中西医结合治疗阳虚寒凝型糖尿病远端对称性多发性神经病变40例临床观察

Clinical Observation on 40 Cases of Integrated Chinese and Western Medicine for Diabetic Distal Symmetrical Polyneuropathy with Yang Deficiency and Cold Coagulation Syndrome

目的:观察阳和四逆汤联合甲钴胺治疗阳虚寒凝型糖尿病远端对称性多发性神经病变(DSPN)的临床疗效。方法:选取80例DSPN患者按随机数字表分为对照组和治疗组各40例。两组均采用胰岛素降糖治疗方案,对照组给予甲钴胺序贯治疗;治疗组在对照组基础上加用阳和四逆汤。4周后,观察两组临床症状评分、血浆同型半胱氨酸(Hcy)水平、胫前及腓总神经神经传导速度变化情况,比较两组总体临床疗效。结果:治疗后,两组临床症状评分及血浆Hcy水平较治疗前均有下降,神经传导速度较治疗前提高(P<0.05),且治疗组疗效优于对照组(P<0.05),综合临床疗效,治疗组总有效率为72.5%,对照组为47.5%,治疗组优于对照组(P<0.05)。结论:阳和四逆汤联合甲钴胺治疗DSPN阳虚寒凝证,能明显改善患者临床症状,提高神经传导速度和降低血浆Hcy水平,疗效优于单纯西药治疗。

Objective To observe the clinical effect of Yanghe Sini decoction combined with mecobalamin on diabetic distal symmetric polyneuropathy(DSPN)with yang deficiency and cold coagulation syndrome.Methods 80 DSPN patients were randomly divided into control group and treatment group with 40 cases in each group.Both groups were treated with insulin hypoglycemic therapy.The control group was treated with mecobalamin in sequence.The treatment group was additionally treated with Yang and Sini Decoction,on the basis of the control group.After 4 weeks of treatment,the overall clinical efficacy of the two groups of patients was determined,and the clinical symptom scores,plasma homocysteine(Hcy)level and the changes of nerve conduction velocity of anterior tibial and common peroneal nerves in the two groups were compared.Results After treatment,the clinical symptom score and plasma Hcy level of the two groups of patients decreased compared with before treatment,and nerve conduction velocity increased compared with before treatment(P<0.05),and the curative effect of the treatment group was better than that of the control group(P<0.05).Comprehensive clinical curative effect,the total effective rate of the treatment group was 72.5%,that of the control group was 47.5%,and that of the treatment group was better than that of the control group(P<0.05).Conclusion Yanghe Sini Decoction combined with mecobalamin in the treatment of DSPN yang deficiency and cold coagulation syndrome can obviously improve the clinical symptoms of patients,increase nerve conduction velocity and reduce plasma Hcy level.The curative effect is better than that of western medicine alone.