α-硫辛酸联合普瑞巴林治疗糖尿病痛性周围神经病变的疗效观察

The curative effects of alpha-lipoic acid combined with pregabalin on diabetic peripheral neuropathy

目的评价α-硫辛酸(ALA)联合普瑞巴林(PGB)在糖尿病痛性周围神经病变(DPNP)治疗中的有效性和安全性,为糖尿病并发症的治疗提供依据。方法选择DPNP患者90例,男性41例,女性49例,随机分为3组:甲钴胺组、ALA组和ALA联合PGB组,每组30例。各组患者予以控制血糖,分别用甲钴胺、ALA以及ALA联合PGB治疗,4周后观察各组疗效、神经传导速度以及不良反应。结果与治疗前比较,治疗后各组患者疼痛程度均下降,差异有统计学意义(P<0.05)。ALA联合PGB组临床总有效率(86.7%)高于甲钴胺组(60.0%)和ALA组(66.7%),差异有统计学意义(P<0.05)。与治疗前比较,治疗后各组的神经传导速度均增加,差异均有统计学意义(P<0.05)。与甲钴胺组治疗后比较,ALA组治疗后正中神经的感觉神经传导速度[(53.6±3.9)m/s]以及腓总神经的运动神经传导速度[(52.6±4.2)m/s]和感觉神经传导速度[(52.1±3.6)m/s]增加,差异均有统计学意义(P<0.05)。与甲钴胺组治疗后比较,ALA联合PGB组治疗后腓总神经的感觉神经传导速度[(51.9±4.1)m/s]以及正中神经的运动神经传导速度[(54.1±3.7)m/s]和感觉神经传导速度[(54.2±3.6)m/s]增加,差异有统计学意义(P<0.05)。3组均未观察到需要临床干预或中止治疗的不良反应。结论 ALA联合PGB可以有效地修复神经,缓解疼痛,提高患者的生活质量,同时具有一定的安全性,为临床治疗DPNP提供一种较好的选择。

Objective To assess the safety and curative effects of alpha-lipoic acid （ALA） combined with pregabalin （PGB） on diabetic peripheral neuropathy （DPNP）. Methods Ninety patients with DPNP（41 males and 49 females） were randomly divided into three groups, i.e. methylcobalamiu group （n=30）, ALA group （n=30） and ALA plus PGB group （n=30）. Three groups were treated with methylcobalamin, ALA and ALA plus PGB for four weeks, respectively. Then the curative effects, nerve conduction velocity and side effects were observed. Results After treatment, the pain was significantly relieved for three groups to some extension （P〈0.05）. The curative effective rate in ALA plus PGB group was 86.7 %, which was significantly higher than that （60.0%） in methylcobalamin group and that （66.7%） in ALA group （P〈0.05）. After treatment, the nerve conduction velocity for three groups increased significantly （P〈0.05）. As compared with methylcobalamin group, the median sensory nerve conduction velocity, common peroneal nmtor nerve conduction velocity and common peroneal sensory nerve conduction velocity in ALA group increased obviously （P〈0.05）, which were （ 53.6 ±3.9）, （52.6 ±4.2） and （52.1 ±3.6） m/s, respectively. As compared with methyleobalamin group, the common peroneal sensory nerve conduction velocity [（ 51.9±4.1 ） m/ss], median motor nerve conduction velocity [（54.1±3.7） m/s] and median sensory nerve conduction velocity [（54.2±3.6） m/s] in ALA plus PGB group increased significantly（P〈0.05 ）.No side effect was found in three groups. Conclusion ALA plus PGB is safe and effective in the treatment of painful diabetic peripheral neuropathy.