刘丹英　王俊

[摘要] 目的 探討α-硫辛酸联合甲钴胺对糖尿病性周围神经病变（DPN）患者血清氧化应激水平的影响及疗效。方法 选择2015年1月～2017年4月住院治疗DPN患者76例，随机分为观察组和对照组各38例。两组患者均予以饮食控制、适当体育锻炼及口服降糖药物或胰岛素注射治疗控制血糖，使得血糖达标。对照组在此基础上加用甲钴胺针肌注0.5 mg/次，1次/d，连用4周。观察组在对照组基础上加用α-硫辛酸针静滴，600 mg/次，1次/d，连用4周。观察两组治疗前后血清氧化应激指标[血清丙二醛（MDA）和超氧化物歧化酶（SOD）]，并评估其临床疗效及不良反应。 结果 治疗4周后，两组血清MDA和SOD指标分别较治疗明显下降或上升（P<0.05或P<0.01），观察组变化幅度较对照组更明显（P<0.05）；同时观察组临床总有效率较对照组更佳（χ2=4.15，P<0.05）。对照组与观察组分别出现不良反应3例（7.89%）和6例（15.79%），症状较轻，均逐渐自行缓解，两组比较差异无统计学意义（χ2=0.50，P>0.05）。 结论 α-硫辛酸结合甲钴胺治疗DPN的疗效明显优于单纯的甲钴胺治疗，安全性佳，且作用机制与其能降低血清MDA指标，升高血清SOD指标，减轻氧自由基对神经损伤，对脂质过氧化损伤起保护作用密切相关。

[关键词] 糖尿病性周围神经病变；α-硫辛酸；甲钴胺；氧化应激

[中图分类号] R587.1 [文献标识码] B [文章编号] 1673-9701（2017）36-0109-04

[Abstract] Objective To investigate the effect of α-lipoic acid combined with mecobalamin on serum oxidative stress in patients with diabetic peripheral neuropathy（DPN） and its therapeutic effect. Methods A total of 76 patients with DPN in our hospital from January 2015 to April 2017 were randomly divided into observation group（n=38） and control group（n=38）. Two groups of patients were given diet control， appropriate physical exercise and oral hypoglycemic drugs or insulin injection treatment to control blood sugar， making the blood glucose reach the standard. And the control group was added with mecobalamin needle intramuscular injection 0.5 mg/times， 1/d， for 4 weeks. The observation group was added with α-lipoic acid needle intravenous， 600 mg/times， 1/d， for 4 weeks based on the treatment of the control group. Serum oxidative stress indicators including serum malondialdehyde（MDA） and superoxide dismutase （SOD） in the two groups were measured before and after treatment， and the clinical efficacy and adverse reactions were evaluated. Results After 4 weeks of treatment， the levels of serum MDA and SOD in the two groups were significantly lower or higher than those before treatment（P<0.05 or P<0.01）. And the magnitude of change in the observation group was more significant than that of he control group（P<0.05）. And the overall effective rate in the observation group was better than that of the control group（χ2=4.15， P<0.05）. There were 3 cases （7.89%） and 6 cases （15.79%） of the adverse reactions in the control group and the observation group， and the symptoms were mild and gradually alleviated. There was no significant difference between the two groups（χ2=0.50， P>0.05）. Conclusion The efficacy of α-lipoic acid combined with mecobalamin in the treatment of DPN is superior to that of methylcobalamin alone. And the safety of the combination therapy is good， and its mechanism is related with the decreasing of the serum MDA， increasing the serum SOD， reducing the oxygen free radicals and the protective effect of lipid peroxidation injury.

[Key words] Diabetic peripheral neuropathy； α-lipoic acid； Mecobalamin； Oxidative stress

糖尿病是中老年患者的常见内分泌疾病，神经病变是其常见的慢性并发症之一，病变累及中枢及周围和自主神经，尤其糖尿病周围神经病变（DPN）最多见，主要表现为局部麻木刺痛，严重时肌肉萎缩等[1-3]。DPN的病因及发病机制很复杂，研究发现氧化应激的损伤引起的脂质过氧化损伤在DPN的發病过程中起及其重要的作用[4-6]。甲钴胺是治疗DPN常用药，可加快修复受损的神经组织，促进受损轴突的修复再生，但是单独使用的效果欠理想，远期效果亦欠佳[7，8]。……