Effect of cinepazide combined with mecobalamine on nerve conduction velocity, vibration perception threshold and serum indexes in patients with diabetic peripheral neuropathy

Objective:To analyze the effect of cinepazide combined with mecobalamine on nerve conduction velocity, vibration perception threshold and serum indexes in patients with diabetic peripheral neuropathy. Methods:90 patients with diabetic peripheral neuropathy treated in our hospital between March 2013 and March 2016 were selected and divided into observation group and control group (n=45) according to random number table, control group received mecobalamine treatment alone and observation group accepted the cinepazide combined with mecobalamine therapy. Differences in nerve conduction velocity, vibration perception threshold as well as serum oxidative stress indexes and nerve injury marker molecules were compared between two groups of patients 2 weeks after treatment. Results:2 weeks after treatment, median nerve, ulnar nerve and peroneal nerve sensory nerve conduction velocity (SNCV) and motor nerve conduction velocity (MNCV) levels of observation group were higher than those of control group (P<0.05) while both lower extremities vibration perception threshold (VPT) levels were lower than those of control group (P<0.05). Serum homocysteine (HCY), advanced glycosylation end products (AGEs), malondialdehyde (MDA), neuron-specific enolase (NSE), high mobility group B1 (HMGB1) and S100βcontent of observation group were lower than those of control group (P<0.05) while reduced glutathione (GSH), superoxide dismutase (SOD), myelin basic protein (MBP) and brain-derived neurotrophic factor (BDNF) content were higher than those of control group (P<0.05). Conclusions:Cinepazide combined with mecobalamine can reduce the nerve injury degree, improve nerve conduction and vibration perception and alleviate the oxidative stress degree in patients with diabetic peripheral neuropathy.

Effects of pestle needle on nerve conduction velocity and inflammatory injury in patients with diabetic peripheral neuropathy

Background:Diabetic peripheral neuropathy(DPN)is one of the most common complications of diabetes mellitus.Impaired neurological function is one of the main characteristics of DPN and is strongly associated with the inflammatory response.Our previous studies have confirmed that pestle needle can improve the nerve function of patients with DPN.But the mechanism of pestle needle treatment of DPN is still unclear.Methods:A total of 70 DPN patients who met the inclusion criteria were randomly divided into two groups.Control group(CG)(n=35)received DPN conventional treatment and the pestle needle group(PNG)(n=35)received pestle needle therapy at Zhiyang(DU09)eight array,Mingmen(DU04)eight array and Heche Road(from Mingmen(DU04)to Changqiang(DU01)),Zusanli(ST36),Sanyinjiao(SP06),Taixi(KI03)and Yongquan(KI01).Patients in the PNG group were required to take this treatment for 4 weeks,5 times a week.Examination indexes were collected before and after treatment,respectively.Nerve function was examined using the Toronto clinical scoring system and nerve conduction velocity detection.Serum inflammatory factors were measured by enzyme linked immunosorbent assay.Results:The Toronto clinical scoring system was significantly reduced in the PNG compared with the CG after treatment.The sensory nerve conduction velocity and motor nerve conduction velocity of the right peroneal and median nerves were significantly faster in the PNG than those in the CG(P<0.05).After treatment,serum interleukin-1 beta,interleukin-6 and tumor necrosis factor-alpha levels decreased in both groups,and the improvement of PNG was better than CG(P<0.05).Conclusion:The pestle needle can significantly improve the symptoms and nerve conduction velocity of DPN,and its mechanism may be related to the reduction of inflammatory factors.

Abnormality of peripheral nerve conduction velocity associated with illness course, symptoms and fasting blood glucose in patients with type 2 diabetes mellitus

BACKGROUND: It has shown that abnormality of peripheral nerve conduction velocity during onset of diabetes mellitus is not related to age and sex, but to symptoms, illness course and level of fasting blood glucose. OBJECTIVE: To measure correlation of abnormality of peripheral nerve conduction velocity with various illness courses, symptoms and levels of fasting blood glucose of patients with type 2 diabetes mellitus. DESIGN: Case analysis. SETTING: Department of Neurology, Central People's Hospital of Huizhou. PARTICIPANTS: A total of 128 patients who were diagnosed as type 2 diabetes mellitus were selected from Central People's Hospital of Huizhou from September 2001 to October 2005. There were 75 males and 53 females aged 32-83 years and the illness course ranged from 1 month to 20 years. METHODS: All 128 patients with type 2 diabetes mellitus received neuro-electrophysiological study and their clinical data were retrospectively analyzed to measure peripheral nerve conduction velocity and fasting blood glucose so as to investigate the correlation of peripheral nerve conduction velocity with clinical symptoms, illness course and levels of fasting blood glucose. MAIN OUTCOME MEASURES: Correlation of peripheral nerve conduction velocity with clinical symptoms, illness course and levels of fasting blood glucose. RESULTS: All 128 patients with type 2 diabetes mellitus were involved in the final analysis. ① Among 128 patients, 114 patients had abnormality of peripheral nerve conduction velocity; 110 patients had clinical symptoms, including 102 patients having abnormality of peripheral nerve conduction velocity; 18 patients did not have clinical symptoms, including 12 patients having abnormality of peripheral nerve conduction velocity. There were significant differences between them (χ 2=8.275, P =0.04). ② Among 128 patients, illness course of 75 patients was equal to or less than 5 years, including 27 patients having abnormality of peripheral nerve conduction velocity; illness course of 53 patients was more than 5 years, including 35 patients having abnormality of peripheral nerve conduction velocity. There were significant differences between them (χ 2=11.469, P =0.003). ③ Among 128 patients, levels of fasting blood glucose of 75 patients was equal to or lower than 11 mmol/L, including 41 patients having abnormality of peripheral nerve conduction velocity; levels of fasting blood glucose of 53 patients was higher than 11 mmol/L, including 38 patients having abnormality of peripheral nerve conduction velocity. There were significant differences between them (χ 2=4.023, P =0.134). CONCLUSION: ① Abnormality of peripheral nerve conduction velocity of patients with type 2 diabetes mellitus is related to illness courses and clinical symptoms. The longer the illness course is, the severer the abnormality of peripheral nerve conduction velocity is. Abnormality of peripheral nerve conduction velocity always occurs on patients who have clinical symptoms. ② Abnormality of peripheral nerve conduction velocity is not related to levels of fasting blood glucose.

探讨F波联合SSR和NCV在糖尿病周围神经病早期的诊断价值

目的探讨F波联合皮肤交感反应(SSR)和常规神经传导检测(NCV)对糖尿病周围神经病(DPN)早期的诊断价值。方法对324例2型糖尿病患者,根据有无周围神经症状分为无症状组(103例)、有症状组(221例)及同期对照组(100例),均行正中神经和胫神经F波,四肢感觉、运动神经传导检测(NCV)和SSR检查。分析比较组间F波、NCV和SSR指标的临床特点。结果糖尿病患者下肢运动、感觉神经损害程度重于上肢,且四肢感觉神经异常比例高于运动神经(P<0.05);对糖尿病有症状组、无症状组进行SSR和NCV联合检测,总异常率为90.1%,明显高于单独应用NCV异常率,差异有统计学意义(P<0.05)。与对照组比较,糖尿病(DM)有症状组上肢正中神经F波出现率减少,F波传导速度减慢,下肢胫神经F波出现率减少,F波潜伏期延长。无症状组仅上肢正中神经F波出现率减少。与DM无症状组比较,有症状组上肢正中神经F波传导速度减慢,下肢F波出现率减少,F波潜伏期延长(P<0.05),而上肢F波出现率差异无统计学意义(P>0.05)。对糖尿病组进行NCV、SSR和F波联合检测异常率为93.2%,明显高于单纯NCV检测(P<0.05)。结论糖尿病在早期无症状时即存在周围神经损害,以小纤维受累为主,F波、SSR联合NCV检测能有效弥补NCV不能反映自主神经小纤维和运动神经近端功能的不足,提高对DPN的早期诊断。

Efficacy and safety of nerve growth factor for the treatment of neurological diseases:a meta-analysis of 64 randomized controlled trials involving 6,297 patients

OBJECTIVE： China is the only country where nerve growth factor is approved for large-scale use as a clinical medicine. More than 10 years ago, in 2003, nerve growth factor injection was listed as a national drug. The goal of this article is to evaluate comprehensively the efficacy and safety of nerve growth factor for the treatment of neurological diseases. DATA RETRIEVAL： A computer-based retrieval was performed from six databases, including the Cochrane Library, PubMed, EMBASE, Sino Med, CNKI, and the VIP database, searching from the clinical establishment of nerve growth factor for treatment until December 31, 2013. The key words for the searches were ＂nerve growth factor, randomized controlled trials＂ in Chinese and in English. DATA SELECTION： Inclusion criteria： any study published in English or Chinese referring to randomized controlled trials of nerve growth factor; patients with neurological diseases such as peripheral nerve injury, central nerve injury, cranial neuropathy, and nervous system infections; patients older than 7 years; similar research methods and outcomes assessing symptoms; and measurement of nerve conduction velocities. The meta-analysis was conducted using Review Manager 5.2.3 software. MAIN OUTCOME MEASURES： The total effective rate, the incidence of adverse effects, and the nerve conduction velocity were recorded for each study. RESULTS： Sixty-four studies involving 6,297 patients with neurological diseases were included. The total effective rate in the group treated with nerve growth factor was significantly higher than that in the control group （P 〈 0.0001, RR： 1.35, 95%CI： 1.30-1.40）. The average nerve conduction velocity in the nerve growth factor group was significantly higher than that in the control group （P 〈 0.00001, MD. 4.59 m/s, 95%CI： 4.12-5.06）. The incidence of pain or sclero- ma at the injection site in the nerve growth factor group was also higher than that in the control group （P 〈 0.00001, RR： 6.30, 95%CI： 3.53-11.27）, but such adverse effects were mild. CONCLUSION： Nerve growth factor can significantly improve nerve function in patients with nervous system disease and is safe and effective.

Qian-Zheng-San promotes regeneration after sciatic nerve crush injury in rats

Qian-Zheng-San, a traditional Chinese prescription consisting of Typhonii Rhizoma, Bombyx Batryticatus, Scorpio, has been found to play an active therapeutic role in central nervous system diseases. However, it is unclear whether Qian-Zheng-San has therapeutic value for peripheral nerve injury. Therefore, we used Sprague-Dawley rats to investigate this. A sciatic nerve crush injury model was induced by clamping the right sciatic nerve. Subsequently, rats in the treatment group were administered 2 mL Qian-Zheng-San(1.75 g/mL) daily as systemic therapy for 1, 2, 4, or 8 weeks. Rats in the control group were not administered Qian-Zheng-San. Rats in sham group did not undergo surgery and systemic therapy. Footprint analysis was used to assess nerve motor function. Electrophysiological experiments were used to detect nerve conduction function. Immunofluorescence staining was used to assess axon counts and morphological analysis. Immunohistochemical staining was used to observe myelin regeneration of the sciatic nerve and the number of motoneurons in the anterior horn of the spinal cord. At 2 and 4 weeks postoperatively, the sciatic nerve function index, nerve conduction velocity, the number of distant regenerated axons and the axon diameter of the sciatic nerve increased in the Qian-Zheng-San treatment group compared with the control group. At 2 weeks postoperatively, nerve fiber diameter, myelin thickness, and the number of motor neurons in the lumbar spinal cord anterior horn increased in the Qian-Zheng-San treatment group compared with the control group. These results indicate that QianZheng-San has a positive effect on peripheral nerve regeneration.

Transdermal delivery of 4-aminopyridine accelerates motor functional recovery and improves nerve morphology following sciatic nerve crush injury in mice

Oral 4-aminopyridine(4-AP)is clinically used for symptomatic relief in multiple sclerosis and we recently demonstrated that systemic 4-AP had previously unknown clinically-relevant effects after traumatic peripheral nerve injury including the promotion of re-myelination,improvement of nerve conductivity,and acceleration of functional recovery.We hypothesized that,instead of oral or injection administration,transdermal 4-AP(TD-4-AP)could also improve functional recovery after traumatic peripheral nerve injury.Mice with surgical traumatic peripheral nerve injury received TD-4AP or vehicle alone and were examined for skin permeability,pharmacokinetics,functional,electrophysiological,and nerve morphological properties.4-AP showed linear pharmacokinetics and the maximum plasma 4-AP concentrations were proportional to TD-4-AP dose.While a single dose of TD-4-AP administration demonstrated rapid transient improvement in motor function,chronic TD-4-AP treatment significantly improved motor function and nerve conduction and these effects were associated with fewer degenerating axons and thicker myelin sheaths than those from vehicle controls.These findings provide direct evidence for the potential transdermal applicability of 4-AP and demonstrate that 4-AP delivered through the skin can enhance in-vivo functional recovery and nerve conduction while decreasing axonal degeneration.The animal experiments were approved by the University Committee on Animal Research(UCAR)at the University of Rochester(UCAR-2009-019)on March 31,2017.

Saikosaponin a increases interleukin-10 expression and inhibits scar formation after sciatic nerve injury

Nerve scarring after peripheral nerve injury can severely hamper nerve regeneration and functional recovery.Further,the anti-inflammatory cytokine,interleukin-10,can inhibit nerve scar formation.Saikosaponin a（SSa） is a monomer molecule extracted from the Chinese medicine,Bupleurum.SSa can exert anti-inflammatory effects in spinal cord injury and traumatic brain injury.However,it has not been shown whether SSa can play a role in peripheral nerve injury.In this study,rats were randomly assigned to three groups.In the sham group,the left sciatic nerve was directly sutured after exposure.In the sciatic nerve injury（SNI） ＋ SSa and SNI groups,the left sciatic nerve was sutured and continuously injected daily with SSa（10 mg/kg） or an equivalent volume of saline for 7 days.Enzyme linked immunosorbent assay results demonstrated that at 7 days after injury,interleukin-10 level was considerably higher in the SNI ＋ SSa group than in the SNI group.Masson staining and western blot assay demonstrated that at 8 weeks after injury,type I and III collagen content was lower and nerve scar formation was visibly less in the SNI ＋ SSa group compared with the SNI group.Simultaneously,sciatic functional index and nerve conduction velocity were improved in the SNI ＋ SSa group compared with the SNI group.These results confirm that SSa can increase the expression of the anti-inflammatory factor,interleukin-10,and reduce nerve scar formation to promote functional recovery of injured sciatic nerve.

Intraoperative single administration of neutrophil peptide 1 accelerates the early functional recovery of peripheral nerves after crush injury

Neutrophil peptide 1 belongs to a family of peptides involved in innate immunity. Continuous intramuscular injection of neutrophil peptide 1 can promote the regeneration of peripheral nerves, but clinical application in this manner is not convenient. To this end, the effects of a single intraoperative administration of neutrophil peptide 1 on peripheral nerve regeneration were experimentally observed. A rat model of sciatic nerve crush injury was established using the clamp method. After model establishment, a normal saline group and a neutrophil peptide 1 group were injected with a single dose of normal saline or 10 μg/mL neutrophil peptide 1, respectively. A sham group, without sciatic nerve crush was also prepared as a control. Sciatic nerve function tests, neuroelectrophysiological tests, and hematoxylin-eosin staining showed that the nerve conduction velocity, sciatic functional index, and tibialis anterior muscle fiber cross-sectional area were better in the neutrophil peptide 1 group than in the normal saline group at 4 weeks after surgery. At 4 and 8 weeks after surgery, there were no differences in the wet weight of the tibialis anterior muscle between the neutrophil peptide 1 and saline groups. Histological staining of the sciatic nerve showed no significant differences in the number of myelinated nerve fibers or the axon cross-sectional area between the neutrophil peptide 1 and normal saline groups. The above data confirmed that a single dose of neutrophil peptide 1 during surgery can promote the recovery of neurological function 4 weeks after sciatic nerve injury. All the experiments were approved by the Medical Ethics Committee of Peking University People's Hospital, China(approval No. 2015-50) on December 9, 2015.

A novel chronic nerve compression model in the rat

Current animal models of chronic peripheral nerve compression are mainly silicone tube models. However, the cross section of the rat sciatic nerve is not a perfect circle, and there are differences in the diameter of the sciatic nerve due to individual differences. The use of a silicone tube with a uniform internal diameter may not provide a reliable and consistent model. We have established a chronic sciatic nerve compression model that can induce demyelination of the sciatic nerve and lead to atrophy of skeletal muscle. In 3-week-old pups and adult rats, the sciatic nerve of the right hind limb was exposed, and a piece of surgical latex glove was gently placed under the nerve. N-butyl-cyanoacrylate was then placed over the nerve, and after it had set, another piece of glove latex was placed on top of the target area and allowed to adhere to the first piece to form a sandwich-like complex. Thus, a chronic sciatic nerve compression model was produced. Control pups with latex or N-butyl-cyanoacrylate were also prepared. Functional changes to nerves were assessed using the hot plate test and electromyography. Immunofluorescence and electron microscopy analyses of the nerves were performed to quantify the degree of neuropathological change. Masson staining was conducted to assess the degree of fibrosis in the gastrocnemius and intrinsic paw muscles. The pup group rats subjected to nerve compression displayed thermal hypoesthesia and a gradual decrease in nerve conduction velocity at 2 weeks after surgery. Neuropathological studies demonstrated that the model caused nerve demyelination and axonal irregularities and triggered collagen deposition in the epineurium and perineurium of the affected nerve at 8 weeks after surgery. The degree of fibrosis in the gastrocnemius and intrinsic paw muscles was significantly increased at 20 weeks after surgery. In conclusion, our novel model can reproduce the functional and histological changes of chronic nerve compression injury that occurs in humans and it will be a useful new tool for investigating the mechanisms underlying chronic nerve compression.

Boric acid reduces axonal and myelin damage in experimental sciatic nerve injury

The aim of this study was to investigate the effects of boric acid in experimental acute sciatic nerve injury. Twenty-eight adult male rats were randomly divided into four equal groups （n = 7）： control （C）, boric acid （BA）, sciatic nerve injury （I） , and sciatic nerve injury ＋ boric acid treatment （BAI）. Sciatic nerve injury was generated using a Yasargil aneurysm clip in the groups I and BAI. Boric acid was given four times at 100 mg/kg to rats in the groups BA and BAI after injury （by gavage at 0, 24, 48 and 72 hours） but no injury was made in the group BA. In vivo electrophysiological tests were performed at the end of the day 4 and sciatic nerve tissue samples were taken for histopathological examination. The amplitude of compound action potential, the nerve conduction velocity and the number of axons were significantly lower and the myelin structure was found to be broken in group I compared with those in groups C and BA. However, the amplitude of the compound action potential, the nerve conduction velocity and the number of axons were significantly greater in group BAI than in group I. Moreover, myelin injury was significantly milder and the intensity of nuclear factor kappa B immunostaining was significantly weaker in group BAI than in group I. The results of this study show that administration of boric acid at 100 mg/kg after sciatic nerve injury in rats markedly reduces myelin and axonal injury and improves the electrophysiological function of injured sciatic nerve possibly through alleviating oxidative stress reactions.

Anterior subcutaneous transposition of the ulnar nerve improves neurological function in patients with cubital tunnel syndrome

Although several surgical procedures exist for treating cubital tunnel syndrome, the best surgical option remains controversial. To evaluate the efficacy of anterior subcutaneous transposition of the ulnar nerve in patients with moderate to severe cubital tunnel syndrome and to analyze prognostic factors, we retrospectively reviewed 62 patients（65 elbows） diagnosed with cubital tunnel syndrome who underwent anterior subcutaneous transposition. Preoperatively, the initial severity of the disease was evaluated using the Mc Gowan scale as modified by Goldberg： 18 patients（28%） had grade IIA neuropathy, 20（31%） had grade IIB, and 27（42%） had grade III. Postoperatively, according to the Wilson ＆ Krout criteria, treatment outcomes were excellent in 38 patients（58%）, good in 16（25%）, fair in 7（11%）, and poor in 4（6%）, with an excellent and good rate of 83%. A negative correlation was found between the preoperative Mc Gowan grade and the postoperative Wilson ＆ Krout score. The patients having fair and poor treatment outcomes had more advanced age, lower nerve conduction velocity, and lower action potential amplitude compared with those having excellent and good treatment outcomes. These results suggest that anterior subcutaneous transposition of the ulnar nerve is effective and safe for the treatment of moderate to severe cubital tunnel syndrome, and initial severity, advancing age, and electrophysiological parameters can affect treatment outcome.

甲钴胺联合依帕司他治疗糖尿病周围神经病变的效果及对患者周围神经传导速度的影响

目的探讨甲钴胺联合依帕司他治疗糖尿病周围神经病变(DPN)的效果。方法将78例DPN患者随机分为两组。对照组应用甲钴胺治疗,观察组则在对照组基础上采用依帕司他治疗。比较两组患者的疗效、神经传导速度与不良反应发生率。结果观察组总有效率为97.44%,高于对照组的82.05%(P<0.05)。治疗后,观察组运动神经与感觉神经传导速度均高于对照组(P<0.05)。两组的不良反应发生率比较无统计学差异(P>0.05)。结论甲钴胺联合依帕司他治疗DPN具有较好的效果,可提高神经传导速度,加速患者病症改善,临床价值显著。

高压氧治疗脊髓损伤的临床效果及对神经电生理的影响

目的探讨高压氧治疗脊髓损伤的临床效果及对神经电生理的影响。方法选取2019年10月至2022年6月吉林大学第二医院脊柱外科收治的104例脊髓损伤患者,采用随机数字表法分为对照组和观察组,每组52例。对照组采用常规治疗,观察组在常规治疗的基础上给予高压氧治疗。比较两组治疗前后的美国脊柱损伤协会(ASIA)神经功能分级,正中神经、尺神经、胫神经、腓总神经的运动神经传导速度(MCV)、感觉神经传导速度(SCV),以及血清白介素(IL)-6、IL-10、IL-17、超敏C反应蛋白(hs-CRP)水平。结果治疗前两组ASIA神经功能分级、MCV、SCV及血清IL-6、IL-10、IL-17、hs-CRP水平比较差异均无统计学意义(P>0.05)。与治疗前相比,治疗后两组ASIA神经功能分级均明显改善,且观察组明显优于对照组,正中神经、尺神经、胫神经、腓总神经MCV及SCV均明显增高,且观察组明显高于对照组,血清IL-6、IL-10、IL-17、hs-CRP水平均明显降低,且观察组明显低于对照组,差异有统计学意义(P<0.05)。结论高压氧治疗脊髓损伤可显著改善神经功能,提高运动及感觉神经传导速度,减轻炎症反应。

艾灸热敏化腧穴结合中药熏蒸治疗腰椎源性下腰痛疗效观察

目的 探讨艾灸热敏化腧穴结合中药熏蒸治疗腰椎源性下腰痛的效果。方法 采用随机平行对照方法将河南中医药大学第一附属医院2020年4月至2023年5月收治的138例腰椎源性下腰痛患者按随机数表法分为对照1组、对照2组和观察组各46例。对照1组采取艾灸热敏化腧穴,对照2组采取中药熏蒸,观察组采取艾灸热敏化腧穴+中药熏蒸。治疗2周后比较三组患者的治疗效果,治疗前、治疗2周后的中医证候积分、视觉模拟评分法(VAS)、改良Qswestry功能障碍指数量表(ODI)、血管活性调节因子[血栓素2 (TXB2)、6-酮-前列腺素(6-keto-PGF1α)]、神经传导速度、等长肌力(IMS)、腰背肌后伸活动度(ROM),同时比较两组患者治疗期间的不良反应发生情况。结果 观察组患者的治疗总有效率为93.48%,明显高于对照1组的76.09%和对照2组的71.74%,差异有统计学意义(P<0.05);治疗2周后,观察组患者的中医证候积分及VAS、ODI评分分别为(1.31±0.30)分、(1.98±0.42)分、(15.24±1.68)分,明显低于对照1组的(1.50±0.33)分、(2.64±0.46)分、(18.78±2.34)分和对照2组的(1.47±0.34)分、(2.70±0.41)分、(19.11±1.29)分,差异均有统计学意义(P<0.05);治疗2周后,观察组患者的血清TXB2水平为(40.42±4.25) ng/mL,明显低于对照1组的(45.56±4.71) ng/mL和对照2组的(44.88±5.03) ng/mL,6-keto-PGF1α水平为(53.53±5.78) ng/mL,明显高于对照1组的(49.95±5.42) ng/mL和对照2组的(50.11±6.64) ng/mL,差异均有统计学意义(P<0.05);治疗2周后,观察组患者的腓总神经、腓浅神经传导速度分别为(42.50±4.43) m/s、(42.63±4.56) m/s,明显快于对照1组的(39.12±3.78) m/s、(39.40±3.87) m/s和对照2组的(38.89±4.05) m/s、(39.11±3.95) m/s,差异均有统计学意义(P<0.05);治疗2周后,观察组患者的ROM、IMS分别为(7.65±1.85)°、(498.68±75.51) N,明显高于对照1组的(6.25±1.36)°、(452.62±70.33) N和对照2组的(6.32±1.44)°、(450.13±72.68) N,差异均有统计学意义(P<0.05);三组患者治疗期间均未出现明显不良反应。结论 艾灸热敏化腧穴结合中药熏蒸能改善腰椎源性下腰痛患者临床症状,调节血管活性因子水平,促进神经传导速度及腰椎功能恢复,疗效显著且安全性高。

硫辛酸胶囊联合甲钴胺片治疗糖尿病周围神经病变的临床疗效

目的 分析硫辛酸胶囊的基础上辅助甲钴胺片治疗糖尿病周围神经病变(DPN)患者的临床效果。方法 本文的研究对象为80例糖尿病周围神经病变患者,根据随机数字法主要分为观察组与对照组。对照组40例患者均以甲钴胺片进行治疗,观察组40例患者均以硫辛酸胶囊联合甲钴胺片治疗。对比两组的临床疗效、运动神经传导速度(MNCV)、感觉神经传导速度(SNCV)、多伦多临床评分系统(TCSS)评分。结果 对比于对照组,观察组患者的总有效率明显较高(P<0.05)。治疗后,与对照组对比,观察组患者MNCV与SNCV升高(P<0.05)。治疗后与对照组对比,观察组患者的TCSS评分较低(P<0.05)。结论 以硫辛酸胶囊辅助甲钴胺片治疗DPN患者可改善运动神经传导速度、感觉神经传导速度,延缓疾病进展,提升治疗效果,值得临床借鉴、推广。

辛桂凝胶贴膏对糖尿病大鼠周围神经病变的影响

目的观察辛桂凝胶贴膏(肉桂、细辛、吴茱萸、川芎、冰片)对糖尿病大鼠周围神经病变的影响。方法采用单次腹腔注射1%链脲佐菌素(STZ,35 mg·kg^(-1))复制2型糖尿病大鼠模型后,结合长期(连续8周)高脂高糖饮食诱导产生糖尿病周围神经病变(DPN)。将SD大鼠随机分为正常组、模型组、甲钴胺组及辛桂凝胶贴膏组,每组6只。辛桂凝胶贴膏组大鼠穴位贴敷辛桂凝胶贴膏,每天1次,持续给药8周;甲钴胺组大鼠给予甲钴胺溶液灌胃(0.045 mg·kg^(-1)),正常组、模型组大鼠给予生理盐水灌胃。第2、4、6、8周测量大鼠体质量、空腹血糖(FBG);第4、8周检测大鼠热刺激缩足反应潜伏期(TWL);第8周检测大鼠的坐骨神经传导速度,包括运动神经传导速度(MNCV)及感觉神经传导速度(SNCV);采用全自动生化分析仪检测大鼠血清总胆固醇(TC)、甘油三酯(TG)、FBG水平;采用ELISA法检测空腹胰岛素(FINS)水平,计算胰岛素抵抗指数(HOMA-IR);HE染色法观察大鼠坐骨神经组织病理变化。结果与正常组比较,模型组大鼠体质量、FINS水平显著降低(P<0.01),FBG、TC、TG水平及HOMA-IR显著升高(P<0.05,P<0.01);TWL、MNCV及SNCV显著降低(P<0.01),坐骨神经纤维排列紊乱松散,出现脱髓鞘、轴突萎缩和空泡样现象。与模型组比较,辛桂凝胶贴膏组大鼠体质量及FBG、TC、TG水平无明显变化(P>0.05),FINS水平明显升高(P<0.05),HOMA-IR明显降低(P<0.05);甲钴胺组及辛桂凝胶贴膏组大鼠的TWL、MNCV及SNCV显著升高(P<0.05,P<0.01),坐骨神经病变情况得到不同程度改善,神经纤维排列较规则,髓鞘缺失和轴突萎缩明显改善。结论辛桂凝胶贴膏可以一定程度改善DPN大鼠的胰岛素抵抗,缓解热刺激敏感度,提高坐骨神经传导速度,对糖尿病大鼠的周围神经具有保护作用,但降糖、降血脂作用不明显。

短时程脊髓电刺激对药物治疗无效的急性带状疱疹神经病理性疼痛和运动麻痹的疗效观察

目的探讨短时程脊髓电刺激(st-SCS)治疗药物无效的急性带状疱疹神经病理性疼痛和肢体运动麻痹的临床疗效。方法选择2019年8月1日至2023年6月30日于南京医科大学附属南京医院疼痛科门诊收治的药物治疗无效的中重度急性带状疱疹神经痛(疱疹起始后1个月内)的34例患者,其中男性15例,女性19例;年龄51~73岁,平均年龄62.6岁;带状疱疹肢体麻痹累及单侧上肢21例,累及单侧下肢13例。接受st-SCS治疗,对治疗效果进行了回溯性分析,分别记录治疗前后各时间节点的疼痛程度的数字评定量表(NRS)评分、匹兹堡睡眠质量指数(PSQI)和疱疹累及的上肢腋神经、正中神经、尺神经及下肢股神经、腓肠神经在运动和感觉方面的神经传导速度(MNCV、SNCV),以及肌力评定量表(MRC)评级记录肌力变化详情。同时记录电刺激治疗周期内出现的不良反应。结果治疗前NRS为(8.2±0.8)分,治疗后14 d、1个月、3个月、6个月NRS评分显著下降[(4.3±1.1)分、(2.9±1.1)分、(2.3±0.9)分、(1.9±0.9)分],差异有显著统计学意义(t=16.52、22.45、27.62、29.60,P<0.001)。治疗前PSQI为14.6±1.6,治疗后3个月、6个月PSQI逐渐下降(5.6±1.1、3.9±0.8),差异有显著统计学意义(t=25.12、32.30,P<0.001)。说明睡眠质量也得到了显著的改善。治疗后3、6个月患者尺神经、正中神经及累及下肢股神经MNCV较治疗前有显著提高(P<0.001),且尺神经、腋神经和股神经SNCV较治疗前差异有统计学意义(P<0.05)。治疗后1、3、6个月,MRC评分逐步提高[(36.4±2.9)分、(38.6±3.7)分、(39.7±3.9)分],较治疗前差异有显著统计学意义(P<0.001)。结论st-SCS可以缓解急性带状疱疹神经痛并且促进受损神经的修复,改善肌力和提高睡眠质量,且不良反应少、安全性高。

六价铬对牛蛙心脏、骨骼肌和坐骨神经干生理功能的影响

【目的】从电生理学角度研究六价铬对牛蛙心脏、腓肠肌和坐骨神经干动作电位的影响,探讨六价铬的毒性作用机制。【方法】将不同浓度重铬酸钾溶液通过腹腔注射和离体心脏灌流法处理牛蛙心脏,测定六价铬对在体和离体心脏心率和收缩力的影响。用重铬酸钾溶液浸润好的纱布包裹腓肠肌,测定腓肠肌收缩力变化。采用细胞外电极引导法,测定六价铬对坐骨神经干动作电位传导速度的影响。【结果】结果显示:重铬酸钾对心率和收缩力具有抑制作用,机制分别与六价铬抑制T型钙通道活性和L型钙通道活性有关;然而1 mg/L铬对在体蛙心作用15 min至30 min后,心率增加,可能是“毒物兴奋效应”所致;0.001 mg/L至10 mg/L六价铬对腓肠肌收缩力具有浓度依赖性增强作用,表现为正性变力效应,可能是“毒物兴奋效应”的结果;100 mg/L六价铬抑制了腓肠肌收缩力,表现为负性变力效应,机制与六价铬对兰尼碱受体(Ryanodine receptor,RyR)的抑制作用有关;六价铬以质量浓度和时间依赖性降低了神经干动作电位传导速度,机制与六价铬对电压门控Na+通道产生的失活作用有关。【结论】六价铬对心肌、骨骼肌和神经均具有毒性作用,结果可为六价铬的毒性作用研究提供一定的电生理实验依据。

依帕司他联合丁苯酞软胶囊对痛性糖尿病周围神经病变患者的影响

目的:分析依帕司他联合丁苯酞软胶囊对痛性糖尿病周围神经病变(PDPN)患者的影响。方法:选取2021年2月—2022年2月通城县人民医院收治的80例PDPN患者作为研究对象,根据掷硬币法将患者分为对照组和研究组,各40例。对照组给予依帕司他,研究组在对照组基础上给予丁苯酞软胶囊,比较两组临床疗效、不良反应、疼痛程度[视觉模拟评分法(VAS)]、正中神经、腓总神经、尺神经的感觉神经传导速度(SNCV)、运动神经传导速度(MNCV)及氧化应激指标[超氧化物歧化酶(SOD),丙二醛(MDA)]水平。结果:研究组临床总有效率高于对照组,差异有统计学意义(P<0.05);两组不良反应发生率比较,差异无统计学意义(P>0.05);治疗1个月后,两组VAS评分低于治疗前,且研究组低于对照组,差异有统计学意义(P<0.05);治疗1个月后,两组正中神经、腓总神经、尺神经的SNCV和MNCV较治疗前提高,且研究组高于对照组,差异有统计学意义(P<0.05);治疗1个月后,两组SOD和MDA水平较治疗前改善,且研究组SOD水平高于对照组,MDA水平低于对照组,差异有统计学意义(P<0.05)。结论:依帕司他与丁苯酞软胶囊联合治疗PNDN,临床疗效好,不良反应发生率较低,能显著降低疼痛程度,提高正中神经、腓总神经、尺神经SNCV和MNCV,改善SOD和MDA水平。