静脉滴注尼莫地平注射液对糖尿病周围神经功能的疗效

Improvement of peripheral neuropathy in type 2 diabetes by intravenous nimodipine infusion

目的 观察尼莫地平对糖尿病周围神经病变的疗效。方法 将合并周围神经病变的 115例 2型糖尿病患者随机分为两组:治疗组(62例)每天给予尼莫地平注射液 20mg静脉滴注,连续 14d;对照组 (53例 )给予丹参注射液 20ml静脉滴注, 连续 14d。观察两组患者治疗前、后神经系统症状及体征变化,并应用肌电图仪测定治疗前、后四肢神经的传导潜伏期、波幅和传导速度变化,同时测定血黏度、血脂、空腹及餐后 2h血糖、胰岛素(Ins)、C 肽和糖化血红蛋白(HbA1c)等指标,计算简易稳态模式评估法的胰岛素抵抗脂数 (HOMA IR)。结果 两组患者治疗前的病程、血压、血糖、血脂、神经系统病变程度的差异无显著性(P>0. 05)。治疗 14d后,治疗组患者的疼痛、麻木等症状较对照组减轻,浅感觉减退异常率下降,膝腱反射减弱也明显好转 (P<0. 05 );治疗组治疗后胫神经、腓神经和腓肠神经的传导速度较治疗前和对照组明显加快 (P值分别 <0. 05和 0. 01 ),HOMA IR显著下降(P<0. 01),血浆黏度和全血高切、低切黏度降低(P<0. 05),红细胞变形指数显著升高 (P<0. 01),聚集指数则明显降低(P<0. 05);血高密度脂蛋白胆固醇增高(P<0. 05) ,而胆固醇、低密度脂蛋白胆固醇变化不大(P>0. 05)。结论 尼莫地平注射液能改善糖尿病周围神经病变。

Objective To observe whether or not nimodipine injection can improve the peripheral neuropathy in diabetic patients.Methods 115 diabetic patients complicated with peripheral neuropathy were divided randomly into two groups:1)Treated group(n=62): Nimodipine 20 mg was given intravenously with normal 1 000 ml per day for 14 days.2)Control group(n=53): Radix salviae miltiorrhiza 20ml was administrated intravenously in normal saline 500 ml also for 14 days. The symptoms and signs were observed and recorded, and the nerve conducting velocity(NCV), latencies and wave amplitudes of median nerve, tibial nerve, peroneal nerve and sural nerve of the lower limbs were measured before and afteries treatment in the two groups using electromyograph (Denmark). The fasting and postprandial plasma glucose levels, serum insulin and C-peptide were measured; HbA1c and the lipoprotein profile were determined before and after the treatment also; the modified index of HOMA insulin-resistance (HOMA-IR)was calculated basing on the fasting levels of glucose and insulin, the whole blood and the plasma viscosities were measured correspondingly.Results All 62 diabetic patients completed the course of 14-day treatment. In the treated group, the numbness, pain and abnormal sensitivity decreased obviously more than those in the control patients, and the decreased knee jerk and superficial sensation recovered; and the pulse of pedisdorsalis became stronger. The NCV of tibial nerve ,peroneal nerve and sural nerve after 14 days of nimodipine administration were faster, more significantly than those of the control group (P<0.05) The plasma and whole blood viscosities decreased significantly in treated patients, and the deformed ability of red blood cell increased, but the aggregation index decreased more significantly than that before treatment. The high-density lipoprotein cholesterol(HDL-C) level of treated group increased significantly, there was no significant difference in TC and LDL-C levels between the two groups, the HOMA-IR index reduced obviously(P<0.01).Conclusion Nimodipine improves the diabetic peripheral neuropathy with the probable mechanism dilatation for nutrient vessels in the nerve tissue improving local ischemia and hypoxia together with decreasing insulin-resistance and blood viscosity.