三仁汤联合常规疗法对糖尿病周围神经病变的临床疗效及血清胰岛素样生长因子-1、肿瘤坏死因子-α水平的影响

The clinical efficacy of Sanren decoction combined with conventional therapy in the treatment of diabetic peripheral neuropathy and its influences on the serum insulin-like growth factor-1 and tumor necrosis factor-αlevels

目的分析三仁汤联合常规疗法治疗糖尿病周围神经病变(DPN)的临床疗效及对病人血清胰岛素样生长因子-1(IGF-1)、肿瘤坏死因子-α(TNF-α)水平的影响。方法选取2018年6月至2020年12月广东省中医院收治的DPN病人76例,按随机数字表法分成对照组(n=38,予常规疗法)与研究组(n=38,予三仁汤联合常规疗法)。经4周治疗后,评价两组临床疗效、中医症候积分,对比血清IGF-1水平、血清TNF-α水平、空腹血糖、餐后2 h血糖(2hPG)、糖化血红蛋白(HbA1c)、胰岛素抵抗指数(HOMA-IR)、神经传导速度。结果研究组总有效率89.47%高于对照组71.05%(P<0.05);治疗后,两组中医症候积分[(20.45±4.11)分、(16.22±3.48)分]均低于治疗前[(24.78±2.59)分、(23.93±2.62)分](P<0.05),且研究组中医症候积分均低于对照组(P<0.05);治疗后,两组血清IGF-1水平[(165.69±10.86)μg/L、(182.85±8.49)μg/L]均高于治疗前[(153.35±13.42)μg/L、(155.54±14.17)μg/L](P<0.05),血清TNF-α水平[(3.58±0.27)μg/L、(3.14±0.35)μg/L]均低于治疗前[(3.92±0.38)μg/L、(3.87±0.44)μg/L](P<0.05),且研究组血清IGF-1水平高于对照组(P<0.05),血清TNF-α水平低于对照组(P<0.05);治疗后,两组空腹血糖[(7.14±0.23)mmol/L、(6.02±0.15)mmol/L]、2hPG[(9.34±0.32)mmol/L、(7.63±0.19)mmol/L]、HbA1c[(7.02±0.23)%、(5.99±0.14)%]、HOMA-IR[(6.46±1.87)、(5.53±1.62)]均低于治疗前[(9.06±0.27)mmol/L、(8.98±0.24)mmol/L、(11.95±0.38)mmol/L、(12.07±0.42)mmol/L、(8.45±0.18)%、(8.51±0.15)%、(8.57±2.68)、(8.73±2.59)](P<0.05),且研究组空腹血糖、2hPG、HbA1c、HOMA-IR均低于对照组(P<0.05);治疗后,研究组腓总神经、胫后神经、正中神经的神经传导速度均高于治疗前(P<0.05),且均高于对照组(P<0.05)。结论三仁汤联合常规治疗DPN具有显著的临床疗效,能减轻病人中医临床症状,调节血清IGF-1、TNF-α水平,改善糖代谢与胰岛素抵抗,提高神经传导速度。

Objective To analyze the clinical efficacy of Sanren decoction combined with conventional therapy in the treatment of diabetic peripheral neuropathy(DPN)and the influences on serum insulin-like growth factor-1(IGF-1)and tumor necrosis factor-α(TNF-α)levels.Methods A total of 76 DPN patients admitted to Guangdong Provincial Hospital of Chinese Medicine from June 2018 to December 2020 were selected and divided into the control group(n=38,given conventional therapy)and the study group(n=38,giv⁃en Sanren decoction combined with conventional therapy)according to the random number table method.After 4 weeks of treatment,the clinical efficacy and TCM syndrome scores of the two groups was evaluated,and the serum IGF-1 level,serum TNF-α level,fasting blood glucose,postprandial 2 h blood glucose(2hPG),glycosylated hemoglobin(HbA1c),insulin resistance index(HOMA-IR),and nerve conduction velocity were compared.Results The total effective rate of the study group was 89.47%,higher than that of the con⁃trol group 71.05%(P<0.05);After treatment,the TCM syndrome scores(20.45±4.11,16.22±3.48)of the two groups were lower than those before treatment(24.78±2.59)(23.93±2.62)(P<0.05),and The scores of TCM syndromes in the study group were lower than those in the control group(P<0.05);After treatment,the serum IGF-1 level[(165.69±10.86)μg/L,(182.85±8.49)μg/L]in the two groups was higher than before treatment[(153.35±13.42)μg/L,(155.54±14.17μg/L](P<0.05),the serum TNF-αlevel[(3.58±0.27)μg/L,(3.14±0.35)μg/L]was lower than before treatment[(3.92±0.38)μg/L,(3.87±0.44)μg/L](P<0.05),and serum IGF-1 level in the study group was higher than that in the control group(P<0.05),the serum TNF-αlevel was lower than that in the control group(P<0.05);After treat⁃ment,the fasting blood glucose[(7. 14±0.23)mmol/L,(6.02±0.15)mmol/L],2hPG[(9.34±0.32)mmol/L,(7.63±0.19)mmol/L],HbA1c[(7.02±0.23)%,(5.99±0.14)%],HOMA-IR[(6.46±1.87),(5.53±1.62)]in the two groups were lower than before treatment[(9.06±0.27)mmol/L,(8.98±0.24)mmol/L,(11.95±0.38)mmol/L,(12.07±0.42)mmol/L,(8.45±0.18)%,(8.51±0.15)%,(8.57±2.68),(8.73±2.59)](P<0.05),and fasting blood glucose,2hPG,HbA1c,HOMA-IR in the study group were lower than those in the control group(P<0.05);Af⁃ter treatment,the nerve conduction velocities of the common peroneal nerve,posterior tibial nerve,and median nerve in the study group were higher than before treatment(P<0.05),and all were higher than those in the control group(P<0.05).Conclusions Sanren decoc⁃tion combined with conventional treatment of DPN has a significant clinical effect.It can alleviate the clinical symptoms of patients with traditional Chinese medicine,regulate serum IGF-1 and TNF-αlevels,improve glucose metabolism and insulin resistance,and in⁃crease nerve conduction velocity.