甲钴胺联合依帕司他对糖尿病性周围神经病变患者的血清炎症因子及电生理指标的影响

Effect of mecobalamin combined with epalrestat on serum inflammatory factors and electrophysiological indexes in the patients with diabetic peripheral neuropathy

目的探讨甲钴胺联合依帕司他对糖尿病性周围神经病变(DPN)患者血清炎症因子及电生理指标的影响。方法将84例DPN患者随机分为观察组和对照组。两组均予以糖尿病基础治疗,包括健康教育、严格饮食控制、适当体育锻炼及药物控制血糖。观察组予以甲钴胺片(0.5 mg/次,3次/d)联合依帕司他片(50 mg/次,3次/d)治疗,对照组予以单纯甲钴胺片(0.5 mg/次,3次/d)治疗,两组疗程均16周。观察两组治疗前后血清hs-CRP和TNF-α水平和神经电生理指标[正中神经及腓总神经运动支传导速度(MCV)与感觉支传导速度(SCV)]的变化,并比较其不良反应。结果治疗16周后,两组血清hs-CRP和TNF-α水平明显下降(P<0.05或P<0.01),观察组下降幅度更显著(P<0.05);同时两组正中神经、腓总神经MCV和SCV较前明显加快(P<0.05或P<0.01),观察组加快幅度更显著(P<0.05)。结论甲钴胺联合依帕司他治疗DPN的患者能明显改善其神经功能,加快周围神经传导速度,安全性较好,其机制可能与其能降低血清hs-CRP和TNF-α水平、抑制血管内皮炎症反应密切相关。

Objective To investigate the effect of mecobalamin combined with epalrestat on serum inflammatory factors and electrophysiologieal indexes in patients with diabetic peripheral neuropathy（DPN）. Methods 84 patients with DPN were randomly divided into observation group and control group. Both groups were given basic diabetes treatment, including health education, strict diet control, proper physical exercise and blood sugar control by drugs. The observation group was given mecobalamin tablets（0.5 mg/time, 3 times/d）combined with epalrestat tablets （50 mg/time, 3 times/d） for treatment. The control group was given mecobalamin tablets（0.5 mg/time, 3 times/d）alone. The course of treatment was 16 weeks for both groups. The changes of serum hs-CRP and TNF-α levels and the electrophysiological indexes [median nerve and common peroneal nerve motor branch conduction velocity（MCV） and sensory branch conduction velocity（SCV）] of two groups were observed before and after treatment, and their adverse reactions were compared. Results After 16 weeks of treatment, the levels of serum hs-CRP and TNF-α in the two groups were significantly decreased（P〈 0.05 or P〈0.01）, and the decrease degree in the observation group was more significant（P〈0.05）;at the same time, the MCV and SCV of the median nerve and the common peroneal nerve of the two groups were significantly faster than before（P〈0.05 or P〈0.01）, and the acceleration degree in the observation group was more significant（P〈0.05）. Con-lusion Meobalamin combined with epalrestat in patients with DPN can significantly improve their neurological function, speed up the peripheral nerve conduction velocity, and the safety is good. The mechanism may be closely related to its ability to reduce serum hs-CRP and TNF-α levels, and inhibit vascular endothelial inflammation.