卢玩芳　张畅

【摘 要】 目的：观察甲钴胺联合复方芪丹方对糖尿病周围神经病变（DPN）的疗效及对氧化应激反应的影响。方法：选取DPN患者96例为研究对象，随机分为对照组和观察组各48例。两组均予DPN常规治疗，对照组予甲钴胺片口服治疗;观察组在对照组基础上予复方芪丹方口服治疗，两组均连续观察12周。评价并比较两组治疗前后感觉功能、神经症状及神经反射功能。测量双侧腓肠神经感觉传导速度（SNCV）及腓总神经运动传导速度（MNCV）。检测两组超氧化物歧化酶（SOD）、谷胱甘肽过氧化物酶（GSH-Px）、丙二醛（MDA）的水平。同时比较治疗后两组临床疗效。结果：观察组临床总有效率83.3%，与对照组相比，差异具有统计学意义（P<0.05）。观察组治疗后感觉功能、神经症状及神经反射评分较对照组显著降低（P<0.05），腓肠神经SNCV、腓总神经MNCV较对照组显著升高（P<0.05）。观察组治疗后MDA血清水平显著低于对照组（P<0.05），而其SOD、GSH-Px血清水平则显著高于对照组（P<0.05）。结论：甲钴胺联合复方芪丹方治疗能有效改善DPN患者临床症状，改善神经传导异常狀态，提高神经传导速度，其机制可能与抑制患者机体内氧化应激反应有关。

【关键词】 复方芪丹方;甲钴胺;糖尿病周围神经病变;疗效;氧化应激

【中图分类号】R587.2 【文献标志码】 A【文章编号】1007-8517（2021）04-0085-05

Abstract：Objective To observe the effect of mecobalamin combined with Qidan compounds on diabetic peripheral neuropathy（DPN） and its effect on oxidative stress.Methods 96 patients with DPN admitted to Huidong TCM hospital from October 2017 to March 2019 were enrolled in the study.They were randomly divided into observation and control group， with 48 cases in each. Both groups were received conventional treatments such as hypoglycemic， hypotensive， lipid-lowering， and anti-platelet aggregation. The control group received oral administration of mecobalamin tablets. The observation group was given orally Qidan compounds based on the control group. All patients were observed continuously for 12 weeks. Before and after treatment， the Toronto clinical scoring system（TCSS） scores were evaluated. The sensory function， neurological symptoms and neuroreflex function were evaluated and compared before and after treatment. The sensory conduction velocity of bilateral sural nerves was measured. And the sensory conduction velocity（SNCV） and motion conduction speed（MNCV） were tested. The serum concentrations of superoxide orgotein dismutase（SOD）， Glutathione peroxidase （GSH-Px）， and malondialdehyde（MDA） were tested as well. Meanwhile， the clinical efficacy of the two groups after treatment were observed.Results The total effective rate of the observation group was 83.3%， which was significantly different from the control group（60.4%） （P<0.05）. The scores of sensory function， neurological symptoms and neuroreflex in the observation group were lower than the control one（P<0.05）. In the observation group， the SNCV and the common peroneal nerve MNCV were significantly higher than those in the control group（P<0.05）. The serum MDA level of the observation group was higher than the control group. And the serum SOD and GSH-Px lever were increased more in the observation group than in the control one（P<0.05）.Conclusion Mecobalamin combined with Qidan compounds could effectively improve the clinical symptoms of DPN patients， which could treat with the abnormal state of nerve conduction， and it could also increase the nerve conduction velocity. The mechanism may be related to the inhibition of oxidative stress in patients.

Keywords：Qidan Compounds;Mecobalamin;Diabetic Peripheral Neuropathy;Efficacy;Oxidative Stress

糖尿病周围神经病变（Diabetic peripheral neuropathy，DPN）是糖尿病神经病变最常见的一种形式，病变主要累及外周神经，引起病变神经所支配的区域出现感觉、运动、排汗等异常，也是诱发糖尿病足溃疡的重要病因之一。DPN的西医病机尚不十分明确，治疗主要以对症支持治疗为主，因此疗效一般，患者在身体、心理健康及生活质量均受影响[1]。中医药在缓解DPN临床症状，减轻神经损伤，改善神经功能上具有独特优势。复方芪丹方是治疗DPN的经验方，临床上多与甲钴胺联用，疗效显著。因此，本研究旨在观察甲钴胺联合复方芪丹方对DPN的疗效及对氧化应激的影响，现报道如下。

1 资料与方法

1.1 一般资料 选取2017年10月至2019年3月惠东县中医院内分泌科收治的DPN患者96例为研究对象，采用求余数方法随机分为观察组和对照组，各48例。……