治疗糖尿病周围神经病变(DPN)的临床疗效。【方法】将126例DPN患者随机分为中医组和对照组,每组各63例。2组患者均给予糖尿病基础治疗,对照组同时给予硫辛酸注射液治疗,中医组在对照组的基础上加用桃红四物汤加味内服和熏洗治疗,连续治疗3周。观察2组患者治疗前后中医证候评分、多伦多临床评分系统(TCSS)评分、神经病变主观症状问卷(TSS)评分、正中神经和腓总神经运动(MNCV)和感觉(SNCV)传导速度、血液流变学指标[全血高切黏度(HSV)、全血低切黏度(LSV)、血浆黏度(PV)、血细胞比容(HCT)、血小板聚集率]和丙二醛(MDA)、超氧化物歧化酶(SOD)、总抗氧化能力(T-AOC)、谷氨酰转肽酶(GGT)、谷胱甘肽过氧化物(GSH-Px)水平的变化情况,并评价2组的临床疗效。【结果】(1)治疗3周后,中医组的总有效率为90.48%,对照组为77.78%,组间比较,中医组的疗效优于对照组,差异有统计学意义(P<0.05)。(2)治疗后,2组患者的中医证候评分、TCSS评分、TSS评分,以及HSV、LSV、PV、HCT、血小板聚集率等血液流变学指标和血清MDA、GGT水平均较治疗前明显降低(P<0.05),而MNCV、SNCV和血清SOD、T-AOC、GSH-Px水平均较治疗前明显升高(P<0.05),且中医组在改善上述指标方面均明显优于对照组,差异均有统计学意义(P<0.05)。【结论】桃红四物汤加味治疗DPN可以提高神经传导速度,抑制氧化应激反应,从而能改善症状,提高疗效。
Objective To study the effects of modified Taohong Siwu Decoction in the treatment of diabetic peripheral neuropathy(DPN). Methods A total of 126 patients with DPN were randomly divided into Chinese medicine group and control group,63 cases in each group. The patients in the two groups were given routine basic treatment for diabetes mellitus,and additionally,the control group was given intravenous injection of Thioctic Acid Injection while Chinese medicine group was given oral use and fumigation administration of modified Taohong Siwu Decoction plus intravenous injection of Thioctic Acid Injection. The treatment lasted for 3 continuous weeks.Before and after treatment,we observed the scores of traditional Chinese medicine(TCM)syndrome,the scores evaluated with Toronto clinical scoring system(TCSS)and total symptoms scores(TSS)of neuropathy subjective symptoms, motion nerve conduction velocity(MNCV)and sensory nerve conduction velocity(SNCV)of the median nerve and common peroneal nerve, hemorheological indexes of whole blood high-shear viscosity(HSV)and low-shear viscosity(LSV),plasma viscosity(PV),hematocrit(HCT),and platelet aggregation rate,and the levels of malondialdehyde(MDA), superoxide dismutase(SOD), total antioxidant capacity(T-AOC),gamma-glutamyltranspeptidase(GGT)and glutathione peroxide(GSH-Px). And after treatment, the clinical efficacy of the two groups was evaluated. Results (1)After treatment for 3 weeks, the total effective rate of Chinese medicine group was 90.48%,significantly higher than that(77.78%)of the control group(P < 0.05).(2)After treatment, the observation indexes of TCM syndrome scores, TCSS scores, TSS, HSV, LSV, PV,HCT, platelet aggregation rate, MDA and GGT were decreased significantly as compared with those before treatment(P<0.05),while the MNCV,SNCV,and the levels of SOD,T-AOC and GSH-Px were increased significantly(P < 0.05),the improvement of the above indexes in Chinese medicine group being superior to that in the control group(P < 0.05). Conclusion Modified Taohong Siwu Decoction exerts enhancing effect for DPN by relieving symptoms through increasing nerve conduction velocity,and inhibiting oxidative stress.
Objective To study the effects of modified Taohong Siwu Decoction in the treatment of diabetic peripheral neuropathy(DPN). Methods A total of 126 patients with DPN were randomly divided into Chinese medicine group and control group,63 cases in each group. The patients in the two groups were given routine basic treatment for diabetes mellitus,and additionally,the control group was given intravenous injection of Thioctic Acid Injection while Chinese medicine group was given oral use and fumigation administration of modified Taohong Siwu Decoction plus intravenous injection of Thioctic Acid Injection. The treatment lasted for 3 continuous weeks.Before and after treatment,we observed the scores of traditional Chinese medicine(TCM)syndrome,the scores evaluated with Toronto clinical scoring system(TCSS)and total symptoms scores(TSS)of neuropathy subjective symptoms, motion nerve conduction velocity(MNCV)and sensory nerve conduction velocity(SNCV)of the median nerve and common peroneal nerve, hemorheological indexes of whole blood high-shear viscosity(HSV)and low-shear viscosity(LSV),plasma viscosity(PV),hematocrit(HCT),and platelet aggregation rate,and the levels of malondialdehyde(MDA), superoxide dismutase(SOD), total antioxidant capacity(T-AOC),gamma-glutamyltranspeptidase(GGT)and glutathione peroxide(GSH-Px). And after treatment, the clinical efficacy of the two groups was evaluated. Results (1)After treatment for 3 weeks, the total effective rate of Chinese medicine group was 90.48%,significantly higher than that(77.78%)of the control group(P < 0.05).(2)After treatment, the observation indexes of TCM syndrome scores, TCSS scores, TSS, HSV, LSV, PV,HCT, platelet aggregation rate, MDA and GGT were decreased significantly as compared with those before treatment(P<0.05),while the MNCV,SNCV,and the levels of SOD,T-AOC and GSH-Px were increased significantly(P < 0.05),the improvement of the above indexes in Chinese medicine group being superior to that in the control group(P < 0.05). Conclusion Modified Taohong Siwu Decoction exerts enhancing effect for DPN by relieving symptoms through increasing nerve conduction velocity,and inhibiting oxidative stress.
引文
[1]许樟荣.糖尿病周围神经病变[J].中国医学前沿杂志,2011,2(3):26.
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[3] Adams A S, Parker M M, Moffet H H, et al. Communication barriers and the clinical recognition of diabetic peripheral neuropathy in a diverse cohort of adults:the DISTANCE study[J].J Health Commun,2016,21(5):544.
[4]饶潇潇,姚广涛,文小平.中药干预糖尿病周围神经病变作用机制研究进展[J].中国中医药信息杂志,2017,24(4):130.
[5]方朝晖,吴以岭,赵进东.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.
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[7]刘凤,毛季萍,颜湘,等.多伦多临床评分系统在糖尿病周围神经病变中的应用价值[J].中南大学学报(医学版),2008,33(12):1137.
[8]刘杰,孙冰,班博,等.糖尿病周围神经病变氧化应激等相关机制探讨[J].北京医学, 2015,12(1):16.
[9] Van Dam P S. Oxidative stress and diabetic neuropathy:pathophysiological mechanisms and treatment perspectives[J]. Diabetes Metab Res Rev,2010,18(3):176.
[10]张敏娟,叶小珍,王坚.血清γ-谷氨酰转肽酶水平与2型糖尿病周围神经病变的关系[J].中华糖尿病杂志,2012,4(12):732.
[11]魏剑芬,吴乃君,陈冬,等.糖尿病周围神经病变患者血清铁蛋白与氧化应激反应的相关性[J].广东医学,2014,13(18):2887.
[12] Obrosova I G,Drel V R,Oltman C L,et al. Role of nitrosative stress in early neuropathy and vascular dysfunction in streptozotocin-diabetic rats[J]. Am J Physiol Endocrinol Metab,2007,293(6):1645.
[13]贲莹,张凤华,梁文杰,等.不同黄芪剂量补阳还五汤对糖尿病大鼠周围神经功能及氧化应激的作用[J].中成药,2015,37(1):199.
[14]林旋,梁佩玲,魏爱生.复方丹参滴丸对糖尿病周围神经病变血液流变学及神经传导速度的影响[J].广州中医药大学学报,2017,34(6):832.
[15]王鸿庆,孙继飞,徐云生.糖尿病周围神经病变的中医研究进展[J].江苏中医药,2015,22(1):83.
[16]刘伟花.糖尿病周围神经病变中医药治疗研究进展[J].辽宁中医药大学学报,2016,18(7):217.
[2]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].中国糖尿病杂志,2014,30(8):893.
[3] Adams A S, Parker M M, Moffet H H, et al. Communication barriers and the clinical recognition of diabetic peripheral neuropathy in a diverse cohort of adults:the DISTANCE study[J].J Health Commun,2016,21(5):544.
[4]饶潇潇,姚广涛,文小平.中药干预糖尿病周围神经病变作用机制研究进展[J].中国中医药信息杂志,2017,24(4):130.
[5]方朝晖,吴以岭,赵进东.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.
[6]郑筱萸.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.
[7]刘凤,毛季萍,颜湘,等.多伦多临床评分系统在糖尿病周围神经病变中的应用价值[J].中南大学学报(医学版),2008,33(12):1137.
[8]刘杰,孙冰,班博,等.糖尿病周围神经病变氧化应激等相关机制探讨[J].北京医学, 2015,12(1):16.
[9] Van Dam P S. Oxidative stress and diabetic neuropathy:pathophysiological mechanisms and treatment perspectives[J]. Diabetes Metab Res Rev,2010,18(3):176.
[10]张敏娟,叶小珍,王坚.血清γ-谷氨酰转肽酶水平与2型糖尿病周围神经病变的关系[J].中华糖尿病杂志,2012,4(12):732.
[11]魏剑芬,吴乃君,陈冬,等.糖尿病周围神经病变患者血清铁蛋白与氧化应激反应的相关性[J].广东医学,2014,13(18):2887.
[12] Obrosova I G,Drel V R,Oltman C L,et al. Role of nitrosative stress in early neuropathy and vascular dysfunction in streptozotocin-diabetic rats[J]. Am J Physiol Endocrinol Metab,2007,293(6):1645.
[13]贲莹,张凤华,梁文杰,等.不同黄芪剂量补阳还五汤对糖尿病大鼠周围神经功能及氧化应激的作用[J].中成药,2015,37(1):199.
[14]林旋,梁佩玲,魏爱生.复方丹参滴丸对糖尿病周围神经病变血液流变学及神经传导速度的影响[J].广州中医药大学学报,2017,34(6):832.
[15]王鸿庆,孙继飞,徐云生.糖尿病周围神经病变的中医研究进展[J].江苏中医药,2015,22(1):83.
[16]刘伟花.糖尿病周围神经病变中医药治疗研究进展[J].辽宁中医药大学学报,2016,18(7):217.