Expression of ceramide galactosy transferase in sciatic nerve of rats with diabetic peripheral neuropathy after electroacupuncture at Zusanli and Shenshu points

BACKGROUND： Ceramide galactosyltransferase （CGT） protein and mRNA expression defect can cause the abnormal morphology and slowing conduction velocity of peripheral nerve. Morphologic change and functional disorder of myelin sheath and axon appear when diabetic peripheral neuropathy （DPN） occurs. Whether electroacupuncture at Zusanfi（ST 36） and Shenshu（BL 32） points can enhance the expression of CGT protein and mRNA in the DPN tissue？ OBJECTIVE： To observe the effect of electroacupuncture at Zusanfi and Shenshu points on motor, sensory conduction velocity and CGT mRNA and its protein expression of sciatic nerve in rats with DPN. DESIGN： A randomized and controlled animal experiment SETTING ： Department of Neurology and Central Laboratory, Yueyang Hospital of Traditional Chinese ＆ Western Medicine, Shanghai University of Traditional Chinese Medicine. MATERIALS ： Totally 60 healthy male Wistar rats of clean grade, aged 4 month, with body mass of 200 to 220 g, were enrolled in this study. Streptozotocin （STZ, Sigma Company of USA, Batch No. S-0130）. METHODS： This study was carried out in the Animal Experimental Center and Central Laboratory, Yueyang Hospital of Traditional Chinese ＆ Western Medicine during February 2005 to March 2006. （1） Fifteen rats were randomly chosen,serving as normal group.AU the other rats were intraperitoneally injected once with STZ to develop experimental diabetic rat models. If fasting blood glucose was ≥ 15 mmol/L,sensory nerve and motor nerve conduction velocity of sciatic nerve was obviously slowed, tail-swaying temperature threshold was increased and myelinated nerve fiber of sciatic nerve changed, DPN models were successful. The successful model rats were randomly assigned into 3 groups： model group, control group（electroacupuncture at non-meridian-non-acupoint）and electroacupuncture group [electroacupuncture at Zusan/i and Shenshu points], with 15 rats each. The rats in the normal group and model group were untouched. In the electroacupuncture group （electroacupuncture at Zusanfi and Shenshu points）, Shenshu point （double） and Zusanfi point （double） were chosen referencing to The Atlas of the Rat＇s Acupoints. G6805- Ⅱ electric acupuncture apparatus was used, and current intensity was controlled at 20 min/time, once every other day, 12 times within 24 days. In the control group, the tip of rat-tail was stimulated, and the concrete procedures were the same as in the electroacupuncture at Zusanfi and Shenshu points. （2） Motor nerve conduction velocity and sensory nerve conduction velocity of rats were detected with neuroelectrophysiology detector in the end of the treatment, and the expressions of CGT protein and mRNA of sciatic nerve were detected with immunohistochemical method and fluorescent quantitative PCR technique. MAIN OUTCOME MEASURES： （1） Motor and sensory nerve conduction velocity. （2） The expression of CGT protein and its mRNA. RESULTS： All the 60 rats entered the stage of result analysis. （1） Comparison of motor and sensory nerve conduction velocity of rats after electroacupuncture： Motor nerve conduction velocity of rats in the model group[（31.37±3.69） m/s], control group [（32.74±5.42） m/s] and electroacupuncture group [（41.30 ±1.15） m/s] was significantly lower than that in the normal group [（41.30±1.15） m/s, P 〈 0.01]; The sensory nerve conduction velocity of rats in the model group[（18.17±9.54） m/s], control group [（21.39±5.61） m/s]and electroacupuncture group [（35.81 ±4.59） m/s] was significantly lower than that in the normal group [（46.38± 6.32） m/s,P 〈 0.01]; The motor and sensory nerve conduction velocity of electroacupuncture group was significantly higher than that in the model group [（38.04±2.01） m/s vs. （32.74±5.42） m/s,（35.81±4.59） m/s vs. （21.39±5.61） m/s,P 〈 0.01]. （2） Comparison of the expression of CGT protein of sciatic nerve of rats： The number of CGT positive cells of sciatic nerve in model group, control group or electroacupuncture group was significantly smaller than that in normal group [（9 770.33±1 461.73）, （10 588.13±1119.52）, （27 518.27± 9 078.29）, （37 769.67±4 021.81）/μm^2,P 〈 0.01]; The number of CGT positive cells of the sciatic nerve in the electroacupuncture group was significantly larger than that in the model group and control group （P 〈 0.01）. The number of CGT positive cells of sciatic nerve was close between control group and electroacupuncture group （P 〉 0.05）. （3） Comparison of CGT mRNA expression of sciatic nerve of rats： Ct value of CGT mRNA of sciatic nerve of rats in the model group,control group and electroacupuncture group was significantly higher than that in the normal group （13.75±2.60,14.81±2.80,11.67±1.75,9.30±0.98, P 〈 0.01 ）; Ct value of CGT mRNA of sciatic nerve of rats in the electroacupuncture group was significantly lower than that in the model group and control group （P 〈 0.01）, and that was close between electroacupuncture group and control group （P 〉 0.05）. CONCLUSION ： Electroacupuncture at Zusanfi and Shenshu points can increase motor and sensory nerve conduction velocity of rats with DPN. It might be associated with up-regulating the expression of CGT mRNA and its protein.

振动感觉阈值(VPT)在糖尿病周围神经病变(DPN)中的诊断价值

目的探讨以振动感觉阈值(vibrating perception threshold,VPT)检查为主联合糖尿病神经病变症状评分(diabetic neuropathy symptom,DNS)、足外观、温度觉、痛觉及触觉5种简易检查方法在糖尿病周围神经病变(diabetic peripheral neuropathy,DPN)中的诊断价值。方法 217例2型糖尿病患者记录DNS,同时行足外观检查、VPT、温度觉、痛觉、半定量音叉、10g尼龙丝检查和肌电图神经传导速度(nerve conducting velocity,NCV)测定。按神经电生理检查结果,分为不合并周围神经病变组(n=130),合并周围神经病变组(n=87),比较两组的基本情况和代谢指标。计算5种联合检查方法的敏感度、特异度、阳性预测值、阴性预测值、准确度、Youden指数以及Kappa值(κ值),与NCV检查进行相关性和一致性分析。结果两组间年龄、糖尿病病程、VPT值有显著差异,DPN组明显高于无DPN组(P<0.05)。VPT与正中运动神经传导速度(motor conducting velocity,MCV)、尺神经MCV、腓总神经MCV、腓浅神经感觉性传导速度(sensory conducting velocity,SCV)、胫神经MCV之间均呈负相关(P<0.05)。5种联合检查方法与NCV检查的秩相关分析均呈显著正相关(P<0.01),VPT联合DNS检查与NCV的相关性最好(r=0.799)。VPT联合DNS检查的敏感度、特异度、准确度分别为74.4%、100%、89.9%,与NCV检查高度一致(κ值为0.780)。结论 VPT联合DNS是准确筛查和诊断DPN的适用方法。

温经通络熏洗方治疗DPN疗效观察及机理探讨

目的探讨温经通络熏洗方治疗糖尿病周围神经病变(DPN)的临床疗效。方法将符合病例标准的DPN患者80例,随机分为两组,每组40例。对照组口服弥可保,治疗组采用温经通络熏洗方治疗。观察两组患者空腹及餐后2 h血糖、糖化血红蛋白、红细胞醛糖还原酶(RBC-AR)、红细胞Na-K-ATPase活性、腓总神经运动神经传导速度(MNCV)、腓肠神经感觉神经传导速度(SNCV)以及临床症状改善情况。结果温经通络熏洗方对DPN患者的症状、体征及相关实验室检查均有不同程度的改善,总有效率为92.5%,与对照组比较有显著性差异(P<0.05)。治疗组临床证候和RBC-AR、红细胞Na-K-ATPase活性,治疗前后及与对照组比较有显著性差异(P<0.05,P<0.01)。血糖及HbAlc治疗后其绝对值均有所下降,但与对照组比较无显著性差异(P>0.05)。结论本研究证实温经通络熏洗方在不影响血糖的情况下,治疗DPN疗效显著。

电针对DPN大鼠坐骨神经神经生长因子调节作用的实验研究

目的探讨电针治疗糖尿病周围神经病变（DPN）调节作用的机制。方法采用链脲佐菌素（STZ）制备DPN大鼠模型，将大鼠随机分为正常组、模型组、西药组和电针组；电针组取大鼠足三里、肾俞穴进行电针治疗，通过免疫组化和荧光定量PCR技术检测坐骨神经神经生长因子（NGF）蛋白和mRNA的表达。结果模型组、西药组和电针组大鼠NGF蛋白和mRNA的表达明显低于正常组（P〈0．05～0．01）；电针组大鼠治疗后坐骨神经NGF蛋白和mRNA表达上调，明显高于模型组（P〈0．01）。结论电针足三里、肾俞穴能够使DPN大鼠坐骨神经NGF蛋白和mRNA表达上调，促进坐骨神经修复。

黄芪联合川芎嗪加中药熏洗治疗糖尿病周围神经病变(DPN)疗效观察

目的观察黄芪联合川芎嗪加中药熏洗治疗糖尿病周围神经病变(DPN)的疗效评价及神经传导速度传导的影响。方法将120例DPN患者随机分成中西医结合治疗组、西医治疗组、对照组,治疗4周(其中川芎嗪治疗2周)后观察三组患者治疗前后的临床疗效评价、神经传导速度的变化。结果各组治疗前后多伦多CSS评分、神经传导速度组内比较(P<0.05);治疗后中西医结合治疗组多伦多CSS评分、神经传导速度与西药治疗组及对照组比较(P<0.05);西医治疗组治疗后上述指标也有明显变化,和对照组相比(P<0.05)。结论黄芪联合川芎嗪加中药熏洗能明显增加神经传导速度,有效改善DPN症状及体征,提示该治疗方法能有效控制和延缓DPN的进一步发展,值得临床上广泛运用和借鉴。

远志对DPN大鼠背根节神经元损伤的预防保护作用

目的:观察远志对糖尿病周围神经病变(DPN)大鼠坐骨神经相关神经元胞体损伤的预防保护作用。方法:Wistar大鼠随机分为3组(n=12):空白对照组,DPN模型组及远志预防组。DPN模型组和远志预防组大鼠建立链脲佐菌素致糖尿病模型后,远志预防组大鼠给予远志(2.7g/kg/d)灌胃6周。以大鼠尾部感觉神经传导速度(SNCV)<30m/s为标准建立DPN大鼠模型。采用免疫组织化学染色法检测坐骨神经对应背根节神经元Bcl-2、Bax阳性细胞数,免疫印迹法检测背根节Bcl-2、Bax蛋白的表达,TUNEL法检测背根节神经元的凋亡指数。结果:与空白对照组比较,DPN模型组大鼠背根节Bc l-2阳性细胞数明显减少、Bcl-2的表达明显降低,Bax阳性细胞数明显增多、Bax的表达和凋亡指数明显升高(P<0.01)。与DPN模型组比较,远志预防组大鼠背根节Bcl-2阳性细胞数明显增多、Bcl-2的表达明显升高,Bax阳性细胞数明显减少、Bax的表达和凋亡指数明显降低(P<0.01)。结论:远志可通过上调DPN大鼠背根节神经元胞体Bcl-2的表达,减少Bax的表达,抑制背根节神经元凋亡,预防DPN大鼠背根节神经元胞体损伤。

血糖控制情况对糖尿病周围神经病变(DPN)患者下肢神经减压术疗效的影响

目的探讨糖尿病周围神经病变(diabetic peripheral neuropathy,DPN)患者的血糖控制情况对周围神经减压手术疗效的影响。方法 2014年12月至2016年6月在复旦大学附属中山医院接受单侧下肢神经减压术的DPN患者共计40例,以HbA1c=8%为标准分为血糖控制尚可组和血糖控制不佳组。在术前1天和术后6个月,测量视觉模拟评分(visual analogue scale,VAS)、两点辨别觉(two point discrimination,TPD)和10 g单丝测验,比较两组患者的手术疗效。结果所有患者术后VAS、TPD和10 g单丝测验结果均较术前均明显改善。血糖控制尚可的患者术后VAS、TPD和10 g单丝测验结果均优于血糖控制不佳的患者。结论良好的血糖控制对DPN患者下肢神经减压术后疼痛的缓解和肢体感觉的恢复具有积极作用,血糖控制尚可的患者手术疗效明显优于血糖控制不佳的患者。

Electroacupuncture combined with intermittent pneumatic compression therapeutic apparatus for diabetic peripheral neuropathy and the effect on HIF-1α and VEGF levels

Objective： To observe the clinical efficacy of electroacupuncture combined with intermittent pneumatic compression therapeutic apparatus for treatment of diabetic peripheral neuropathy, and the effect on serum VEGF and HIF-lα levels of patients. Methods： Ninety-six patients were randomly divided into electroacupuncture treatment group （EA group）, intermittent pneumatic compression treatment group （IPC group）, electroacupuncture combined with intermittent pneumatic compression treatment group （EA ＋ IPC group） and cobamamide group （CM group）, with 24 cases in each group. Electroacupuncture treatment （once a day）, intermittent pneumatic com pression treatment （twice a day） and intramuscular injection with cobamamide （1 rag, once a day） were carried out in EA group, IPC group and CM group, respectively, and intermittent pneumatic compres- sion treatment （twice a day） was conducted on the basis of electroacupuncture treatment （once a day） in EA＋IPC group. After treatment for 2 consecutive weeks, the differences in subjective symptoms, mo- tor nerve conduction velocity, sensory nerve conduction velocity and serum HIF-lα and VEGF levels of patients in the four groups before and after treatment were observed and compared. Results： After treatment for 2 weeks, the differences in total effective rate between EA group and CM group, IPC group and CM group, as well as EA ＋ IPC group and CM group were all significant （all P 〈 0.05）, and the total effective rate in EA＋ IPC group was significantly higher than that in EA group and IPC group （both P 〈 0.05）. After treatment for 2 weeks, the motor nerve conduction velocity and sensory nerve conduction velocity of median nerve and common peroneal nerve of patients in EA group, 1PC group and EA＋IPC group were all higher than that before treatment （all P 〈 0.05）; the motor nerve conduction velocity of median nerve and the sensory nerve conduction velocity of common peroneal nerve in EA group were all higher than that in CM group （both P 〈 0.05）; the motor nerve conduction velocity and sensory nerve conduction velocity of median nerve in IPC group were also all higher than that in CM group （both P 〈 0.05）; the motor nerve conduction velocity and sensory nerve conduction velocity of median nerve and common peroneal nerve in EA＋IPC group were all higher than that in CM group （both P 〈 0.05）; the sensory nerve conduction velocity of common peroneal nerve in EA ＋ 1PC group was higher than that in EA group and IPC group （both P 〈 0.05）, and the motor nerve conduction velocity of median nerve in EA＋IPC group was higher than that in IPC group （P 〈 0.05）. The serum HIF-1α and VEGF levels of patients in EA group, IPC group and EA ＋ IPC group after treatment significantly reduced （all P 〈 0.05）. and were lower than that in CM group after treatment （all P 〈 0.05）; the serum HIF-lα and VEGF levels of patients in EA ＋ IPC group after treatment were lower than that in EA group and IPC group, and the difference in serum HIF-lα level was statistically significant （both P 〈 0.05）. Conclusion： Electroacupuncture combined with intermittent pneumatic compression therapeutic apparatus can effectively improve the clinical symptoms of patients with diabetic peripheral neuropathy, the efficacy were better than electroacupuncture, intermittent pneumatic compression treatment and cobamamide.

针药结合对DPN患者FBG、PBG、NO、SOD含量和MDNS评分的影响

目的:观察和比较针药结合对糖尿病周围神经病变(DPN)患者FBG、PBG、NO和SOD含量和MDNS评分的影响,探讨针药结合的作用机制.方法:将70例患者随机分为两组比较观察,有完整资料者58例,其中针药治疗组33例,药物对照组25例.结果:治疗3周后,治疗组和对照组都能使空腹血糖(FBG)及餐后血糖(PBG)显著下降,治疗组餐后血糖比对照组下降更为明显,P<0.05,而空腹血糖的下降两组间无明显差异;两组的NO含量和药物组SOD的含量无明显影响(P>0.05);而针药组的SOD值升高和MDNS改善明显优于对照组,P<0.05;MDNS评分与FBG、PBG明显正相关,与NO和SOD含量呈负相关.结论:针药结合能对单纯药物治疗控制较差的餐后血糖起明显调节作用;针药结合能有效提高SOD水平,改善糖尿病周围神经病变患者MDNS评分,提高临床疗效;但短期疗效上,针药结合对NO含量无明显影响.

Clinical study on acupuncture combined with western medication for diabetic peripheral neuropathy

Objective:To compare the clinical effect differences between western medication,acupuncture,and acupuncture combine with western medication in the treatment of diabetic peripheral neuropathy.Methods:Ninety-three patients were randomized into western medication group,acupuncture group,and combination group,with 31 cases in each.The patients in western medication group were treated with lipoic acid injection and mecobalamin injection/tablets.The patients in acupuncture group were treated with acupuncture,and the acupoints were selected according to the symptoms.The needles were retained for 30 min,once a day.The patients in combination group were treated with both western medication and acupuncture,specific methods as the above.The treatments were for 18 days in succession in all of three group.The motor nerve conduction velocity(MNCV) and sensory nerve conduction velocity(SNCV) of median nerve and common peroneal nerve,as well as the changes of symptoms and signs of patients were observed before and after treatment.The clinical effect was evaluated.Results:After treatment,the median nerve MNCV in the three groups,the median nerve SNCV and common peroneal nerve MNCV in acupuncture group and combination groups,and the common peroneal nerve SNCV in acupuncture group were all higher than those of before treatment,with significantly statistical differences(all P<0.05).After treatment,the MNCV and SNCV of median nerve and common peroneal nerve in combination group were higher than those in western medication group and acupuncture group,with significantly statistical differences(all P<0.05).After treatment,the number of patients in the three groups with the symptoms and signs was lower than that of before treatment.The effective rate in combination group was 96.8%(30/31),higher than those of western medication group,74.2%(23/31),and acupuncture group,83.8%(26/31),with significantly statistical differences(both P<0.05).Conclusion:Acupuncture combined with western medication in the treatment of diabetic peripheral neuropathy can improve the nerve conduction velocity and improve the symptoms and signs of diabetic patients,with a better effect than those of western medication and simple acupuncture.

Experiences in Treating Diabetic Peripheral Neuropathy with Traditional Chinese Medicine

Diabetic peripheral neuropathy （DPN） is a common chronic complication in diabetic patients, closely correlated with the development of the disease and with poorly controlled glucose levels. The common clinical signs show paresthesia, mostly manifesting as multiple peripheral neuritis, such as having a chilly or causalgic feeling, anaesthesia, formication, and pain, etc.

Nerve Regeneration Should Be Highly Valued in the Treatment of Diabetic Peripheral Neuropathy

Diabetic peripheral neuropathy （DPN） is the most common chronic complication of the long-term complications of diabetes, affecting up to 90% of patients during the progress of the disease. Many parts of the nerve system, including the sensory nerves, motor nerves and autonomic nerves, can be affected, leading to various clinical features.

补阳还五汤对糖尿病周围神经病变大鼠的止痛作用及机制研究

【目的】探讨补阳还五汤对糖尿病周围神经病变(DPN)大鼠的止痛作用及机制。【方法】将60只大鼠分为正常组,模型组(MNCV)和感觉神经传导速度(SNCV),中药低、中、高剂量组,中药高剂量+H-89[蛋白激酶A(PKA)抑制剂]组,每组10只。除正常组,其他各组大鼠采用高脂高糖饲料饲喂结合腹腔注射链脲佐菌素(STZ)法构建DPN模型。给药结束后,检测大鼠足热痛阈值,测定大鼠运动神经传导速度(MNCV)和感觉神经传导速度(SNCV),免疫组织化学法观察表皮内神经纤维密度(IENF),酶联免疫吸附分析(ELISA)检测血清空腹胰岛素(FINS)、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、胰岛素抵抗指数(HOMA-IR),白细胞介素(IL)-1β、IL-6、肿瘤坏死因子α(TNF-α),血管内皮生长因子(VEGF)、血管生成素1(Ang-1)、CD34水平,坐骨神经组织中环磷酸腺苷(cAMP)浓度,Western Blot法检测坐骨神经组织中PKA和反应元件结合蛋白(CREB)表达水平。【结果】与正常组比较,模型组足热痛阈值,TC、TG、LDL-C、HOMA-IR,IL-1β、IL-6和TNF-α水平均显著增加(P<0.05),HDL-C、FINS,VEGF、Ang-1、CD34,IENF,MNCV和SNCV值,cAMP浓度水平,PKA和CREB磷酸化水平均显著降低(P<0.05);与模型组比较,中药低、中、高剂量组上述指标均得到显著改善(P<0.05),且呈剂量依赖性;与中药高剂量+H-89组比较,中药高剂量组各指标水平均被逆转。【结论】补阳还五汤可改善DPN大鼠胰岛素抵抗、血脂代谢,减轻肢体疼痛,改善局部微循环障碍,保护神经功能,体现了“活血通络止痛”的治疗特点;补阳还五汤的止痛作用可能与改善局部微循环障碍、抑制炎症因子释放及调节cAMP/PKA/CREB信号通路蛋白表达有关。

中药专利复方治疗糖尿病周围神经病变的用药规律分析

【目的】采用数据挖掘方法分析国家专利中药复方治疗糖尿病周围神经病变(diabetic peripheral neuropathy,DPN)的用药规律,为临床用药提供参考。【方法】在国家知识产权局网站检索中药复方治疗DPN的专利,使用Excel 2021进行频数统计,运用RAW Graphs 2.0制作高频中药功效的桑基图,运用SPSS Statistics 25.0软件进行药物的系统聚类分析,基于Cytoscape 3.9.1挖掘核心处方。【结果】共纳入101首中药专利复方,涉及243味中药。出现频次居前3位的中药为丹参、黄芪、白芍。治疗DPN的专利复方药物的药性以温、平为主,药味以甘、苦、辛为主,归经以归肝、心、脾经居多。药物按功效主要可分为补虚药、活血化瘀药、解表药、平肝熄风药、清热药、止血药、安神药、利水渗湿药。关联规则分析中支持度最高的药物组合为黄芪-当归;系统聚类分析将出现频次居前31位的中药分成7组,挖掘得到的核心处方包含黄芪、川芎、鸡血藤、丹参、牛膝、桂枝、当归共7味药。【结论】专利中药复方治疗DPN以补虚、活血化瘀为主,兼以温通经络,重视后天之本,健脾更不忘疏肝;临证时可选用黄芪-当归及白芍-丹参药对;核心方(黄芪、川芎、鸡血藤、丹参、牛膝、桂枝、当归)可加减用于DPN的全病程治疗。

3.0T超导磁共振成像和单核细胞与高密度脂蛋白比值、成纤维细胞生长因子与糖尿病周围神经病变的关系

目的:探究3.0T超导磁共振成像(MRI)及成纤维细胞生长因子(FGF21)、单核细胞/高密度脂蛋白比值(MHR)与糖尿病周围神经病变(DPN)的相关性。方法:选取2021年1月至2022年12月新疆医科大学附属中医医院诊治的80例2型糖尿病(T2DM)患者,根据是否合并DPN将其分为DPN组(44例)和非DPN(NDPN)组(36例)。两组均采用3.0T超导MRI行磁共振(MR)扩散张量成像技术检查,通过酶联免疫吸附试验(ELISA)检测血清FGF21、MHR水平。比较两组MR扩散张量成像检查参数中视神经各向异性分数(FA)、平均弥散系数(MD)、平行扩散系数(λ_(∥))及垂直扩散系数(λ_(⊥))值,以及血清FGF21、MHR水平差异。采用Spearman秩相关分析探究MR弥散张量成像参数及FGF21、MHR与DPN的相关性。结果:两组患者的性别、体质量指数(BMI)比较,差异无统计学意义(P>0.05),DPN组患者的年龄、病程均显著高于NDPN组,差异有统计学意义(t=5.039、7.852,P<0.05),FA值显著低于NDPN组,MD、λ_(∥)及λ_(⊥)值显著高于NDPN组,差异有统计学意义(t=8.934、10.459、12.233、4.640,P<0.05);DPN组血清FGF21、MHR水平显著高于NDPN组,差异有统计学意义(t=3.286、24.509,P<0.05)。Spearman秩相关性结果显示,患者的年龄、病程、MD、λ_(∥)、λ_(⊥)值、FGF21及MHR水平与DPN呈显著正相关(r=0.458、0.666、0.836、0.799、0.445、0.282、0.864,P<0.05),FA与DPN呈显著负相关(r=-0.753,P<0.05)。结论:MR弥散张量成像相关参数及FGF21、MHR水平均与DPN存在显著相关性,且患者的年龄、病程也与DPN的发生有关,需引起临床的重视。

中壮医结合诊治糖尿病周围神经病变思路探赜

从中医络病理论、壮医道路理论认识唐尿病周围神经病变(DPN)发病机制,以此为例探索中壮医结合之路。基于中医络病理论对DPN发病机制再认识,初期为气络病变,因气络虚滞在经而发病,病久为脉络病变,因脉络瘀滞入血而发病。受中医络病理论对DNP再认识的启示,认识到DPN壮医发病机制为龙路火路不通,病初为火路不通,病久为龙路不通。贯串中医学、壮医学、西医学对DPN的认识,发现DPN发病初期与“气络病变-火路不通-NEI网络”有相关性,病久与“脉络病变-龙路不通-血管系统病”有相关性。结合临床经验,认识到中壮医结合治疗DPN具有互助性。该病机的互通性与治疗的互助性丰富了DPN的诊治思维,创立了中壮医结合诊治DPN的思路,促进了壮医与中医的融合发展,为少数民族医药研究提供了新的视角。

加味黄芪桂枝五物汤治疗糖尿病周围神经病变临床研究

目的:观察加味黄芪桂枝五物汤治疗糖尿病周围神经病变(DPN)的疗效。方法:70例随机分为对照组与研究组各35例,对照组给予甲钴胺片,研究组给予加味黄芪桂枝五物汤。结果:研究组总有效率高于对照组(P<0.05)。两组治疗后正中神经SCV、胫后神经SCV、腓肠神经SCV、腓总神经MCV水平均升高,且研究组高于对照组(P<0.05)。结论:加味黄芪桂枝五物汤治疗DPN疗效较好。

糖尿病周围神经病变的综合护理干预效果研究

目的探讨综合护理干预措施在糖尿病周围神经病变(DPN)中的应用效果。方法按照随机化原则将90例DPN患者随机分对照组和干预组,各45例,对照组给予常规护理,干预组给予综合护理干预措施;比较两组干预前后的焦虑得分、抑郁得分、疼痛得分、踝-肱指数(ABI)、临床疗效等指标。结果实施干预后,干预组与对照组相比,具有较低的焦虑和抑郁得分(P<0.01)、疼痛得分明显减轻(P<0.01)、更高的ABI(P<0.01);干预组的总有效率为91.1%,明显高于对照组的71.1%(P<0.05)。结论 DPN患者实施综合护理干预后,可明显缓解心理压力,减轻患者痛苦,改善临床治疗效果,提高患者生活质量。

中药筋脉通胶囊治疗糖尿病周围神经病变的临床疗效观察

目的观察中药筋脉通胶囊对糖尿病周围神经病变(DPN)的治疗作用。方法采用随机平行对照试验方法,将54例2型DPN患者分为筋脉通组和弥可保组。两组均予降糖、降压等基础治疗,治疗组予筋脉通胶囊,对照组予甲钴胺片。治疗前后进行神经功能和中医证候评分以及神经电生理和血糖、血脂、肝肾功能、血尿常规等检测。结果与治疗前比较,治疗组的中医症状总分与神经功能评分明显下降(P<0.01或P<0.05);神经系统症状减轻,神经体征总体改善率为50.0%;交感神经皮肤反应(SSR)异常的改善率为36.0%,SSR上肢波幅明显增高(P<0.05);神经传导速度(NCV)的改善率为MCV15.8%、SCV25.0%,尺神经运动波幅较治疗前明显增高(P<0.05);肝、肾功能及血、尿常规检测未见异常改变(P>0.05);与弥可保组比较差异无统计学意义(P>0.05)。结论筋脉通能明显改善DPN患者的临床症状和神经体征,对SSR及NCV检测参数亦有一定作用。

强力天麻杜仲胶囊联合甲钴胺治疗糖尿病周围神经病变观察

目的评估雷氏强力天麻杜仲胶囊联合甲钴胺治疗糖尿病周围神经病变的疗效,探讨强力天麻杜仲胶囊治疗糖尿病周围神经病变的有效性。方法糖尿病合并周围神经病变患者140例,分为强力天麻杜仲联合甲钴胺治疗组(A组)35例、卡马西平联合甲钴胺治疗组(B组)35例、单用强力天麻杜仲组(C组)和单用甲钴胺治疗组(D组)各35例。用药8周后比较4组患者临床症状缓解率、用药前后肌电图及下肢动脉超声改变、检测患者血肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)及血流变指标。结果与D组比较,A、B组周围神经症状缓解率提高。A组感觉神经传导波幅改善更为明显,胫神经H反射潜伏期缩短。下肢动脉超声显示A组和C组患者用药后下肢动脉多普勒流速曲线参数增加。A组和C组用药后血IL-6、TNF-α水平显著降低、血流变指标改善。结论强力天麻杜仲胶囊联合甲钴胺能够明显缓解糖尿病周围神经病变患者临床症状、改善下肢动脉血流和神经传导速度及胫神经H反射、减轻机体炎症反应。