己酮可可碱联合甲钴胺治疗糖尿病周围神经病变的临床研究

Clinical study on pentoxifylline combined with mecobalamin in the treatment of diabetic peripheral neuropathy

目的探讨己酮可可碱联合甲钴胺治疗糖尿病周围神经病变患者的临床疗效及其机制。方法将2018年2月—2019年2月在河北省优抚医院治疗的90例2型糖尿病周围神经病变患者随机分为对照组和治疗组,每组45例。2组均给予常规饮食控制及运动疗法,并予以口服降糖药和/或胰岛素控制血糖在正常范围。在此基础上,对照组予以甲钴胺片口服,治疗组予以甲钴胺片联合己酮可可碱缓释片口服。观察2组治疗2个月后胫后神经、腓总神经、正中神经的运动传导速度(MCV)与感觉神经传导速度(SCV)及炎性因子[血清白细胞介素-6(IL-6)、基质金属蛋白酶(MMPs)、C反应蛋白(CRP)]、氧化应激指标[超氧化物歧化酶(SOD)、丙二醛(MDA)、总抗氧化能力(TAOC)]的变化。结果2组治疗2个月后胫后神经、腓总神经、正中神经的MCV与SCV均显著较治疗前加快(P均<0.05),且治疗组均明显快于对照组(P均<0.05)。与治疗前比较,2组治疗2个月后血清IL-6、MMPs、CRP、MDA水平均明显降低(P均<0.05),SOD、TAOC水平均明显升高(P均<0.05);治疗2个月后与对照组比较,治疗组血清IL-6、MMPs、CRP、MDA水平更低(P均<0.05),SOD、TAOC水平更高(P均<0.05)。结论己酮可可碱联合甲钴胺可明显加快糖尿病周围神经病变患者神经传导速度,修复周围神经,机制与减轻炎性反应及氧化应激反应有关。

Objective It is to explore the clinical efficacy and mechanism of pentoxifylline combined with mecobalamin in the treatment of diabetic peripheral neuropathy.Methods Ninety patients with type 2 diabetic peripheral neuropathy treated at Hebei Provincial Special Care Hospital from February 2018 to February 2019 were randomly divided into a control group and a treatment group,45 cases in each group.Both groups were given conventional diet control and exercise therapy,and oral hypoglycemic drugs and/or insulin were used to control blood glucose in the normal range.On the basis of above treatment,the control group was orally administered mecobalamin tablets,and the treatment group was orally administered mecobalamin tablets combined with pentoxifylline sustained-release tablets.The changes of the motor conduction velocity(MCV),sensory nerve conduction velocity(SCV)of posterior tibial nerve,commor peroneal nerve,median nerve,and inflammatory factors[serum interleukin-6(IL-6),matrix metalloproteinases(MMPs),C-reactive protein(CRP)],oxidative stress indicators[superoxide dismutase(SOD),malondialdehyde(MDA),total antioxidant capacity(TAOC)]before and after 2 months of treatment were observed in the two groups.Results After 2 months of treatment,MCV and SCV of posterior tibial nerve,commor peroneal nerve,median nerve of the two groups were significantly faster than those before treatment(P<0.05),and the indexes in the treatment group were significantly faster than the control group(P<0.05).Compared with before treatment,the levels of serum IL-6,MMPs,CRP,and MDA in the two groups were significantly reduced,and the levels of SOD and TAOC were significantly increased after 2 months of treatment(all P<0.05);the serum levels of IL-6,MMPs,CRP,and MDA were lower and the levels of SOD and TAOC were higher in the treatment group than those in the control group(P<0.05).Conclusion Pentoxifylline combined with mecobalamin can significantly accelerate nerve conduction and repair peripheral nerves in patients with diabetic peripheral neuropathy.The mechanism is related to reducing inflammatory and oxidative stress responses.