银杏提取物与潘生丁复方制剂联合甲钴胺治疗糖尿病周围神经病变(英文)

Effect of combination of compound preparation between gingko extract and dipyridamole and methycobal on the treatment of diabetic peripheral neuropathy

背景:大量基础研究和临床观察证明银杏提取物与潘生丁复方制剂有明显的改善微循环的作用,甲钴胺是临床上常用的神经修复剂,将两者联合治疗糖尿病周围神经病变疗效更佳。目的:观察银杏提取物与潘生丁复方制剂与甲钴胺联合应用对糖尿病周围神经病变患者腓总神经神经传导速度和血液流变学的改善效果。设计:以患者为观察对象,随机对照设计的验证性实验。单位:华中科技大学同济医学院附属同济医院综合科。对象:选择2002-01/2005-01在华中科技大学同济医学院附属同济医院综合科住院的2型糖尿病并发周围神经病变患者120例,随机(投币)分为治疗组和对照组各60例,患者对治疗均知情同意。方法:治疗组应用银杏提取物与潘生丁复方制剂(贵州益佰制药有限公司生产)25mL+生理盐水250mL静脉滴注,1次/d,同时应用甲钴胺(日本卫材株式会社产品)500μg肌肉注射,1次/d,连续应用4周;对照组用甲钴胺500μg肌肉注射,1次/d,连续应用4周。主要观察指标:治疗前1d及治疗4周后两组患者腓神经的神经传导速度,血液流变学指标(包括血黏度、红细胞压积和血小板聚集率)。结果:120例全部进入结果分析。①运动神经传导速度:治疗组治疗后快于治疗前和对照组治疗后[(45.6±4.3),(38.5±3.8),(41.4±6.2)m/s,t=9.585,4.312,P<0.01];感觉神经传导速度:治疗组治疗后快于治疗前和对照组治疗后[(45.8±4.2),(36.7±4.8),(38.2±4.9)m/s,t=11.047,9.120,P<0.01]。②治疗组治疗后全血黏度高切、低切和血浆黏度均显著低于治疗前和对照组治疗后(P<0.01)。③治疗组治疗后红细胞压积显著低于治疗前和对照组治疗后[(41.32±3.56)%,(46.32±3.43)%,(44.32±4.49)%,t=7.834,4.05,P<0.01]。④治疗组治疗后血小板聚集率显著低于治疗前和对照组治疗后[(31.35±2.11)%,(48.44±2.68)%,(45.91±3.54)%,t=38.810,27.367,P<0.01]。结论:银杏提取物与潘生丁复方制剂与甲钴胺联合应用可提高神经传导速度,降低血黏度和血小板聚集率,是治疗糖尿病周围神经病变的有效方法。

BACKGROUND： Many basic researches and clinical observations prove that compound preparation of gingko extract and dipyridamole has an obvious effect on microociroulation. Methycobal is commonly used to repair nerve on clinic. Combination of compound preparation and methycobal has a great effect on treating diabetic peripheral neuropathy （DPN）. OBJECTIVE： To observe the improved effect of combination of compound preparation and methycobal on conduction velocity of common peroneal nerve and hemorheology of DPN patients. DESIGN： Randomized controlled design and validated experiment on the basis of patients. SETTING： Department of Comprehensive Medicine, Tongji Hospital of Tongji Hedical College, Huazhong University of Science and Technology. PARTICIPANTS： A total of 120 patients with type 2 diabetes mellitus （DM） combined with DPN were selected from the Department of Comprehensive Medicine in Tongji Hospital of Tongji Medical College affiliated to Huazhung University of Science and Technology between January 2002 and January 2005. Subjects were randomly divided into treatment group and control group with 60 in each group. All cases were consent. METHODS： Cases in the treatment group were venously dripped with 25 mL compound preparation and 250 mL saline （Guizhou Yibai Pharmacology Company Limited） once a day; meanwhile, 500 μg methycobal （Eisai Community, Japan） was intramuscularly injected into cases once a day for 4 successive weeks. Cases in the control group were intramuscularly injected with 500 μg methycobal once a day for 4 weeks. MAIN OUTCOME MEASURES： Conduction velocity of peroneal nerve and hemorbeological indexes （blood viscosity, hematocrit and aggregative rate of platelet） of patients in the two groups at 1 day before treatment and at 4 weeks after treatment. RESULTS： A total of 120 patients were involved in the final analysis. ① Conduction velocity of motor nerve was faster in treatment group after treatment than that before treatment and that in control group after treatment [（45.6±4.3）, （38.5±3.8）, （41.4±6.2） m/s, t=9.585, 4.312, P 〈 0.01]; conduction velocity of sensory nerve was faster in treatment group after treatment than that before treatment and that in control group after treatment [（45.8 ±4.2）, （36.7±4.8）, （38.2±4.9） m/s, t=11.047, 9.120, P 〈 0.01]. ② Values of high-shearlng blood viscosity, low-shearing blood viscosity and plasma viscosity were lower in treatment group after treatment than those before treatment and those in control group after treatment （P 〈 0.01）. ③Value of hematocrit was lower in treatment group after treatment than those before treatment and those in control group after treatment [（41.32±3.56）%, （46.32±3.43）%, （44.32±4.49）%, t=7.834,4.05, P 〈 0.01]. ④ Aggregative rate of platelet was lower in treatment group after treatment than those before treatment and those in control group after treatment [（31.35±2.11）%, （48.44±2.68）%, （45.91±3.54）%, t=38.810, 27.367, P 〈 0.01]. CONCLUSION： Combination of compound preparation and methycobal can increase nerve conduction velocity and decrease blood viscosity and aggregative rate of platelet, and it is also an effective method for treating DPN.