陈瑜 陈英俊 王俊

[摘要] 目的 探討甲钴胺联合依帕司他对糖尿病性周围神经病变（DPN）患者血清炎症因子及电生理指标的影响。方法 将84例DPN患者随机分为观察组和对照组。两组均予以糖尿病基础治疗，包括健康教育、严格饮食控制、适当体育锻炼及药物控制血糖。观察组予以甲钴胺片（0.5 mg/次，3次/d）联合依帕司他片（50 mg/次，3次/d）治疗，对照组予以单纯甲钴胺片（0.5 mg/次，3次/d）治疗，两组疗程均16周。观察两组治疗前后血清hs-CRP和TNF-α水平和神经电生理指标[正中神经及腓总神经运动支传导速度（MCV）与感觉支传导速度（SCV）]的变化，并比较其不良反应。 结果 治疗16周后，两组血清hs-CRP和TNF-α水平明显下降（P<0.05或P<0.01），观察组下降幅度更显著（P<0.05）；同时两组正中神经、腓总神经MCV和SCV较前明显加快（P<0.05或P<0.01），观察组加快幅度更显著（P<0.05）。 结论 甲钴胺联合依帕司他治疗DPN的患者能明显改善其神经功能，加快周围神经传导速度，安全性较好，其机制可能与其能降低血清hs-CRP和TNF-α水平、抑制血管内皮炎症反应密切相关。

[关键词] 糖尿病性周围神经病变；甲钴胺；依帕司他；炎症因子；电生理指标

[中图分类号] R587.1 [文献标识码] A [文章编号] 1673-9701（2018）02-0027-04

[Abstract] Objective To investigate the effect of mecobalamin combined with epalrestat on serum inflammatory factors and electrophysiological indexes in patients with diabetic peripheral neuropathy（DPN）. Methods 84 patients with DPN were randomly divided into observation group and control group. Both groups were given basic diabetes treatment， including health education， strict diet control， proper physical exercise and blood sugar control by drugs. The observation group was given mecobalamin tablets（0.5 mg/time， 3 times/d）combined with epalrestat tablets （50 mg/time， 3 times/d）for treatment. The control group was given mecobalamin tablets（0.5 mg/time， 3 times/d）alone. The course of treatment was 16 weeks for both groups. The changes of serum hs-CRP and TNF-α levels and the electrophysiological indexes [median nerve and common peroneal nerve motor branch conduction velocity（MCV） and sensory branch conduction velocity（SCV）] of two groups were observed before and after treatment， and their adverse reactions were compared. Results After 16 weeks of treatment， the levels of serum hs-CRP and TNF-α in the two groups were significantly decreased（P<0.05 or P<0.01）， and the decrease degree in the observation group was more significant（P<0.05）；at the same time， the MCV and SCV of the median nerve and the common peroneal nerve of the two groups were significantly faster than before（P<0.05 or P<0.01）， and the acceleration degree in the observation group was more significant（P<0.05）. Conclusion Mecobalamin combined with epalrestat in patients with DPN can significantly improve their neurological function， speed up the peripheral nerve conduction velocity， and the safety is good. The mechanism may be closely related to its ability to reduce serum hs-CRP and TNF-α levels， and inhibit vascular endothelial inflammation.

[Key words] Diabetic peripheral neuropathy（DPN）； Mecobalamin； Epalrestat； Inflammatory factors；Electrophysiological indexes

糖尿病是以血糖升高为主要表现的慢性内分泌疾病，糖尿病周围神经病变（diabetic peripheral neuropathy，DPN）是其常见的并发症之一，发病率高达50%～60%，以感觉神经受累为主，表现为局部麻木刺痛、严重时肌肉萎缩等，是引起患者致残的最主要原因[1-3]。DPN的发病机制迄今国内外尚不完全清楚，其中超敏C反应蛋白（high-sensitivity C-reactive protein，hs-CRP）和肿瘤坏死因子-α（tumor necrosis factor，TNF-α）等介导的炎症反应在DPN的作用越来越受到临床的重视[4，5]。目前临床上对DPN治疗以营养神经与改善微循环为主，代表药物为维生素B12为辅基的甲钴胺，虽部分患者使用后的临床效果欠佳[6，7]。依帕司他是一种醛糖还原酶抑制药，能减少糖尿病患者山梨醇的蓄积量，改善代谢紊乱状况，加快外周神经支配区域的感觉运动障碍好转，近年来其联合甲钴胺治疗DPN取得了较好的效果，但两者联合使用是否抑制炎症反应目前国内外报道不多[8-10]。……