加味补阳还五汤对糖尿病周围神经病变患者血清PNT,IGF-1的影响
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摘要
目的:探讨糖尿病周围神经病变(diabetic peripheral neuropathy,DPN)患者血清前神经降压肽(proneurotensin,PNT),胰岛素样生长因子-1 (insulin-like growth factor-1,IGF-1)水平变化及其与神经传导速度(nerve conduction velocity,NCV),多伦多临床评分系统(toronto clinical scoring system,TCSS)评分之间的关系;观察加味补阳还五汤对DPN患者的临床疗效及对PNT,IGF-1水平的影响。方法:DPN患者68例,随机分为治疗组和对照组,各34例。两组患者在常规糖尿病治疗基础上均给予甲钴胺胶囊口服;治疗组另外口服加味补阳还五汤,共4周。观察两组患者治疗前与治疗后正中神经感觉传导速度(sensory nerve conduction velocity,SNCV),正中神经运动传导速度(motor nerve conduction velocity,MNCV),腓总神经SNCV,腓总神经MNCV,TCSS评分及血清PNT,IGF-1水平。结果:两组患者治疗前正中神经SNCV,正中神经MNCV,腓总神经SNCV,腓总神经MNCV,TCSS评分及血清PNT,IGF-1水平比较差异均无统计学意义。血清PNT,IGF-1水平与正中神经SNCV,正中神经MNCV,腓总神经SNCV,腓总神经MNCV之间存在显著正相关(P <0. 05),与TCSS评分之间存在显著负相关(P <0. 05)。两组患者治疗后正中神经SNCV,正中神经MNCV,腓总神经SNCV,腓总神经MNCV及血清PNT,IGF-1水平较本组治疗前均明显升高,TCSS评分均明显下降(P <0. 05)。治疗后治疗组正中神经SNCV,正中神经MNCV,腓总神经SNCV,腓总神经MNCV及血清PNT,IGF-1水平均高于对照组,TCSS评分低于对照组(P <0. 05)。总有效率比较,治疗组高于对照组(P <0. 05)。结论:血清PNT,IGF-1可能参与了糖尿病患者DPN的发生和进展,加味补阳还五汤能升高DPN患者血清PNT,IGF-1水平,提高NCV,降低TCSS评分,对DPN有确切疗效。
Objective: To investigate the changes of serum proneurotensin( PNT) and insulin-like growth factor-1( IGF-1) levels in patients with diabetic peripheral neuropathy( DPN) and their relationship with nerve conduction velocity( NCV) and Toronto Clinical Scoring System( TCSS),so as to observe the clinical efficacy of modified Buyang Huanwu Tang on DPN patients and its effect on the levels of PNT and IGF-1. Method: Totally 68 patients with DPN were randomly divided into treatment group and control group,with 34 cases in each group. Both groups were given mecobalamin capsules orally in addition to routine therapy of diabetes,while the treatment group was given modified Buyang Huanwu Tang orally for 4 weeks. The sensory nerve conduction velocity( SNCV) of median nerve,motor nerve conduction velocity( MNCV) of median nerve,SNCV of common peroneal nerve,MNCV of common peroneal nerve,TCSS score and serum PNT,IGF-1 levels were observed before and after treatment. Result: Before treatment,there was no significant difference in SNCV of median nerve,MNCV of median nerve,SNCV of common peroneal nerve,MNCV of common peroneal nerve,TCSS score and serum levels of PNT and IGF-1 between two groups. Serum levels of PNT and IGF-1 were positively correlated with SNCV of median nerve,MNCV of median nerve,SNCV of common peroneal nerve and MNCV of common peroneal nerve( P < 0. 05),and negatively correlated with TCSS score( P < 0. 05). Compared with those before treatment,SNCV of median nerve,MNCV of median nerve,SNCV of common peroneal nerve,MNCV of common peroneal nerve and the levels of serum PNT and IGF-1 in both groups were significantly increased( P < 0. 05),while TCSS scores were significantly decreased( P < 0. 05). Compared with control group,SNCV of median nerve,MNCV of median nerve,SNCV of common peroneal nerve,MNCV of common peroneal nerve and the levels of serum PNT and IGF-1 in treatment group were higher than those in control group( P < 0. 05),TCSS score was lower than that in the control group( P < 0. 05),and the total effective rate in treatment group was higher than that in control group( P <0. 05). Conclusion: Serum PNT and IGF-1 may be involved in the occurrence and progress of DPN in patients with diabetes mellitus. Modified Buyang Huanwu Tang can increase the levels of serum PNT,IGF-1,NCV but reduce TCSS score in patients with DPN. It has a definite curative effect on DPN.
Objective: To investigate the changes of serum proneurotensin( PNT) and insulin-like growth factor-1( IGF-1) levels in patients with diabetic peripheral neuropathy( DPN) and their relationship with nerve conduction velocity( NCV) and Toronto Clinical Scoring System( TCSS),so as to observe the clinical efficacy of modified Buyang Huanwu Tang on DPN patients and its effect on the levels of PNT and IGF-1. Method: Totally 68 patients with DPN were randomly divided into treatment group and control group,with 34 cases in each group. Both groups were given mecobalamin capsules orally in addition to routine therapy of diabetes,while the treatment group was given modified Buyang Huanwu Tang orally for 4 weeks. The sensory nerve conduction velocity( SNCV) of median nerve,motor nerve conduction velocity( MNCV) of median nerve,SNCV of common peroneal nerve,MNCV of common peroneal nerve,TCSS score and serum PNT,IGF-1 levels were observed before and after treatment. Result: Before treatment,there was no significant difference in SNCV of median nerve,MNCV of median nerve,SNCV of common peroneal nerve,MNCV of common peroneal nerve,TCSS score and serum levels of PNT and IGF-1 between two groups. Serum levels of PNT and IGF-1 were positively correlated with SNCV of median nerve,MNCV of median nerve,SNCV of common peroneal nerve and MNCV of common peroneal nerve( P < 0. 05),and negatively correlated with TCSS score( P < 0. 05). Compared with those before treatment,SNCV of median nerve,MNCV of median nerve,SNCV of common peroneal nerve,MNCV of common peroneal nerve and the levels of serum PNT and IGF-1 in both groups were significantly increased( P < 0. 05),while TCSS scores were significantly decreased( P < 0. 05). Compared with control group,SNCV of median nerve,MNCV of median nerve,SNCV of common peroneal nerve,MNCV of common peroneal nerve and the levels of serum PNT and IGF-1 in treatment group were higher than those in control group( P < 0. 05),TCSS score was lower than that in the control group( P < 0. 05),and the total effective rate in treatment group was higher than that in control group( P <0. 05). Conclusion: Serum PNT and IGF-1 may be involved in the occurrence and progress of DPN in patients with diabetes mellitus. Modified Buyang Huanwu Tang can increase the levels of serum PNT,IGF-1,NCV but reduce TCSS score in patients with DPN. It has a definite curative effect on DPN.
引文
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[3]金秀平,刘佳.血浆神经降压素与糖尿病周围神经病变的关系[J].实用医学杂志,2010,26(18):3353-3354.
[4]唐梅,王琪,李赫冬,等.胰岛素样生长因子-1在神经前体细胞中抗凋亡的作用[J].四川大学学报:医学版,2014,45(1):15-18.
[5]孙殿静,谷巍,刘晴晴.依帕司他联合硫辛酸治疗糖尿病周围神经病变的临床观察[J].中国药房,2017,28(23):3226-3229.
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[7]甄燕,高素红,武春林,等.度洛西汀联合甲钴胺治疗痛性糖尿病周围神经病变的临床疗效观察[J].临床合理用药杂志,2015,8(4):82-83.
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[11]方朝晖,吴以岭,赵进东.糖尿病周围神经病变中医临床诊疗指南(2016年版)[J].中医杂志,2017,58(7):625-630.
[12]裴强,桑文凤,赵习德.桂枝茯苓胶囊联合鼠神经生长因子治疗糖尿病周围神经病变[J].中成药,2013,35(7):1396-1399.
[13]宁冬平,许可,朱惠娟,等.血清新脂肪因子前神经降压肽与贵州省汉族人群代谢综合征相关[J].基础医学与临床,2018,38(12):1673-1679.
[14]林旋,魏爱生,叶建红,等.α-硫辛酸治疗糖尿病周围神经病变的的效果及对胰岛素样生长因子-1的影响[J].中国老年学杂志,2017,37(12):2948-2950.
[15]郭慧,李树成,马民.糖尿病周围神经病变的病因病机及证治探讨[J].新中医,2009,41(12):3-4.
[16]罗贤红,卢敏,李雄,等.加味补阳还五汤治疗外伤性周围神经损伤脉络瘀阻证[J].中国实验方剂学杂志,2016,22(9):167-171.
[17]赵胜,毛奇.补阳还五汤合八珍汤治疗糖尿病肌萎缩的疗效及其对患者血糖、胰岛功能、神经传导功能、血清相关因子的影响[J].中国实验方剂学杂志,2018,24(22):175-180.
[18]丁瑜芝,袁松涛,刘云.糖尿病周围神经病变及黄芪甲苷对其治疗作用的研究进展[J].江苏医药,2013,39(15):1817-1819.
[19]陈梦静,龚雪媛,龚恒佩,等.芍药苷对皮质酮致原代皮层细胞神经损伤的保护作用及机制研究[J].中华中医药杂志,2018,33(4):1507-1511.
[20]彭其胜.红花注射液对大鼠周围神经缺血再灌注损伤的保护作用及其机制研究[J].中国药房,2011,22(23):2139-2141.
[21]文欢,张大燕,王伟,等.天麻素对糖氧剥夺再复供皮层神经细胞NF-κB炎症级联信号通路表达的影响[J].中国实验方剂学杂志,2017,23(21):104-111.
[22]杜清华,曹唯仪,王宏涛,等.土鳖虫活性组分对过氧化氢损伤血管内皮细胞的保护作用[J].中医药信息,2014,31(3):10-14.
[23]黄庆,李志武,马志国,等.地龙的研究进展[J].中国实验方剂学杂志,2018,24(13):220-226.
[24]张娥,徐藜栩,赵统德,等.水蛭对动脉粥样硬化发生的相关细胞作用研究进展[J].中国动脉硬化杂志,2017,25(11):1184-1188.
[25]袁伟,王友明,侯仙明,等.蜣螂在糖尿病周围神经病变治疗中的重要作用[J].中国中医基础医学杂志,2014,20(2):245-246.
[2]李颖,李刚,冯波.糖尿病周围神经病变的诊治进展[J].中国糖尿病杂志,2013,21(9):769-772.
[3]金秀平,刘佳.血浆神经降压素与糖尿病周围神经病变的关系[J].实用医学杂志,2010,26(18):3353-3354.
[4]唐梅,王琪,李赫冬,等.胰岛素样生长因子-1在神经前体细胞中抗凋亡的作用[J].四川大学学报:医学版,2014,45(1):15-18.
[5]孙殿静,谷巍,刘晴晴.依帕司他联合硫辛酸治疗糖尿病周围神经病变的临床观察[J].中国药房,2017,28(23):3226-3229.
[6]中国医师协会神经内科医师分会疼痛和感觉障碍专委会.糖尿病性周围神经病理性疼痛诊疗专家共识[J].中国疼痛医学杂志,2018,24(8):561-567.
[7]甄燕,高素红,武春林,等.度洛西汀联合甲钴胺治疗痛性糖尿病周围神经病变的临床疗效观察[J].临床合理用药杂志,2015,8(4):82-83.
[8]张涛静,龚燕冰,周晖,等.糖尿病周围神经病变的中西医诊治[J].中华中医药杂志,2014,29(8):2433-2436.
[9]宋春宇,王中京,赵湜,等.甲钴胺联合α-硫辛酸治疗糖尿病周围神经病变对神经电生理的影响[J].广东医学,2015,36(11):1754-1757.
[10]李翠娟,巩振东,苗彦霞.中医药治疗糖尿病周围神经病变用药规律分析[J].现代中医药,2010,30(4):75-76.
[11]方朝晖,吴以岭,赵进东.糖尿病周围神经病变中医临床诊疗指南(2016年版)[J].中医杂志,2017,58(7):625-630.
[12]裴强,桑文凤,赵习德.桂枝茯苓胶囊联合鼠神经生长因子治疗糖尿病周围神经病变[J].中成药,2013,35(7):1396-1399.
[13]宁冬平,许可,朱惠娟,等.血清新脂肪因子前神经降压肽与贵州省汉族人群代谢综合征相关[J].基础医学与临床,2018,38(12):1673-1679.
[14]林旋,魏爱生,叶建红,等.α-硫辛酸治疗糖尿病周围神经病变的的效果及对胰岛素样生长因子-1的影响[J].中国老年学杂志,2017,37(12):2948-2950.
[15]郭慧,李树成,马民.糖尿病周围神经病变的病因病机及证治探讨[J].新中医,2009,41(12):3-4.
[16]罗贤红,卢敏,李雄,等.加味补阳还五汤治疗外伤性周围神经损伤脉络瘀阻证[J].中国实验方剂学杂志,2016,22(9):167-171.
[17]赵胜,毛奇.补阳还五汤合八珍汤治疗糖尿病肌萎缩的疗效及其对患者血糖、胰岛功能、神经传导功能、血清相关因子的影响[J].中国实验方剂学杂志,2018,24(22):175-180.
[18]丁瑜芝,袁松涛,刘云.糖尿病周围神经病变及黄芪甲苷对其治疗作用的研究进展[J].江苏医药,2013,39(15):1817-1819.
[19]陈梦静,龚雪媛,龚恒佩,等.芍药苷对皮质酮致原代皮层细胞神经损伤的保护作用及机制研究[J].中华中医药杂志,2018,33(4):1507-1511.
[20]彭其胜.红花注射液对大鼠周围神经缺血再灌注损伤的保护作用及其机制研究[J].中国药房,2011,22(23):2139-2141.
[21]文欢,张大燕,王伟,等.天麻素对糖氧剥夺再复供皮层神经细胞NF-κB炎症级联信号通路表达的影响[J].中国实验方剂学杂志,2017,23(21):104-111.
[22]杜清华,曹唯仪,王宏涛,等.土鳖虫活性组分对过氧化氢损伤血管内皮细胞的保护作用[J].中医药信息,2014,31(3):10-14.
[23]黄庆,李志武,马志国,等.地龙的研究进展[J].中国实验方剂学杂志,2018,24(13):220-226.
[24]张娥,徐藜栩,赵统德,等.水蛭对动脉粥样硬化发生的相关细胞作用研究进展[J].中国动脉硬化杂志,2017,25(11):1184-1188.
[25]袁伟,王友明,侯仙明,等.蜣螂在糖尿病周围神经病变治疗中的重要作用[J].中国中医基础医学杂志,2014,20(2):245-246.