黄莺莺　李莉霞　何苏

[摘要] 目的 分析糖尿病周圍神经病变（DPN）患者应用依帕司他联合甲钴胺片治疗的效果。 方法 将四川省南充市第二人民医院2016年6月～2017年6月收治的94例DPN患者作为研究对象，按照随机数字表法，将患者随机分为对照组与联合组，每组各47例。对照组给予甲钴胺片治疗，0.5～1.0 mg/次，3次/d；联合组在对照组治疗基础上应用依帕司他进行治疗，50 mg/次，3次/d。两组患者均治疗8周。比较两组临床疗效、治疗前后白细胞介素-1β（IL-1β）和基质金属蛋白酶9（MMP-9）含量变化及不良反应的发生情况。 结果 联合组治疗总有效率为91.49%，较对照组的72.34%显著升高（P < 0.05）。两组治疗后神经传导速度较治疗前均显著升高，且联合组较对照组显著升高（均P < 0.05）。两组患者治疗后IL-1β与MMP-9水平较治疗前均显著降低，且联合组IL-1β与MMP-9水平较对照组均显著降低（均P < 0.01）。两组患者不良反应发生率的比较，差异无统计学意义（P > 0.05）。 结论 DPN患者应用依帕司他可取得良好的治疗效果，且可有效调节IL-1β与MMP-9表达，可明显降低血清炎性介质的水平，有效减缓病情进展程度，可增强临床效果，因此具有良好的临床应用价值。

[关键词] 糖尿病周围神经病变；依帕司他；白细胞介素-1β；基质金属蛋白酶9

[中图分类号] R969.4 [文献标识码] A [文章编号] 1673-7210（2018）07（b）-0063-04

Efficacy of Epalrestat combined with Mecobalamin Tablets in the treatment of diabetic peripheral neuropathy

HUANG Yingying1 LI Lixia1 HE Su1 LONG Shiyu2

1.Department of Neurology， Nanchong Second People′s Hospital， Nanchong Mental Health Center of Sichuan Province， Sichuan Province， Nanchong 637000， China； 2.Department of Neurology， Nanchong Fifth People′s Hospital， Sichuan Province， Nanchong 637000， China

[Abstract] Objective To analyze the efficacy of Epalrestat combined with Mecobalamin Tablets on patients with diabetic peripheral neuropathy （DPN）. Methods Ninety-four patients with DPN treated in Nanchong Second People′s Hospital of SichuanProvince from June 2016 to June 2017 were selected. According to the random number table method， the patients were divided into the control group and the combined group， with 47 cases in each group. The control group was treated with Mecobalamin Tablets， 0.5-1.0 mg/time and 3 times/d， and the combined group was treated with Epalrestat on the basis of the control group， 50 mg/time， and 3 times/d. The two groups were treated for 8 weeks. The clinical efficacy， the changes of interleukin-1β （IL-1β） and matrix metalloproteinase 9 （MMP-9） levels before and after treatment and the incidence of adverse reactions were compared between the two groups. Results The total effective rate of the combined group was 91.49%， which was significantly higher than that of the control group （72.34%） （P < 0.05）. After treatment， nerve conduction velocity in the two groups increased significantly in comparison of those before treatment， and the level in the combined group was significantly higher than that in the control group （P < 0.05）. The levels of IL-1β and MMP-9 in the two groups were significantly lower than those before treatment， and the levels of IL-1β and MMP-9 in the combined group were significantly lower than those in the control group （all P < 0.05）. There was no significant difference in the incidence rate of adverse reactions between the two groups （P > 0.05）. Conclusion The application of Epalrestat in patients with DPN has good therapeutic effect， which can effectively regulate the expression of IL-1β and MMP-9. And it can obviously reduce the level of serum inflammatory mediators， effectively slow down the rogression of the disease， and can enhance the clinical effect， so it has better clinical value.

[Key words] Diabetic peripheral neuropathy； Epalrestat； Interleukin-1β； Matrix etalloproteinase-9

近年来，我国糖尿病周围神经病变（diabetic peripheral neuropathy，DPN）的发病率逐年升高，并且发病群体呈现年轻化趋势。目前，对DPN患者的治疗仍采取药物控制血糖的方法，并且临床已有诸多治疗此类患者的药物，其种类多而杂。虽然药物治疗在控制DPN患者血糖水平上具有重要作用，但控制炎性因子等表达水平的效果仍有待提高。据报道[1-3]，在DPN发生和发展过程中，白细胞介素-1β（IL-1β）与基质金属蛋白酶9（MMP-9）水平明显升高，同时二者可促进DPN的病情进展。本研究将探讨DPN患者应用依帕司他联合甲钴……