糖尿病周围神经病变中医临床及实验研究近况

Traditional Chinese Medicine in Clinical Treatment of Diabetic Peripheral Neuropathy

糖尿病周围神经病变(diabetic peripheral neuropathy,DPN)是糖尿病最常见的慢性并发症,为微血管并发症之一,目前现代医学对其发病机制研究尚不明确,普遍认为高血糖诱发的氧化应激起到关键作用。现代医学对其治疗手段较多应用降糖、营养神经、改善微循环、抑制山梨醇生成、抗氧化等药物,取得了一定临床疗效,但对于顽固痛性神经病变,尚无有效方法,只能应用止痛药物对症处理。近年来,中医药对于本病的临床治疗取得了较大进展,对中医药的作用机制研究不断深入。本文检索了近10年的文献,从病因病机、辨证分型、专方专药、中医外治联合西药、针药结合、实验研究等多个方面进行归纳总结。研究发现,中医认为本病属"络病"范畴,目前主要采用益气养阴、温阳、活血化瘀、通络等治法,内外结合,具有多靶点起效的特点。但目前的研究多集中于某方或某药,观察指标以血糖,血脂,超氧化物歧化酶(SOD),丙二醛(MDA),神经传导速度为主,分子水平、细胞水平的指标较少。如何在中医理论指导下,结合现代科技手段,多个方面阐述中医药治疗DPN的作用机制及开展量效关系毒理研究,是目前急需解决的关键问题。

Diabetic peripheral neuropathy（ DPN） is the most common chronic complications of diabetes,and one of microvascular complications. Modern medical studies have not defined the pathogenesis,and generally believed that high blood sugar-induced oxidative stress plays a key role. Modern medicines for hypoglycemic,nutrition,improving microcirculation,inhibiting sorbitol production and resisting oxidation have showed a certain clinical curative effect. However,here is still no effective method to treat stubborn painful neuropathy,which could still be relieved with analgesic drugs. In recent years,traditional Chinese medicine（ TCM） has made great progress in clinical treatment of the disease,with further researches on the mechanism of action of TCM. Nearly 10 years of literatures were retrieved to summarize the etiology and pathogenesis,syndrome type differentiation, specially designed medicine, TCM combined with western medicine, combination of acupuncture with medicine and experimental researches. According to the studies,TCM believes that this disease belongs to a ‘collateral disease ＇,and mainly treated with therapies for tonifying Qi and Yin,warming Yang,promoting blood circulation to remove blood stasis,and dredging collaterals,and combination of internal and external treatment could show the multi-target effect. But the current researches mostly focused on a specific prescription or medicine,and paid more attention to observation indexes in blood sugar,blood fat,superoxide dismutase（ SOD）,malondialdehyde（ MDA）,and nerve conduction velocity than the molecular and cellular indexes. Therefore,how to define the mechanism of action of TCM in treatment of DPN and conduct concentrationresponse relationship and toxicology researches by using modern technologies under the guidance of TCM theory is a key problem to be solved.