硫辛酸联合葡萄糖酸钙及硫酸镁对恶性肿瘤化疗所致的周围神经病变的疗效观察

Clinical Observation of Lipoic Acid Combined with Calcium Gluconate and Magnesium Sulfate in the Treatment of Malignant Tumor Chemotherapy-induced Peripheral Neuropathy

目的探讨硫辛酸联合葡萄糖酸钙/硫酸镁对恶性肿瘤化疗药物所致周围神经病变(CIPN)的治疗效果。方法将179例接受化疗并明确诊断为CIPN的恶性肿瘤患者随机分为对照组(90例)和研究组(89例),对照组患者给予葡萄糖酸钙10 ml和25%硫酸镁10 ml注入5%葡萄糖溶液静脉滴注;研究组患者在对照组治疗的基础上加用α-硫辛酸注射液600 mg入0.9%氯化钠注射液静脉滴注。2组均治疗24天,观察2组患者治疗前后正中神经和腓总神经的传导速度,采用视觉模拟评分(VAS)评价治疗前后疼痛情况,并评估治疗效果和不良反应。结果研究组和对照组治疗后正中神经和腓总神经的传导速度均较治疗前有不同程度的提高(P<0.05、P<0.01),但研究组较对照组神经传导速度提高更显著(P<0.05)。研究组治疗后VAS评分较治疗前显著下降(P<0.05),而对照组治疗前后VAS评分无显著差异(P>0.05)。治疗24天后,研究组治疗总有效率为95.51%(85/89),显著高于对照组的83.33%(75/90)(P<0.05)。2组不良反应发生率无显著差异(12.36%vs 8.89%,P>0.05),均无严重不良反应发生。结论硫辛酸联合葡萄糖酸钙及硫酸镁能够加快恶性肿瘤CIPN患者感觉及运动神经的传导速度,改善患者的临床症状和体征,具有协同作用,且用药安全,值得临床应用。

Objective To explore the therapeutic effect of lipoic acid combined with calcium gluconate and magnesium sulfate for malignant tumor chemotherapy-induced peripheral neuropathy( CIPN). Methods A total of 179 patients with malignant tumor who underwent chemotherapy and diagnosed as CIPN were randomly divided into the control group( n = 90) and the study group( n = 89). The control group received intravenous infusion with calcium gluconate 10 ml and 25% magnesium sulfate10 ml added in 5% glucose solution; and besides the above treatment,the study group were additionally administrated with α-lipoic acid 600 mg added in 0. 9% sodium chloride,all patients were treated for 24 days,and the nerve conducting velocity( NCV) of median nerve and common peroneal nerve before and after treatment in the 2 groups were observed and compared,the pain degree before and after treatment were evaluated by visual analysis score( VAS),and then the therapeutic effect and adverse reactions of the 2 groups were also evaluated. Results The NCV of median nerve and common peroneal nerve were both improved compared with those before the treatment in the 2 groups( P < 0. 05,P < 0. 01),but the study group showed a more significant improvement( P < 0. 05); VAS scores after treatment statistically decreased than that before the treatment in the study group( P < 0. 05),but there had no difference in VAS scores before and after treatment in the control group( P > 0. 05). After treating for 30 days,the effective rate of the study group [95. 51%( 85 /89) ]was higher than that of the control group[83. 33%( 75 /90) ]( P < 0. 05);there had no difference in adverse drug reaction rate between the 2 groups( 12. 36% vs 8. 89%,P > 0. 05),and no severe adverse reactions occurred in all patients. Conclusion Lipoic acid combined with calcium gluconate and magnesium sulfate can speed up the NCV of sensory nerve and motor nerve in CIPN patients,and improve the clinical symptoms and signs with synergistic effect and medication safety,and it is worthy of application in clinic.