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

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。

Effect of Modified Buyang Huanwu Tang on Serum PNT and IGF-1 in Patients with Diabetic Peripheral Neuropathy

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.