依帕司他联合α-硫辛酸治疗老年糖尿病周围神经病变的效果及对氧化应激反应的影响

Effect of epalrestat combined with α-thioctic acid in the treatment of diabetic peripheral neuropathy and its effect on oxidative stress response in senile patients

目的观察依帕司他联合α-硫辛酸治疗老年糖尿病周围神经病变(DPN)的临床效果及对机体氧化应激反应的影响。方法选择2016年5月至2017年8月广州中医药大学附属粤海医院内分泌科收治的240例老年DPN患者为研究对象,按照就诊先后顺序以随机数字表法将患者分为对照组和观察组,每组120例。2组患者均予以胰岛素皮下注射控制血糖;在此基础上,对照组患者给予依帕司他50 mg,口服,每日3次,疗程4周;观察组患者在对照组治疗基础上给予α-硫辛酸0.6 g,静脉滴注,每日1次,给药2周后改为硫辛酸胶囊600 mg,口服,每日1次,治疗2周。比较2组患者的治疗总有效率及治疗前和治疗4周后的多伦多临床评分系统(TCSS)评分、神经病变自觉症状问卷(TSS)评分,并比较2组患者治疗前、治疗4周后正中神经、腓总神经的运动神经传导速度(MCV)、感觉神经传导速度(SCV)和血清超氧化物歧化酶(SOD)、还原型谷胱甘肽(GSH)水平。结果治疗4周后,对照组和观察组患者的治疗总有效率分别为79.2%(95/120)、95.0%(114/120),观察组患者治疗总有效率显著高于对照组(χ~2=7.142,P<0.05)。2组患者治疗前TCSS和TSS评分、正中神经和腓总神经MCV、SCV及血清SOD、GSH水平比较差异均无统计学意义(P>0.05)。治疗4周后,2组患者TCSS和TSS评分较治疗前显著降低,正中神经和腓总神经MCV、SCV较治疗前显著增加,血清SOD、GSH水平较治疗前显著升高(P<0.05)。治疗4周后,观察组患者TCSS、TSS评分显著低于对照组(P<0.05),正中神经和腓总神经MCV显著高于对照组(P<0.05),腓总神经SCV显著高于对照组(P<0.05),血清SOD、GSH水平显著高于对照组(P<0.05)。结论依帕司他联合α-硫辛酸治疗老年DNP可显著增加神经传导速度,降低血清氧化应激反应水平,促进神经功能恢复。

Objective To observe the clinical effect of epalrestat combined withα-thioctic acid in the treatment of diabetic peripheral neuropathy(DPN)and its effect on oxidative stress response in senile patients.Methods A total of 240 senile patients with DPN admitted to Yuehai Hospital Affiliated to Guangdong University of Chinese Medicine from May 2016 to August 2017 were selected as the research objects,and the patients were divided into observation group and control group according to the order of visits,120 cases in each group.The patients in the two groups were given insulin injection by subcutaneous injection to control blood sugar.The patients in the control group were treated with epalrestat 50 mg orally,three times a day for 4 weeks.On the basis of the treatment in the control group,the patients in the observation group were treated withα-thioctic acid 0.6 g by intravenous drip,once a day;two weeks after administration,the patients were treated with thioctic acid capsule 600 mg orally,once a day for 2 weeks.The total effective rate,the Toronto clinical scoring system(TCSS)score and the total symptoms scales(TSS)score of neuropathy before and after 4 weeks of treatment were compared between the two groups.The motor conduction velocity(MCV),sensory conduction velocity(SCV)of median nerve and common peroneal nerve,and the levels of serum superoxide dismutase(SOD)and reduced glutathione hormone(GSH)were compared between the two groups before and after 4 weeks of treatment.Results After 4 weeks of treatment,the total effective rate in the control group and the observation group was 79.2%(95/120)and 95.0%(114/120),respectively.The total effective rate in the observation group was significantly higher than that in the control group(χ~2=7.142,P<0.05).There was no significant difference in TCSS score,TSS score,MCV and SCV of median nerve and common peroneal nerve,the levels of serum SOD and GSH between the two groups before treatment(P>0.05).Compared with before treatment,the TCSS score and TSS score decreased significantly,the MCV and SCV of median nerve and common peroneal nerve increased significantly,and the levels of serum SOD and GSH increased significantly in the two groups after 4 weeks of treatment(P<0.05).Compared with the control group,the TCSS score and TSS score decreased significantly(P<0.05),while the MCV of median nerve and common peroneal nerve,the SCV of common peroneal nerve and the levels of serum SOD and GSH increased significantly after 4 weeks of treatment in the observation group(P<0.05).Conclusion Epalrestat combined withα-thioctic acid can significantly increase nerve conduction velocity,reduce serum oxidative stress response,and promote the recovery of nerve function in senile patients with DPN.