普瑞巴林与度洛西汀治疗糖尿病痛性神经病变的疗效对比

目的:观察普瑞巴林与度洛西汀治疗糖尿病痛性神经病变的疗效。方法:入选2型糖尿病患者98例,随机分为两组:普瑞巴林组(n=50),盐酸度洛西汀组(n=48),共观察4周,治疗开始和治疗后4周采用简明疼痛量表(Brief Pain Inventory,BPI)和McGill疼痛问卷简表(Short Form McGill Pain Questionnaire,SF-MPQ)进行疼痛评分并记录药物不良反应。结果:治疗前后主要终点指标BPI评分,普瑞巴林组为(5.6±1.3)vs(1.5±1.1)分;度洛西汀组为(4.8±1.7)vs(1.8±1.3)分(P均0.01)。治疗前后SFMPQ评分,普瑞巴林组从治疗前的(75±6)分降低至治疗后4周的(24±4)分,度洛西汀组从治疗前的(71±7)分降低至治疗后4周的(26±3)分。经秩和检验或χ2检验,两组差异没有统计学意义(P0.05)。普瑞巴林组不良反应明显低于度洛西汀组,差异有统计学意义(P0.01)。结论:普瑞巴林和度洛西汀均可缓解糖尿病痛性神经病变,疗效相当,但普瑞巴林不良反应相对较少。     

度洛西汀联合甲钴胺治疗痛性糖尿病周围神经病变的临床疗效观察

目的观察度洛西汀联合甲钴胺治疗痛性糖尿病时对周围神经病变的治疗效果。方法将200例糖尿病伴周围神经病变患者随机分为研究组和对照组各100例。研究组患者使用度洛西汀联合甲钴胺治疗,比较2组临床疗效,以及2组患者治疗前后神经传导速度、视觉模拟疼痛评分(VAS)及睡眠时间变化。结果观察组总有效率为85.0%高于对照组的70.0%,差异有统计学意义(P<0.05)。治疗前,2组正中神经和腓总神经MCV、SCV差异无统计学意义(P>0.05),治疗后,2组正中神经和腓总神经MCV、SCV速度均高于治疗前,且观察组高于对照组(P<0.05)。治疗前2组VAS评分和睡眠时间差异无统计学意义(P>0.05)。治疗后,2组VAS评分均低于治疗前,睡眠时间长于治疗前,且观察组优于对照组(P<0.05)。结论度洛西汀联合甲钴胺治疗痛性糖尿病周围神经病变较单纯使用甲钴胺具有更好的治疗效果,明显改善患者的生活质量,具有较好的临床应用价值。     

糖尿病痛性神经病变的治疗新进展

目的:糖尿病痛性神经病变引起的神经痛让患者备受煎熬,有效缓解患者神经痛、改善患者生活质量,越来越受到医学界关注。如何选择多种治疗神经痛药物,成为临床医生面临的问题。方法:本文概括了糖尿病痛性神经病变的可能发生机制及治疗药物,结合2017年美国糖尿病协会(ADA)糖尿病医学诊疗标准与糖尿病神经病变立场声明,归纳了糖尿病痛性神经病变的治疗进展。结果:纳入了糖尿病痛性神经病变的多种药物治疗相关研究结果。结论:随着越来越多关于糖尿病痛性神经病变药物的临床研究开展及指南的不断更新,人们对糖尿病痛性神经病变治疗的认识越来越多。     

糖尿病痛性神经病变

<正>糖尿病神经病变是糖尿病患者中最常见也是最易致残的慢性并发症之一。目前糖尿病神经病变的发病机制包括多元醇通路亢进、非酶蛋白质糖基化、肌醇耗竭及脂代谢异常在内的代谢学说,和血供障碍学说、氧化应激学说、神经营养因子的缺乏以及免疫学说,其产生背景是长期高血糖。而从中医学的角度,糖尿病周围神经病变属于消渴痹证,是因消渴(糖     

痛性糖尿病神经病变的药物治疗

1概述近年来,随着我国糖尿病患者的绝对数量和患病率的增加,在糖尿病的临床诊疗中,痛性糖尿病神经病变(painful diabetic neuropathy,PDN)已屡见不鲜,是内分泌科常见的以疼痛为主诉的疾病之一。PDN作为一种常见的神经病理性疼痛,影响着患者机体功能和生活质量、病死率及公共健康医疗费用[1-2]。澳大利亚的一项人群研究评估了平均病程约为8年的2型糖尿病患者,研究发现,其痛性糖尿病多发神经病变的患     

度洛西汀联合硫辛酸治疗糖尿病周围神经病变性疼痛的疗效观察

目的:探讨度洛西汀联合硫辛酸治疗糖尿病周围神经病变性疼痛的有效性及安全性。方法:将78例糖尿病周围神经病变性疼痛患者随机分为两组,西汀组口服度洛西汀,联合组口服度洛西汀和静脉滴注硫辛酸,比较两组疗效。结果:两组治疗后正中神经感觉传导速度(median nerve conduction velocity,MNCV)、腓总神经感觉传导速度(phil nerve conduction velocity,PNCV)、尺神经感觉传导速度(ulnar nerve conduction velocity,UNCV)均显著提高(P<0.05);联合组治疗4周、8周后MNCV、PNCV、UNCV均显著高于治疗前及同期西汀组(P<0.05);两组治疗后疼痛强度简易评述量表(VRS)、数字疼痛强度量表(NRS)评分显著下降(P<0.05);联合组治疗4周、8周后VRS、NRS评分显著低于治疗前及同期西汀组(P<0.05);两组不良反应发生率(30.77%和23.08%)差异无统计学意义(P>0.05);两组治疗前、治疗8周后胆固醇(TC)、甘油三酯(TG)、丙氨酸氨基转移酶(ALT)、门冬氨酸氨基转移酶(AST)、血肌酐(SCr)指标水平均无显著性变化(P>0.05)。结论:度洛西汀联合硫辛酸治疗糖尿病周围神经病变性疼痛,能有效改善患者神经功能,减轻疼痛症状,且安全可靠。     

硫辛酸联合加巴喷丁治疗痛性糖尿病神经病变的临床效果

目的：探讨硫辛酸联合加巴喷丁治疗痛性糖尿病神经病变的效果。方法选取2013年1月~2014年1月本院收治的80例痛性糖尿病神经病变患者,随机分为A、B组,每组各40例,A组给予硫辛酸治疗,B组给予硫辛酸联合加巴喷丁治疗,经过4周治疗后,比较两组患者治疗前后临床表现、视觉模拟评分（VAS）及运动神经传导速度（MNCV）、感觉神经传导速度（SNCV）的变化情况。结果两组患者治疗后疼痛均有一定程度缓解,A组患者的总有效率为80.0%,B组为92.5%,两组差异有统计学意义（P〈0.05）;两组患者的VAS均下降,组间差异有统计学意义（P〈0.05）;两组患者的MNCV及SNCV均改善,两组患者的SNCV差异有统计学意义（P〈0.05）,MNCV差异无统计学意义（P〉0.05）。结论硫辛酸联合加巴喷丁治疗痛性糖尿病神经病变的效果显著。     

鼠神经生长因子治疗糖尿病痛性神经病变的临床效果分析

目的 分析鼠神经生长因子治疗糖尿病痛性神经病变的临床效果.方法 66例糖尿病痛性神经病变患者随机的分为对照组和实验组,每组各有33例患者,对照组患者肌肉注射500μg甲钴胺,1日1次;实验组患者肌肉注射1000U鼠神经生长因子,1日1次;两组患者均肌肉注射4周,比较分析两组患者的临床治疗效果和治疗前后神经感觉传导速度、神经运动传导速度.结果 对照组中总有效率为63.64%;而实验组总有效率为87.88%.治疗后实验组的SCV和MCV明显高于与对照组,存在着显著性差异(P<0.05).结论 鼠神经生长因子在治疗糖尿病痛性神经病变中临床效果较为明显,在临床中具有推广和应用价值.     

盐酸度洛西汀在糖尿病痛性周围神经病变治疗中的应用

糖尿病周围神经病变是糖尿病最常见的慢性并发症之一,发病机制尚未完全明了。度洛西汀能阻断5-羟色胺(5-HT)和去甲肾上腺素(NE)的吸收、转运及结合,强烈抑制5-HT和NE再摄取,使大脑和脊髓中的5-HT和NE浓度升高,使这两种神经递质在调控情感和对疼痛敏感程度方面的作用提高,增加机体对疼痛的耐受力,从而缓解疼痛。     

阿米替林联合α-硫辛酸治疗痛性糖尿病周围神经病变临床疗效

目的：观察阿米替林联合α-硫辛酸治疗痛性糖尿病周围神经病变的临床效果。方法100例糖尿病周围神经病变患者随机分为观察组（50例）和对照组（50例）。观察组给予阿米替林联合α-硫辛酸治疗;对照组单纯给予α-硫辛酸。治疗4周。比较两组治疗前后神经症状、体征及神经传导速度。结果观察组与对照组相比,前者临床缓解率明显比对照组高,前者神经传导速度比对照组高,差异有统计学意义（P〈0.05）。结论在临床中,采用两种药物联合的方法比单纯采用一种药物的效果更佳,患者满意度更高,副作用更小。     

Pharmacologic management of diabetic peripheral neuropathic pain

Introduction: Diabetic peripheral neuropathic pain (DPNP) is a debilitating and distressing complication that occurs in patients with diabetes mellitus. This article provides an overview of diabetic peripheral neuropathy focusing on DPNP.

Areas covered: This article reviews the diagnosis, pathogenesis, prevention and treatment of diabetic neuropathy and neuropathic pain. A comprehensive and systematic Medline search of the published literature for treatment of diabetic peripheral neuropathy was done from 1965 to December 2012. Studies not in English language were excluded.

Expert opinion: Neuropathic pain is difficult to treat, and patients rarely experience complete pain relief. Despite several pharmacological agents being used in the treatment of DPNP, only duloxetine and pregabalin have evidence-based support for controlling DPNP.     

加巴喷丁治疗糖尿病周围神经痛的Meta分析

目的 评价加巴喷丁治疗糖尿病性周围神经痛的有效性和安全性.方法 采用循证医学的文献分析评价方法,计算机检索Cochrane图书馆系统评价数据库、Pubmed、中国学术期刊全文数据库、万方数据库、维普数据库等,采用RevMan5.2软件进行Meta分析.结果 纳入研究12项,共931例患者,Meta分析显示加巴喷丁反应有效率[OR=2.99,95%CI(1.72,5.20),P <0.000 1]及不良反应发生率[OR=4.05,95%CI(1.10,14.95),P=0.04]均高于安慰剂,加巴喷丁治疗效果高于卡马西平/奥卡西平[OR=3.60,95%CI(1.14,11.31),P=0.03]和维生素B₁₂,而不良反应则较卡马西平轻;加巴喷丁与度洛西汀、普瑞巴林比较,治疗效果相当,但度洛西汀[OR=2.06,95%CI(1.22,3.48),P=0.007]和普瑞巴林的不良反应较少.结论 加巴喷丁治疗糖尿病性周围神经痛效果显著,安全性较好.     

Emerging drugs for diabetic peripheral neuropathy and neuropathic pain

Introduction: Diabetic sensorimotor polyneuropathy (DSPN) is a common complication of diabetes.

Areas covered: In this review, the authors discuss the emerging drugs for DSPN, which aim either at improving alleviation of neuropathic pain or addressing the putative mechanisms underlying diabetic neuropathy.

Expert Opinion: Current treatment does not address the sensory deficits and pathogenesis underlying DSPN, so there is an unmet need for treatment options targeting the natural history of the condition. Some of these pathogenetic therapies have demonstrated clinically relevant improvements in neuropathic endpoints in recent randomised controlled trials. Since any effective analgesic monotherapy is known to induce a clinically meaningful response in only some 50% of the patients, there remains a substantial unmet need in patients with neuropathic pain. Advanced knowledge in the neurobiology of neuropathic pain and improved phenotypic profiling have led to a burst of research into novel pharmaceutical approaches. An array of promising molecular entities have reached the clinical stage of development, which should improve our therapeutic armamentarium in the fight against DSPN and neuropathic pain in the foreseeable future.     

Medication adherence and healthcare costs among patients with diabetic peripheral neuropathic pain initiating duloxetine versus pregabalin

Abstract

Objective:

To examine the impact of medication choice between duloxetine or pregabalin on medication adherence and direct healthcare costs among patients with diabetic peripheral neuropathic pain (DPNP).     

Safety and tolerability of duloxetine in the acute management of diabetic peripheral neuropathic pain: analysis of pooled data from three placebo-controlled clinical trials

Objective: Summarize safety and tolerability of duloxetine in treating diabetic peripheral neuropathic pain.

Research design and methods: Pooled data from three double-blind, randomized studies with 12-week, placebo-controlled (acute) and 52-week, routine-care-controlled (extension) phases.

Main outcome measures: Frequency/discontinuations due to treatment-emergent adverse events (TEAEs).

Results: There were 1139 (placebo, n = 339; duloxetine, n = 800) and 867 (routine-care, n = 287; duloxetine, n = 580) patients in the acute and extension phases, respectively. Patient details were as follow: 60 years (mean age); Caucasian, 84%; and male, 57%. In the acute phase, there were significantly more TEAEs, duloxetine versus placebo (p = 0.001), the most common being nausea and somnolence. Discontinuations due to adverse events were significantly greater (12.5 vs 5.6%, p < 0.001), with similar outcomes in the extension phase. Baseline-to-endpoint aspartate transaminase/alanine transaminase were significantly increased and fasting plasma glucose was increased for duloxetine (0.67 mmol/l) versus decreased in routine-care (-0.64 mmol/l, p < 0.001). HbA1c was significantly increased, duloxetine vs routine-care, in the extension phase (52 vs 19%, p < 0.001). Endpoint measures neuropathy, nephropathy and retinopathy indicated no disease progression.

Conclusions: Duloxetine was generally safe and well tolerated, with the three most commonly reported TEAEs being nausea, somnolence and constipation. Modest changes in glycemia were associated with duloxetine. Aspartate transaminase/alanine transaminase increases were transient and not considered predictive of more severe outcomes.     

通迪胶囊在各类周围神经痛治疗中的临床观察

目的：观察通迪胶囊在各类周围神经痛治疗中的临床效果。方法将60例患者随机分为通迪胶囊治疗组和空心胶囊安慰剂组,每组30例。结果通迪胶囊组有效率99%,安慰剂组有效率为13.3%,两者间差异有统计学意义（P〈0.05）。结论通迪胶囊在各类周围神经痛治疗中有效,值得临床推广使用。     

阿米替林对神经病理性疼痛大鼠脊髓GLAST的影响

目的观察阿米替林对SNI大鼠脊髓谷氨酸-天冬氨酸转运体(GLAST)表达影响。方法60只♂SD大鼠,分为空白对照组(A)、SNI模型组(B)、阿米替林(AMI)注射对照组(C)、SNI模型+AMI治疗组(D),经腹腔分别给予0.2ml生理盐水(A、B)、10mg.kg-1AMI(C和D),每日两次。术后1、3、5d取各组大鼠L3~L6脊髓,分别检测GLAST的蛋白和mRNA表达改变,同时观察机械缩足反射阈值(mechanical withdrawal threshold,MWT)改变。结果与对照组相比,B组大鼠MWT随时间明显下降,GLAST蛋白和mRNA表达先增加再降低,C组大鼠MWT无改变,但是GLAST蛋白和mRNA表达随时间逐渐增加,D组大鼠MWT给药后3d停止下降,GLAST蛋白和mRNA表达明显增高,但不随时间变化。结论阿米替林可以增加GLAST蛋白表达,可能是治疗神经病理性疼痛的机制之一。     

Topical amitriptyline and ketamine for post-herpetic neuralgia and other forms of neuropathic pain

Introduction: Neuropathic pain (NP) has several therapeutic options but efficacy is limited and adverse effects occur, such that additional treatment options are needed. A topical formulation containing amitriptyline 4% and ketamine 2% (AmiKet) may provide such an option.

Areas covered: This report summarizes both published and unpublished results of clinical trials with AmiKet. In post-herpetic neuralgia (PHN), AmiKet produces a significant analgesia which is comparable to that produced by oral gabapentin. In diabetic painful neuropathy, AmiKet showed a strong trend towards pain reduction. In mixed neuropathic pain, case series reports suggest a favourable response rate, but are limited by trial characteristics. AmiKet is absorbed minimally following topical administration. Over 700 patients have now received topical AmiKet in clinical regimens, and it is well-tolerated with the adverse effects mainly being application site reactions. Both agents are polymodal, and several mechanisms may contribute to the peripheral efficacy of AmiKet.

Expert opinion: Topical AmiKet has the potential to be a first-line treatment option for PHN, and to be useful in other NP conditions. Furthermore, AmiKet has the potential to be an adjunct to systemic therapies, with the targeting of a peripheral compartment in addition to central sites of action representing a rational drug combination.     

普瑞巴林用于化疗诱导的周围神经病理性疼痛的疗效

目的观察普瑞巴林治疗化疗诱导的外周神经病理性疼痛的疗效及安全性。方法肿瘤化疗后出现周围神经病理性疼痛患者42例随机分为两组。A组20例,每日给予普瑞巴林300mg加甲钴胺治疗;B组22例,仅给予甲钴胺治疗。持续治疗4周。采用视觉模拟评分(VAS)进行疼痛评估,计算疼痛下降指数;比较两组的疗效及不良反应。结果治疗4周后,A组治疗有效率为75.0%,明显高于B组的40.9%(P<0.05)。两组不良反应均较轻。结论在甲钴胺治疗的基础上,兼用普瑞巴林更能有效缓解化疗诱导的周围神经病理性疼痛,不良反应少。