针刺治疗糖尿病患者肢体远端对称性多发性周围神经病变：随机对照研究

Acupuncture for distal symmetric multiple peripheral neuropathy of diabetes mellitus:a randomized controlled trial

目的:比较针刺与西药硫辛酸联合前列地尔静脉滴注治疗糖尿病患者肢体远端对称性多发性周围神经病变的临床疗效差异。方法:将60例患者随机分为针刺组(31例)和西药组(29例)。两组皆进行基础治疗,使血糖控制在合理范围内。在此基础上,针刺组予以针刺膈俞、胃脘下俞、肝俞、脾俞、肾俞、足三里、太溪、阿是穴等进行治疗;西药组采用硫辛酸0.6g、前列地尔10mg静脉滴注。两组均每日治疗1次,10d为一疗程,疗程间休息2d,连续治疗3个疗程。观察两组患者治疗前后糖尿病周围神经病变积分、神经传导速度的变化,并评定疗效。结果:治疗后两组糖尿病周围神经病变积分均较治疗前降低(均P<0.05),且针刺组优于西药组(P<0.05);治疗后两组正中神经、腓总神经各自感觉神经传导速度(SNCV)及运动神经传导速度(MNCV)均较治疗前提高(均P<0.05);两组间腓总神经SNCV及MNCV比较,针刺组优于西药组(均P<0.05);两组间正中神经MNCV比较,针刺组优于西药组(P<0.05);正中神经SNCV比较,差异无统计学意义(P>0.05);针刺组总有效率为83.9%(26/31),优于西药组的62.1%(18/29,P<0.05)。结论:针刺和常规西药方法治疗糖尿病患者肢体远端对称性多发性周围神经病变皆具有良好的疗效,针刺在改善患者感觉障碍、反射及肌力减弱等临床体征、提高患者神经的传导性及临床疗效方面优于西药组。

Objective To compare the clinical efficacy between acupuncture and intravenous administration of lipoic acid and alprostadil for distal symmetric multiple peripheral neuropathy of diabetes mellitus.Methods Sixty patients were randomly divided into an acupuncture group（31 cases）and a medication group（29 cases）.Patients in the two groups received basic treatment to control blood sugar within a safe range.On this basis,patients in the acupuncture group were treated with acupuncture at Geshu（BL 17）,Weiwanxiashu（EX-B 3）,Ganshu（BL 18）,Pishu（BL 20）,Shenshu（BL 23）,Zusanli（ST 36）,Taixi（KI 3）,ashi points,etc.Patients in the medication group were treated with intravenous administration of lipoic acid（0.6 g）and alprostadil（10 mg）.The treatment was given once a day,10 days for a course of treatment;there was an interval of 2 days between courses,and totally 3 courses were given.The score of peripheral neuropathy of diabetes mellitus,the change of nerve conduction velocity and clinical efficacy before and after treatment in the two groups were observed.Results After treatment,the score of peripheral neuropathy was significantly reduced in the two groups（both P〈0.05）,which was more significant in the acupuncture group（P〈0.05）.After treatment,the sensory nerve conduction velocity（SNCV）and motor nerve conduction velocity（MNCV）of median nerve and common peroneal nerve were significantly increased in the two groups（all P〈0.05）.Compared between two groups,the SNCV and MNCV of common peroneal nerve in the acupuncture group were significantly superior to those in the medication group（both P〈0.05）;the MNCV of median nerve in the acupuncture group was significantly superior to that in the medication group（P〈0.05）;the SNCV of median nerve in the acupuncture group was not significantly different from that in the medication group（P〈0.05）.The total effective rate was 83.9%（26/31）in the acupuncture group,which was significantly superior to 62.1%（18/29）in the medication group（P〈0.05）.Conclusion Acupuncture and conventional medication both have satisfied effects for distal symmetric multiple peripheral neuropathy of diabetes mellitus,and acupuncture is superior to medication on improving clinical signs of sensory disorder,reflection disturbance and muscle weakness,nerve conduction and clinical curative effect.