中西医结合对糖尿病周围神经病变患者血清Hcy和Cys-C水平的影响

Effect of Combined Chinese and Western Medicine on Serum Hcy and Cys-C Levels in Patients with Diabetic Peripheral Neuropathy

目的:观察中西医结合治疗糖尿病周围神经病变(diabetic peripheral neuropathy,DPN)的疗效以及对血清同型半胱氨酸(homocysteine,Hcy)和胱抑素C(Cystatin C,Cys-C)水平的影响。方法:86例DPN患者按数字表法随机分为对照组和治疗组均43例。两组均参照《糖尿病中医诊疗标准》给予基础治疗;对照组采取硫辛酸注射液500 mg静脉滴注治疗,1次·d-1;治疗组在对照组治疗基础上采取芍药甘草汤合四物汤加减治疗,每天1剂。所有患者均连续治疗4周。比较两组中医临床症状评分和两组感觉神经传导速度(sensory nerve conduction velocity,SNCV)、运动神经传导速度(motor nerve conduction velocity,MNCV);两组温度觉采用Tip Thcrm温度浅感觉仪法测定,触觉采用尼龙丝(Semmes-weinstein)单丝法测定;腱反射检测采用多伦多临床神经病变评分;检测两组血清Hcy和Cys-C水平。结果:治疗组治疗后中医临床症状各项目评分均显著低于对照组(P<0.01);治疗组有效率为90.70%,优于对照组的69.77%,两组比较,差异有统计学意义(P<0.05);治疗组治疗后患者正中神经SNCV和MNCV传导速度显著高于对照组(P<0.01);治疗组治疗后患者血清Hcy和Cys-C水平均明显低于对照组(P<0.01)。结论:芍药甘草汤合四物汤加减治疗DPN阴虚血瘀证可明显改善患者临床症状和神经传导速度,提高临床治疗效果,降低血清Hcy和Cys-C水平。

Objective：To observe clinical effect of of combined Chinese and western medicine in treating diabetes peripheral neuropathy （DPN）and its influences on levels of serum homocycteine（Hcy）and cystatin C（Cys-C）. Methods：86 patients with DPN in neurology of our hospital were randomly divided into treatment group and control group of 43 patients each according to the random number table. Patients in both groups received basic treatment by reference to TCM Diagnostic Criteria of Diabetes. Patients in control group received thioctic acid injection through an intravenous drip with 500mg per time and qd. Based on the treatment of control group,patients in treatment group were given Shaoyao Gancao Tang and Siwu Tang with one bag a day,boiled two times internally. Both groups received 4-weeks period of treatment. Scores of TCM clinic symptom and nerve conduction velocity in two groups were compared. Thermal sensation in two groups was evaluated by the Tip Thcrm Temperature shallow feeling instrument. Touch in both groups was observed by Semmes-weinstein one nylon method. Tendon reflexes were detected by Toronto clinical scoring system（TCSS）. Levels of serum Hcy and Cys-C were detected between two groups. Results：After treatment,project scores of TCM clinic symptom were evidently lower than contol group with significant differences（P ﹤ 0. 01）. The total effective rate in the treatment group was 90. 70% superior to 69. 77% in the control group（P ﹤ 0. 05）. After treatment,SNCV and MNCV of median nerve for patients in treatment groups were higher than those of control with significant differences（P ﹤ 0. 01）. After treatment,levels of serum Hcy and Cys-C were evidently lower in treatment group with sig- nificant differences（P ﹤ 0. 01）. Conclusion：Shaoyao Gancao Tang and Siwu Tang in treating DPN of Yin deficiency and blood stasis syndrome can evidently improve clinical symptoms,nerve conduction velocity and improve clinical curative effect,and reduce levels of serum Hcy and Cys-C.