芍药甘草汤合四物汤加减结合西医常规疗法治疗糖尿病周围神经病变临床研究

Clinical study ofShaoyao-Gancao decoction combined withSiwu decoction for the treatment of diabetic peripheral neuropathy

目的：评价芍药甘草汤合四物汤加减结合西医常规疗法治疗DPN的临床疗效。方法将符合入选标准的76例DPN患者按随机数字表法分为2组，每组38例。对照组在常规治疗基础上配合谷维素注射液治疗，观察组在对照组基础上加用芍药甘草汤合四物汤加减治疗。2组均治疗1个月。分别于治疗前后检测患者FPG、2 hPG、HbAlc、TC、TG、LDL-C、HDL-C水平，采用LBY-N6A自清洗旋转式黏度计检测全血黏度及血浆黏度，采用温氏分血管法检测红细胞压积，采用比浊法检测血小板聚集率，采用肌电仪检测胫神经和腓总神经的神经传导速度（nerve conduction velocity, NCV），评价临床疗效。结果观察组总有效率为89.5%（34/38）、对照组为71.1%（27/38），2组总有效率比较差异有统计学意义（χ2＝4.070，P＝0.044）。治疗后，观察组FPG[（6.12±0.38）mmol/L比（6.58±0.52）mmol/L，t＝4.403]、2 hPBG[（7.83±0.82）mmol/L比（8.41±0.93）mmol/L，t＝2.884]、HbAlc[（6.27±0.52）%比（6.82±0.64）%， t＝4.112]水平低于对照组（P＜0.05）；观察组TC[（4.73±0.83）mmol/L比（5.11±0.64）mmol/L，t＝2.235]、TG[（1.83±0.35）mmol/L 比（2.03±0.41）mmol/L ， t＝2.287]及 LDL-C[（2.91±0.54）mmol/L 比（3.25±0.58）mmol/L，t＝2.645]水平低于对照组（P＜0.05），HDL-C[（1.47±0.33）mmol/L比（1.26±0.31）mmol/L， t＝-2.859]水平高于对照组（P＜0.05）；全血比黏度[（10.16±2.12）mPa？s比（11.33±2.51）mPa？s，t＝2.195]、血浆黏度[（1.24±0.25）mPa？s 比（1.62±0.37）mPa？s ， t＝5.246]、红细胞压积[（0.31±0.16）L/L 比（0.42±0.08）L/L，t＝3.791]及血小板聚集率[（50.21±8.03）%比（54.16±7.82）%，t＝2.172]均低于对照组（P＜0.05）。治疗后，观察组胫神经[（45.22±3.20）m/s 比（38.26±5.19）m/s ， t＝-7.037]与腓总神经[（43.22±6.34）m/s比（36.23±4.81）m/s，t＝-5.415]的NCV高于对照组（P＜0.05）。结论芍药甘草汤合四物汤加减结合西医常规疗法可有效改善DPN患者的血糖、血脂及血液流变学状态，提高胫神经和腓总神经的NCV，疗效优于常规西医疗法治疗。

ObjectiveTo explore clinical effect and safety ofShaoyao-Gancao decoction combined withSiwu decoction for the patients with diabetic peripheral neuropathy （DPN）.MethodsA total of 76 patients with DPN in our hospital from 2013 July to October 2015 were divided into control group and observation group by the random number method, 38 patients in each group. The control group were treated with conventional treatment combined with oryzanol injection, and the observation group were treated with Shaoyao-Gancaodecoction combined withSiwu decoction on the basis of control group. Both groups were treated for one month. The level of FPG, 2 hPG, HbAlc, TC, TG, LDL-C and HDL-C was detected respectively before and after treatment. The whole blood viscosity and plasma viscosity was detected with LBY-N6A self-cleaning＆nbsp;rotary viscosimeter. The red blood cells deposited and platelet aggregation rate were tested with Winchester points vascular method and turbidimetric method, respectively.The leg nerve and sural nerve of nerve conduction velocity （nerve conduction velocity, NCV） were determined with electromyography, at the same time the clinical curative effect was evaluted.ResultsTotal effect rate of observation group was 89.5% （34/38）, which was significantly higher than the control group 71.1% （27/38）, and the difference was statistically significant （χ2=4.070,P=0.044）; After treatment, the levels of FPG （6.12 ± 0.38 mmol/Lvs.6.58 ± 0.52 mmol/L, t=4.403）, 2 hPG （7.83 ± 0.82 mmol/Lvs. 8.41 ± 0.93 mmol/L,t=2.884）, HbAlc （6.27 ± 0.52%vs. 6.82 ± 0.64%, t=4.112） in the observation group were lower than those in the control group （P〈0.05）. The levels of TC （4.73 ± 0.83 mmol/L vs. 5.11 ± 0.64 mmol/L,t=52.235）, TG （1.83 ± 0.35 mmol/Lvs. 2.03 ± 0.41 mmol/L, t=2.287） and LDL-C （2.91 ± 0.54 mmol/Lvs. 3.25 ± 0.58 mmol/L,t=2.645） in the observation group were lower than those in the control group （P〈0.05）, and the HDL-C （1.47 ± 0.33 mmol/Lvs. 1.26 ± 0.31 mmol/L,t=-2.859） in the observation group was higher than than that in the control group（P〈0.05）. The level of whole blood specific viscosity （10.16 ± 2.12 mPa-svs. 11.33 ± 2.51 mPa-s,t=2.195）, plasma viscosity （1.24 ± 0.25 mPa-svs. 1.62 ± 0.37 mPa-s,t=5.246）, red blood cell volume （0.31 ± 0.16L/Lvs. 0.42 ± 0.08 L/L,t=3.791） and platelet aggregation rate （50.21% ± 8.03%vs. 54.16% ± 7.82%,t=2.172） in the observation group were significantly lower than those in control group （P〈0.05）. The tibial nerve velocity （45.22 ± 3.20 m/svs. 38.26 ± 5.19 m/s,t=-7.037） and the common nerve velocity （43.22 ± 6.34 m/svs. 36.23 ± 4.81,t=-5.415） in the observation group were as significantly higher than those in control group （P〈0.05）.ConclusionsThe Shaoyao-Gancaodecoction combined withSiwu decoction could improve the state of blood sugar, blood lipid and blood rheology of patients with DPN, and improve nerve transfer speed of leg nerve and sural nerve, the curative effect is better than conventional western medicine therapy alone.