木丹颗粒治疗糖尿病周围神经病变患者的疗效及对其血清氧化应激、炎症因子及疼痛物质水平的影响

The Curative Effect of Mudan Granule in the Treatment of Diabetic Peripheral Neuropathy and Its Influence on Serum Oxidative Stress,Inflammatory Factors and Pain Substance Levels

目的观察分析木丹颗粒在糖尿病周围神经病变(Diabetic peripheral neuropathy,DPN)患者中的应用价值。方法选取2018年8月—2020年8月期间南京市江宁医院内分泌科门诊收治的96例气虚络阻证DPN患者作为研究对象,采用随机数字表法将患者分为对照组和观察组,每组各48例。对照组予以常规治疗,观察组在对照组基础上加用木丹颗粒。观察两组患者治疗前后炎症因子[超敏C反应蛋白(High sensitive C-reactive protein,hs-CRP)、NOD样受体蛋白-3(NOD-like receptor thermal protein domain associated protein 3,NLRP3)、白细胞介素1β(Interleukin-1β,IL-1β)、白细胞介素18(Interleukin-18,IL-18)],氧化应激指标[丙二醛(Malondialdehyde,MDA)、超氧化物歧化酶(Superoxide dismutase,SOD)、总抗氧化能力(Total antioxidant capacity,T-AOC)],疼痛物质[β内啡肽(β-endorphin,β-EP)、五羟色胺(5-hydroxytryptophan,5-HT)]、神经传导功能[腓总神经和胫神经的感觉神经传导速度(Sensory nerve conduction velocity,SCV)、运动神经传导速度(Motor nerve conduction velocity,MCV)]、中医证候积分和血糖指标[空腹血糖(Fasting plasma glucose,FPG)、餐后2 h血糖(2 h PG)、糖化血红蛋白(Glycated hemoglobin glycosylated hemoglobin,HbA1c)]水平,评估疗效及安全性。结果治疗后两组患者hs-CRP、NLRP3、IL-1β、IL-18水平均较治疗前降低(P<0.05);且观察组炎症因子水平较对照组明显降低(P<0.05)。治疗后两组患者MDA、T-AOC均较治疗前降低,SOD较治疗前提高(P<0.05);且观察组血清氧化指标较对照组改善更明显(P<0.05)。治疗后两组患者β-EP水平较治疗前提高,5-HT水平较治疗前降低(P<0.05);且观察组疼痛物质较对照组改善更明显(P<0.05)。治疗后两组患者腓总神经及胫神经MCV、SCV指标均较治疗前升高(P<0.05);且观察组神经传导功能指标较对照组明显提高(P<0.05)。治疗后观察组各项中医证候积分均较治疗前减少(P<0.05);且观察组各项评分明显低于对照组(P<0.05)。治疗后两组患者血糖指标均较治疗前明显降低(P<0.05)。治疗后观察组总有效率为95.83%(46/48),明显高于对照组81.25%(39/48)(P<0.05)。两组患者不良反应发生率比较,差异无统计学意义(P>0.05)。结论木丹颗粒治疗DPN能改善患者氧化应激指标,减轻炎症反应,降低止痛物质水平,改善神经传导功能和临床症状,疗效显著,且不良反应小。

Objective To observe and analyze the application value of Mudan granules in patients with diabetic peripheral neuropathy(DPN).Method 96 cases of DPN patients with Qi deficiency and collateral block syndrome diagnosed and treated in the Department of Endocrinology of Nanjing Jiangning Hospital from August 2018 to August 2020 were selected as the research object.The patients were divided into a control group and an observation group by a random number table method,each group 48 cases each.The control group received conventional treatment,and the observation group received Mudan granules on the basis of the control group.The inflammatory factors[hypersensitive C-reactive protein(hs-CRP),NOD-like receptor protein-3(NLRP3),interleukin 1β(IL-1β),interleukin 18(IL-18)before medicationand 12 weeks after medication],oxidative stress indicators[malondialdehyde(MDA),superoxide dismutase(SOD),total antioxidant capacity(T-AOC)],pain substances[β-endorphin(β-EP),serotonin(5-HT)],nerve conduction function[sensory nerve conduction velocity(SCV)of common peroneal nerve and tibial nerve,motor nerve conduction velocity(MCV)],TCM syndrome score[fatigue,limb pain,numbness of limbs,easy eating Hunger]and blood glucose indicators[fasting blood glucose(FPG),2 h postprandial blood glucose(2 h PG),glycosylated hemoglobin(HbA1 c)]changes were compared before and after treatment to evaluate efficacy and safety.Result After treatment,the levels of hs-CRP,NLRP3,IL-1β,and IL-18 in the two groups were lower than before treatment(P<0.05).The levels of inflammatory factors in the observation group were significantly lower than those in the control group(P<0.05).After treatment,MDA and T-AOC of the two groups of patients were lower than before treatment,and SOD was higher than before treatment(P<0.05);and the serum oxidation index of the observation group improved more significantly than that of the control group(P<0.05).After treatment,theβ-EP level of the two groups of patients was higher than that before the treatment,and the 5-HT level was lower than that before the treatment(P<0.05);and the pain substances in the observation group improved more significantly than the control group(P<0.05).After treatment,the MCV and SCV indexes of the common peroneal nerve and tibial nerve of the two groups of patients were higher than before treatment(P<0.05);and the nerve conduction function indexes of the observation group were significantly higher than those of the control group(P<0.05).After treatment,the scores of various TCM syndromes in the observation group were reduced compared with those before treatment(P<0.05);and the scores of the observation group were significantly lower than those of the control group(P<0.05).After treatment,the blood glucose indexes of the two groups were significantly lower than before treatment(P<0.05).After treatment,the total effective rate of the observation group was 95.83%(46/48),which was significantly higher than that of the control group 81.25%(39/48)(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups of patients(P>0.05).Conclusion The treatment of DPN with Mudan granules can improve patients′oxidative stress indicators,reduce inflammation,reduce the level of analgesic substances,improve nerve conduction function and clinical symptoms.The effect is significant and the adverse reactions are small.