补中益气汤合血府逐瘀汤治疗1型糖尿病合并脑干脱髓鞘病变临床报道1例

Treating one case of type 1 diabetes mellitus plus brain stem demyelinating lesion with the Buzhong Yiqi decoction plus the Xuefu Zhuyu decoction

随着社会经济的发展和居民生活水平的提高,糖尿病的患病率逐年升高,成为威胁人民健康的重大社会问题。糖尿病患者如果不重视,又没有十分合理地控制血糖,随着病情的不断加重,后期就会引发一系列并发症,导致神经、肾、眼、足等衰竭病变,且在现有医疗条件下难以治愈。糖尿病继发周围神经病变、周围神经脱髓鞘、脊髓病已是临床常见病,但糖尿病并发脑干脱髓鞘病变还少见报道。湖北省宜昌市中医医院收治一例1型糖尿病合并脑干脱髓鞘病变的患者,该患者患有1型糖尿病史多年且血糖控制较差,使用糖皮质激素无疑会升高血糖,增加酮症酸中毒、高渗高血糖状态的风险,在这种情况下可以选择中药,运用补中益气汤合血府逐瘀汤治疗,即可有效改善临床症状,并有助于控制血糖和血脂水平,用药过程中避免了使用糖皮质激素带来的不良反应,经济方便。文章分享治疗案例经验,以期为临床提供进一步参考。

With the development of social economy and the improvement of residents’living standards,the prevalence of diabetes is increasing year by year,which has become a major social problem threatening people’s health.If diabetic patients do not pay attention to it and do not control their blood glucose very reasonably,with the continuous aggravation of the disease,a series of complications will occur,leading to nerve,kidney,eye,foot and other failure lesions,and they are difficult to cure.Diabetic peripheral neuropathy,diabetic peripheral nerve demyelination and diabetic myelopathy have been common clinical diseases,but diabetic cerebral stem demyelination is rarely reported.Our hospital admitted a patient with type 1 diabetes mellitus plus brainstem demyelinating lesions,the patient has a history of type 1 diabetes mellitus for many years and poor blood glucose control.Application of glucocorticoids will undoubtedly increase blood glucose,increase the risk of ketoacidosis,hyperosmolar hyperglycemia state.In this case,TCM medicine[the Buzhong Yiqi decoction(补中益气汤)and the Xuefu Zhuyu decoction(血府逐瘀汤)]was chosen,and has a achieved good curative effect.The treatment can effectively improve clinical symptoms,and help control blood glucose and blood lipid levels,avoiding the adverse reactions caused by the use of glucocorticoids,with economical and convenient.The case will be shared below for a clinical reference.