中医药治疗糖尿病性神经源性膀胱研究进展

Research Progress on Treating Neurogenic Bladder of Diabetes with Traditional Chinese Medicine

糖尿病性神经源性膀胱(DNB)是一种由高血糖引起的自主神经受损导致的异常排尿反应和膀胱功能障碍的统称,多见于糖尿病病史15年以上的患者。近年来,中医药被广泛应用于DNB的治疗,其临床疗效显著,不良反应较小,且能够避免外科手术创伤,减少并发症的危害,提高患者的生活质量。对DNB的发病机制、病因病机及中医药治疗研究进展进行综述,西医对其发病机制尚未完全阐明,现认为可能与糖代谢改变、神经传导通路障碍、逼尿肌细胞损伤、氧化应激损伤、尿路上皮的改变及尿道的形态和功能改变等有关。中医则认为DNB病位主要位于肾和膀胱,与肺、脾、肝、心、小肠、三焦关系密切。中医药治疗方面多采用著名医家的独到疗法,结合针灸、穴位贴敷、中药封包、循经走罐、滚珠式手足按摩、耳穴贴压、穴位注射、低频脉冲及推拿等外治方式,内外合治,临床疗效突出。参考文献41篇。

Diabetic neuropathic bladder(DNB)is a condition characterized by abnormal urination reactions and bladder dysfunction caused by autonomic nerve damage due to high blood glucose level.It is common in patients with a history of diabetes for more than 15 years.In recent years,traditional Chinese medicine(TCM)has been widely used in the treatment of DNB due to its significant clinical efficacy,minimal adverse reactions,avoidance of surgical trauma,reduction of complications,and improvement in patients’quality of life.This article reviews the pathogenesis,etiology,and progress of TCM treatment for DNB.Western medicine has not fully elucidated its pathogenesis which is currently thought to be related to altered glucose metabolism,blocked neural conduction pathways,damage to detrusor cells,oxidative stress damage,changes in the urothelium,and morphological and functional changes in the urethra.According to TCM,DNB is primarily located in the kidneys and bladder,closely related to lungs,spleen,liver,heart,small intestine,and triple energizer.TCM treatment often involves unique therapies from various renowned medical experts,combined with external treatments such as acupuncture,moxibustion,acupoint application,Chi⁃nese medicinals sealing,cupping along meridians,rolling bead hand and foot tuina,ear acupressure applica⁃tion,acupoint injection,low-frequency pulse,and tuina.The combined internal and external treatment has dem⁃onstrated prominent clinical efficacy.Forty-one references were cited.