平衡针结合柴胡疏肝散治疗糖尿病痛性周围神经病变的疗效及部分机制

Study on Effects of Balanced Acupuncture Combined with Chaihu Shugan Powder on Diabetic Painful Peripheral Neuropathy and Some Mechanisms

目的:探究平衡针结合柴胡疏肝散治疗糖尿病痛性周围神经病变(DPN)的临床效果,对其作用机制进行研究,以期精准治疗。方法:选取2013年1月至2017年1月北京市朝阳区中医医院收治符合纳入条件DPN患者102例作为研究对象,按照就诊顺序编号随机分为对照组和观察组,每组51例。对照组给予西医常规治疗,观察组加用平衡针结合柴胡疏肝散治疗,均治疗4周。观察2组治疗前、治疗后空腹血糖(FBG)、餐后2 h血糖(2 hPBG)、糖化血红蛋白(HbA1c)水平变化并比较;观察2组治疗前、治疗后正中神经、腓总神经、胫后神经的运动神经传导速度(MCV)、感觉神经传导速度(SCV)水平变化并比较;观察2组治疗前、治疗后血液流变学指标全血高切黏度(HSV)、全血低切黏度(LSV)、血浆黏度(PSV)、血细胞比容(Hct)、血小板聚集率变化并比较;观察治疗前、治疗后应激指标C反应蛋白(CRP)、内皮素-1(ET-1)、丙二醇(MDA)、超氧化物歧化酶(SOD)含量变化并比较;观察2组治疗前、治疗后白细胞(WBC)、丙氨酸转氨酶(ALT)、肌酐(Cr)、血红蛋白(Hb)、血小板(PLT)变化并比较。结果:治疗前2组FBG、2 hPBG、HbA1c比较,差异无统计学意义(P>0.05),治疗后2组FBG、2 hPBG、HbA1c较治疗前均显著下降,差异有统计学意义(P<0.05),治疗后观察组患者以上指标均显著低于对照组,差异有统计学意义(P<0.05)。治疗前2组正中神经、腓总神经、胫后神经MCV、SCV比较,差异无统计学意义(P>0.05),治疗后2组以上指标均较治疗前均显著升高(P<0.05),治疗后观察组以上指标均显著高于对照组,差异有统计学意义(P<0.05)。治疗前2组CRP、ET-1、MDA、SOD比较,差异无统计学意义(P>0.05),治疗后2组CRP、ET-1、MDA较治疗前均显著下降,SOD较治疗前均显著升高,差异有统计学意义(P<0.05),治疗后观察组CRP、ET-1、MDA显著低于对照组,SOD显著高于对照组,差异有统计学意义(P<0.05)。治疗前2组HSV、LSV、PSV、HCT、血小板聚集率比较,差异无统计学意义(P>0.05),治疗后2组以上指标较治疗前均显著下降,差异有统计学意义(P<0.05),治疗后观察组以上各指标均显著低于对照组,差异有统计学意义(P<0.05)。2组治疗前、治疗后在WBC、ALT、Cr、Hb、PLT上比较均无显著变化,差异无统计学意义(P>0.05)。结论:平衡针联合柴胡疏肝散能改善DPN患者血液流变学,抑制氧化应激反应,清除氧自由基,提高感觉和运动神经传导速度,从而改善临床症状,降低血糖,且安全性高。

Objective:To explore the clinical efficay of balanced acupuncture combined with Chaihu Shugan Powder on diabetic painful peripheral neuropathy(DPN),and to study its mechanism of action in order to precise treatment.Methods:A total of 102 patients with DPN who met the inclusion criteria were enrolled as research subjects in Chaoyang District Hospital of Traditional Chinese Medicine in Beijing from January 2013 to January 2017.They were randomly divided into control group(51 cases)and observation group(51 cases)according to their numbers of treating order.The control group was treated with routine western medicine,while the observation group was treated with routine western medicine plus balanced acupuncture combined with Chaihu Shugan Powder,both for 4 weeks.The changes of fasting blood glucose(FBG),postprandial blood glucose after 2 h(2 hPBG)and glycosylated hemoglobin(HbA1c)levels before and after the treatment were observed and compared between the 2 groups.The motor nerve conduction velocity(MCV)and sensory nerve conduction velocity(SCV)of median nerve,common peroneal nerve and posterior tibial nerve were observed and compared before and after the treatment between the 2 groups.The changes of hemorheological indexes such as whole blood high shear viscosity(HSV),whole blood low shear viscosity(LSV),plasma viscosity(PSV),hematocrit(HCT),platelet aggregation rate before and after the treatment were observed and compared between the 2 groups.The content changes of C-reactive proteinen(CRP),dothelin-1(ET-1),propylene glycol(MDA)and superoxide dismutase(SOD)were observed and compared before and after the treatment between the 2 groups.The changes of white blood cell(WBC),alanine transaminase(ALT),creatinine(Cr),hemoglobin(Hb)and platelet(PLT)were observed and compared before and after the treatment between the 2 groups.Results:1)There were comparable differences in the FBG,2 hPBG and HbA1c between the 2 groups before the treatment(P>0.05).After the treatment,the FBG,2 hPBG and HbA1c in the 2 groups were decreased significantly compared with those before the treatment(P<0.05).After the treatment,the above indexes in the observation group were significantly lower than those in the control group(P<0.05).2)The MCV and SCV of median nerve,common peroneal nerve,posterior tibial nerve in the 2 groups were comparable before the treatment(P>0.05).After the treatment,the above indexes of the 2 groups were significantly higher than those before the treatment(P<0.05).After the treatment,the above indexes of the observation group were significantly higher than those of the control group(P<0.05).3)There were comparable differences in the CRP,ET-1,MDA and SOD between the 2 groups before the treatment(P>0.05).After the treatment,the CRP,ET-1 and MDA in the 2 groups were decreased significantly compared with those before the treatment,while the SOD was increased significantly compared with those before the treatment(P<0.05).After the treatment,the CRP,ET-1 and MDA in the observation group were significantly lower than those in the control group,and SOD was significantly higher than that in the control group(P<0.05).4)There were comparable differences in the HSV,LSV,PSV,HCT and platelet aggregation rate between the 2 groups before the treatment(P>0.05).After the treatment,the above indexes of the 2 groups were significantly lower than those of the control group(P<0.05).After the treatment,the above indexes of the observation group were significantly lower than those of the control group(P<0.05).5)There was no significant change in the WBC,ALT,Cr,Hb and PLT between the 2 groups before and after the treatment,without statistically significant difference(P>0.05).Conclusion:Balanced acupuncture combined with Chaihu Shugan Powder can improve hemorheology,inhibit oxidative stress reaction,scavenge oxygen free radicals,and increase sensory and motor nerve conduction velocity in DPN patients,thereby improving clinical symptoms and reducing blood sugar,with high safety.