补阳还五汤合增液汤加减对糖尿病周围神经病变神经功能和氧化应激反应的影响

Effect of Buyanghuanwu Decoction Combined with Zengye Decoction on Nerve Function and Oxidative Stress of Diabetic Peripheral Neuropathy

目的：观察补阳还五汤合增液汤加减治疗糖尿病周围神经病变的临床疗效及其对氧化应激的影响。方法：将120例患者随机按数字表法分为观察组和对照组各60例。对照组,甲钴胺片,每次0.5 mg,每天3次;胰激肽原酶肠溶片,空腹服用,每次240 U,每日3次。观察组在对照组基础上加用补阳还五汤合增液汤加减内服。两组疗程均为8周。治疗前后进行多伦多临床神经病变评分和中医证候评分;检测治疗前后正中神经、腓总神经的运动神经传导速度（motor nerve conduction velocity,MNCV）及感觉神经传导速度（sensory nerve conduction velocity,SNCV）的变化,检测治疗前后血清丙二醛、NO、总抗氧化能力（total antioxidant capacity,TAOC）、超氧化物歧化酶（superoxide dismutase,SOD）和还原型谷胱甘肽（reduced glutathione,GSH）水平;进行安全性评价。结果：观察组临床有效率为96.67%,优于对照组的85.00%（χ~2=4.904,P〈0.05）;治疗后观察组神经症状评分、神经反射评分及感觉功能检查评分均低于对照组（P〈0.01）;治疗后观察组中医证候评分低于对照组（P〈0.01）;治疗后观察组正中神经和腓总神经的MNCV和SNCV均快于对照组（P〈0.01）;治疗后观察组TAOC、GSH和SOD水平高于对照组（P〈0.01）,丙二醛水平低于对照组（P〈0.01）;观察组未发现明显不良反应。结论：补阳还五汤合增液汤加减治疗糖尿病周围神经病变临床疗效显著,能减轻症状,促进神经功能恢复,临床疗效优于单纯西医治疗,其作用机制可能与减轻氧化应激损伤有关。

Objective： To observe the clinical efficacy of Buyanghuanwu Decoction Combined with Zengye Decoction on nerve function and oxidative stress in treatment of diabetic peripheral neuropathy. Methods： 120 patients were randomly divided into observation groupand control group,with 60 cases in each group. The control group was treataed with methylcobalamin tablets,0. 5mg,3times a day,and pancreatic kallikrein enteric-coated tablets,with empty stomach,each 240 U,3 times a day. Based on that of the control group,the observation group was also treated with Buyanghuanwu Decoction Combined with Zengye Decoction. The treatment lasted for 8 weeks. The Toronto clinical neuropathy scores and TCM syndrome scores of the two groups before and after treatment were recorded; Changes of the motor nerve conduction velocity（ MNCV）,sensory nerve conduction velocity（ SNCV）,serum MDA,NO,the total antioxidant capacity（ TAOC）,superoxide dismutase（ SOD） and reduced glutathione（ GSH） of the two groups were also be detected before and after treatment,and the safety evaluation were conducted later. Results： The clinical effective rate of the observation group was 96. 67% and that of the control group was 85. 00%,with the former being better（ χ~2=4. 904,P 〈0. 05）; after treatment,the observation group neurological symptoms score,score reflexes and sensory function test scores were lower than the control group（ P 〈0. 01）; After treatment,the TCM syndrome scores of observation group was better than that of the control group（ P 〈0. 01）; After treatment median nerve and the MNCV and SNCV of the observation group were faster than those of the control group（ P 〈0. 01）. After treatment TAOC,GSH and SOD levels of the observation group were higher than those of the control group（ P 〈0. 01）,while the MDA level was lower than that of the control group（ P 〈0. 01）; There was no significant adverse reaction in the observation group. Conclusion： Buyanghuanwu Decoction combined with Zengye Decoction can achieve significant clinical efficacy in treatment of diabetic peripheral neuropathy,by reducing symptoms and promoting recovery of neurological functions. The clinical efficacy is superior to that of western medicine,the mechanism of which may be related to the alleviation of the oxidative stress injury.