α-硫辛酸联合前列地尔治疗糖尿病周围神经病变的疗效及机制

Curative effect and mechanism of alpha-lipoicacid combined with prostaglandin E1 in the treatment of diabetic peripheral neuropathy

目的探讨α-硫辛酸(ALA)联合前列地尔(PGE1)治疗糖尿病周围神经病变(DPN)的临床疗效、安全性及作用机制。方法选择2014-04—2015-04我院收治的67例DPN患者为研究对象,采用随机数字表法分为实验组(35例)和对照组(32例)。对照组给予常规血糖控制及PGE1治疗,实验组在此基础上另予ALA联合治疗。分别采用多伦多临床症状系统(TCSS)评分、神经病变自觉症状问卷(TSS)及视觉模拟评分法(visual analogue scale,VAS)评估患者治疗前后的临床症状、神经病变自觉症状及感觉程度,检测2组患者治疗前后血清中的氧化应激指标丙二醛(MDA)、超氧化物歧化酶(SOD)的水平,并比较不良反应发生情况。结果 (1)治疗后2组患者的TCSS评分、TSS评分,及疼痛、麻木、烧灼及感觉减退的VAS评分均低于治疗前,且实验组低于对照组(P<0.05);(2)与治疗前相比,2组患者治疗后的MDA水平明显下降,而SOD水平明显上升(P<0.05),2组比较,治疗前与治疗后MDA及SOD水平差异均无统计学意义(P>0.05);(3)2组患者均未出现严重不良反应。结论 ALA联合PGE1治疗DPN安全有效,能够明显改善患者的临床症状及氧化应激水平,值得临床推广应用。

Objective To explore the curative effect and mechanism of alpha-lipoicacid（ALA）combined with prostaglandin E1（PGE1）in the treatment of diabetic peripheral neuropathy（DPN）.Methods Six-seven cases with DPN in our hospital from April 2014 to April 2015 were selected as object,who were divided into experimental group（35cases）and control group（32cases）by random digital table method.The patients in control group were given conventional blood-sugar-control treatment and PGE1 therapy,while the experimental group received combined therapy of ALA and PGE1.Then Toronto clinical scoring system（TCSS）,neuropathy self-conscious symptom（TSS）,and visual analogue scale（VAS）were used to test clinical symptoms,self-feeling symptoms of nervous lesions and feeling degree before and after treatment.The levels of serum malondialdehyde（MDA）and superoxide dismutase（SOD）in the two groups were detected before and after treatment,and adverse events during treatment were compared.Results After treatment,the scores of TCSS,TSS and VAS scores referring to pain,numbness,burning and hypesthesia in both groups were significantly decreased（P〈0.05）,and the experimental group showed lower scores than control group（P〈0.05）.After treatment,the level of MDA were declined while the level of SOD were increased（P〈0.05）,but no significant differences were found between two groups（P〉0.05）.There were no serious adverse reactions in both groups.Conclusion The combined therapy of alpha-lipoicacid and alprostadil can exert an powerful effect on clinical symptoms and oxidative stress levels,with both safety and efficacy,which should be worthy of clinical application.