痛性糖尿病周围神经病变的药物治疗进展

Research progress of pharmacotherapy on painful diabetes peripheral neuropathy

痛性糖尿病周围神经病变(diabetes peripheral neuropathy,DPN)严重影响着患者寿命及其生活质量。该病确切发生机制尚不完全明确,故对治疗提出了很大挑战。目前积极控制高血糖以及对危险因素进行管理是预防和治疗痛性DPN的重要措施。除此之外,还有病因治疗和对症止痛治疗,后者主要包括全身用药的镇痛类药物、抗抑郁药、抗惊厥药以及中成药等。另外,药物的局部治疗也取得了较好的疗效。但是对于单药治疗后疼痛缓解不显著的患者,联合用药可明显减轻患者症状且安全性与单药相当。由于目前痛性DPN的治疗仍存在争议,治疗方案选择仍然存在着较大的个体化差异,因此对于痛性DPN的药物治疗应基于患者疼痛评估和药学评估多层面的研究结果。

Painful diabetes peripheral neuropathy(DPN) seriously affects the life span and quality of life.Because of not entirely clear exact mechanisms,therapy is faced with great challenges.At present,actively controlling hyperglycemia and managing risk factors are important measures for the prevention and treatment of DPN.In addition,etiological treatment and symptomatic analgesia treatment are popular,and the latter includes systemic analgesics,antidepressant,anticonvulsants,and Chinese traditional medicine,moreover,topical treatment of drugs also brings satisfactory therapeutic effects.However, pain relief is not significant in the patients with treatment by monotherapy,so drug combination can significantly relieve the patient′s symptoms,with comparative security to single drug.Because controversy exists in the treatment of painful DPN,and large individualized differences also appear in the treatment options,therefore,the therapy of painful DPN should be based on the multilayered results of patient pain assessment and pharmaceutical evaluation.