针药并用治疗2型糖尿病周围神经病变疗效观察

目的:观察针药并用治疗2型糖尿病周围神经病变的临床疗效.方法:将80例符合诊断标准的患者随机分为2组,在常规控制血糖的基础上,对照组40例予弥可保口服,500μg/d,3次/d;治疗组40例子大活络丸口服,1丸/次,3次/d,针灸隔日1次.2组均以8周为1个疗程.结果:治疗组显效率为57.5%,总有效率92.5%;对照组显效率37.5%,总有效率70.0%.2组比较,显效率和总有效率、神经传导速度变化均有显著差异(P＜0.05,P＜0.01),治疗组优于对照组.结论:针药并用治疗糖尿病周围神经病变疗效优于单纯西药组.     

远志对DPN大鼠血糖和尾部SNCV的影响

目的:观察远志对糖尿病周围神经病变(DPN)大鼠血糖和尾部感觉神经传导速度(SNCV)及血糖的影响.方法:48只雄性Wistar大鼠随机分为4组,正常对照组、DPN模型组、远志治疗组和远志预防组,每组12只.测定各组大鼠尾部SNCV及空腹血糖.结果:与正常对照组比较,DPN模型组大鼠血糖明显升高、尾部SNCV明显降低(P＜0.01);远志治疗组、远志预防组大鼠血糖明显低于DPN模型组、尾部SNCV明显高于模型组(P＜0.01).结论:远志可明显提高DPN大鼠尾部SNCV、降低血糖,并对DPN大鼠尾部SNCV降低、血糖升高具有预防作用.     

Detection of uremic neuropathy by reflex response latency

Dialysis time necessary for treatment of terminal renal failure is very different in different patients. Adequacy of therapy cannot be controlled by laboratory measures but only clinical means. Uremic peripheral neuropathy is regarded as the most reliable indicator of insufficient dialysis treatment. Serial measurements of peripheral nerve function therefore make individual adjustment of dialysis schedule possible. In some cases motor nerve conduction velocity is not sensitive enough for this purpose, as conduction velocity in afferent nerve fibers is disturbed at an earlier stage of uremic intoxication. Measurement of sensory nerve conduction velocity is time consuming and afferent fibers can also be examined in proprioceptive reflexes. Ths suitability of H-reflex response latency (RRL) for detection of slight uremic neuropathy was analysed. The wide range of RRL in healthy subjects can be explained by the different length of neural pathway in different subjects. A strong correlation between RRL and body height was found in healthy subjects. Relating RRL to the body height gives a highly sensitive measure of peripheral nerve function. Asymptomatic uremic neuropathy was detected very much earlier by RRL than by motor nerve conduction velocity. The method proved to be well suited for routine monitoring of uremic neuropathy in patients on dialysis.     

针灸治疗2型糖尿病周围神经病变疗效观察

目的:观察针灸治疗2型糖尿病周围神经病变的临床疗效.方法:将40例符合诊断标准的患者随机分成两组,在常规控制血糖的基础上,对照组20例给予弥可保口服,500μg/日,3次/日;治疗组20例,给予针灸隔日1次.两组均以4周为1个疗程.结果:治疗组显效率为55%,总有效率为90%.对照组显效率为35%,总有效率为65%.两组比较,显效率与总有效率、神经传导速度变化差异均有显著(P＜0.05,P＜0.01),治疗组优于对照组.结论:针灸治疗糖尿病周围神经病变优于单纯西药组.     

Management of diabetic complications: A chemical constituents based approach

Ethnopharmacological relevance

Long term hyperglycemia leads to development of complications associated with diabetes. Diabetic complications are now a global health problem without effective therapeutic approach. Hyperglycemia and oxidative stress are important components for the development of diabetic complications. Over the past few decades, herbal medicines have attracted much attention as potential therapeutic agents in the prevention and treatment of diabetic complications due to their multiple targets and less toxic side effects. This review aims to assess the current available knowledge of medicinal herbs for attenuation and management of diabetic complications and their underlying mechanisms.

Material and methods

Bibliographic investigation was carried out by scrutinizing classical text books and peer reviewed papers, consulting worldwide accepted scientific databases (SCOPUS, PUBMED, SCIELO, NISCAIR, Google Scholar) to retrieve available published literature. The inclusion criteria for the selection of plants were based upon all medicinal herbs and their active compounds with attributed potentials in relieving diabetic complications. Moreover, plants which have potential effect in ameliorating oxidative stress in diabetic animals have been included.

Results

Overall, 238 articles were reviewed for plant literature and out of the reviewed literature, 127 articles were selected for the study. Various medicinal plants/plant extracts containing flavonoids, alkaloids, phenolic compounds, terpenoids, saponins and phytosterol type chemical constituents were found to be effective in the management of diabetic complications. This effect might be attributed to amelioration of persistent hyperglycemia, oxidative stress and modulation of various metabolic pathways involved in the pathogenesis of diabetic complications.

Conclusion

Screening chemical candidate from herbal medicine might be a promising approach for new drug discovery to treat the diabetic complications. There is still a dire need to explore the mechanism of action of various plant extracts and their toxicity profile and to determine their role in therapy of diabetic complications. Moreover, a perfect rodent model which completely mimics human diabetic complications should be developed.     

鼠神经生长因子治疗糖尿病周围神经病变的疗效观察

目的:观察鼠神经生长因子治疗糖尿病周围神经病变(diabetic perineuropathy heuropathy,DPN)的临床疗效。方法:65例DPN患者随机分为A、B两组,A组为鼠源性神经生长因子治疗组,B组为甲钴胺治疗组,观察两组治疗前、后的临床疗效;神经运动传导速度(MNCV)、神经感觉传导速度(SNCV)的改善情况及不良反应发生情况。结果:A组总有效率为81.82%,高于B组(59.38%),差异具有统计学意义(P<0.01);两组治疗后MNCV、SNCV较治疗前均改善,差异有统计学意义(P<0.05);治疗后A组改善情况优于B组,差异有统计学意义(P<0.01)。结论:鼠神经生长因子治疗糖尿病周围神经病变疗效确切,是治疗糖尿病周围神经病变的一种较好方法,值得在临床推广应用。     

灯盏花素联合甲钴胺治疗糖尿病周围神经病变

目的 观察灯盏花素联合甲钴胺治疗糖尿病周围神经病变(DPN)的临床效果.方法 选取DPN患者60例,随机分为治疗组及对照组,各30例,治疗组给予灯盏花素注射液静滴联合甲钻胺肌肉注射治疗,对照组仅给予甲钴胺肌注治疗,均2周为1疗程,对比2组治疗前及治疗1疗程后糖化血红蛋白(HbA1C)、空腹血糖(FBG)变化、感觉神经传导速度(SNCV)改善情况及临床疗效.结果 治疗后2组SNCV与治疗前比较差异均有统计学意义(P＜0.05);治疗组SNCV改善优于对照组(P＜0.05);治疗组总有效率86.7％,高于对照组的66.7％(P＜0.05).结论 灯盏花素注射液静滴联合甲钴胺肌注能有效改善DPN患者的神经传导速度及临床症状.     

Nitrosative stress and peripheral diabetic neuropathy in leptin-deficient (ob/ob) mice

Nitrosative stress contributes to nerve conduction slowing, thermal hypoalgesia, and impaired nitrergic innervation in animal models of Type 1 diabetes. The role for reactive nitrogen species in Type 2 diabetes-associated neuropathy remains unexplored. This study evaluated the role for nitrosative stress in functional and structural neuropathic changes in ob/ob mice, a model of Type 2 diabetes with mild hyperglycemia and obesity. Two structurally diverse peroxynitrite decomposition catalysts, Fe(III) tetrakis-2-(N-triethylene glycol monomethyl ether)-pyridyl porphyrin (FP15) and Fe(III) tetra-mesitylporphyrin octasulfonate (FeTMPS), were administered to control and 8-week-old ob/ob mice for 3 weeks at the doses of 5 mg kg(-1) day(-1) (FP15) and 5 and 10 mg kg(-1) day(-1) (FeTMPS). The 11-week-old ob/ob mice developed motor nerve conduction velocity (MNCV) and hind-limb digital sensory nerve conduction velocity (SNCV) deficits, thermal hypoalgesia, tactile allodynia, and a remarkable ( approximately 78%) loss of intraepidermal nerve fibers. They also had increased nitrotyrosine and poly(ADP-ribose) immunofluorescence in the sciatic nerve, spinal cord, and dorsal root ganglion neurons. Treatment with two structurally diverse peroxynitrite decomposition catalysts was associated with restoration of normal MNCV and SNCV, and alleviation of thermal hypoalgesia. Tactile response thresholds increased in response to peroxynitrite decomposition catalyst treatment, but still remained approximately 2.7- to 3.2-fold lower compared with non-diabetic controls. Intraepidermal nerve fiber loss was not alleviated by either FP15 or FeTMPS. Nitrotyrosine and poly(ADP-ribose) immunofluorescence in sciatic nerve, spinal cord, and dorsal root ganglia of peroxynitrite decomposition catalyst-treated ob/ob mice were essentially normal. In conclusion, nitrosative stress plays an important role in functional abnormalities associated with large motor, large sensory, and small sensory fiber neuropathy, but not in small sensory nerve fiber degeneration, in this animal model. Peroxynitrite decomposition catalysts alleviate Type 2 diabetes-associated sensory nerve dysfunction, likely by mechanism(s) not involving arrest of degenerative changes or enhanced regeneration of small sensory nerve fibers.     

点刺“委中”放血对实验性腰椎间盘突出症坐骨神经传导速度和髓核组织白细胞介素-1α的影响

目的:通过观察实验性腰椎间盘突出症(lumbar intervertebral disc protrusion,LIDP)家兔坐骨神经传导速度(sciatic nerve conduction velocity,SNCV)和髓核组织中白细胞介素-1α(interleukin-1α,IL-1α)水平变化,探讨点刺"委中"放血治疗LIDP的机制。方法:40只健康新西兰家兔随机分为4组,即空白组、LIDP模型组、点刺委中组和点刺非穴对照点组。自制的LIDP动物病理模型造模器造实验性LIDP病理模型,三棱针点刺"委中"或对照点放血治疗,左右交替,连续7 d。采用BL-410生理信号记录系统记录SNCV,酶联免疫吸附法测定腰椎间盘髓核组织中IL-1α的含量。结果:点刺委中组治疗后SNCV显著高于治疗前(P<0.01),其治疗前后SNCV的差值显著高于模型组和非穴对照组(P<0.05);点刺"委中"放血可降低LIDP家兔髓核组织中IL-1α含量,与模型组和非穴对照组比较差异有显著性意义(P<0.01,0.05)。结论:点刺"委中"穴可明显增快LIDP家兔的SNCV,减少IL-1α等炎症因子含量以减轻炎症反应可能是点刺"委中"放血治疗LIDP的机制之一。     

鼠神经生长因子联合银杏叶胶囊治疗糖尿病周围神经病变的疗效观察

目的探讨注射用鼠神经生长因子联合银杏叶胶囊治疗糖尿病周围神经病变的临床疗效。方法选取2016年5月—2017年5月海南省第三人民医院收治的64例糖尿病周围神经病变患者为研究对象,按就诊先后顺序编号并按照奇偶数的形式随机分为对照组和治疗组,每组各32例。对照组患者口服银杏叶胶囊,1~2粒/次,3次/d。治疗组在对照组治疗的基础上肌肉注射注射用鼠神经生长因子,1瓶/d,加入2 m L注射水溶解,1次/d。两组患者均持续治疗2周。观察两组临床疗效,比较治疗前后两组患者的神经评分、运动神经传导速度(MNCV)、感觉神经传导速度(SNCV)和血液流变学指标。结果治疗后,对照组和治疗组的临床总有效率分别为78.1%、96.9%,两组比较差异具有统计学意义(P0.05)。治疗后,两组患者神经症状评分、神经体征评分均显著降低,同组治疗前后比较差异具有统计学意义(P0.05);治疗后,治疗组神经评分明显低于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,两组患者正中神经、腓总神经的MNCV和SNCV均显著升高,同组治疗前后比较差异具有统计学意义(P0.05);治疗后,治疗组MNCV、SNCV明显高于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,两组全血黏度、血浆黏度、红细胞压积、血沉均显著降低,同组治疗前后比较差异具有统计学意义(P0.05);治疗后,治疗组血液流变学指标明显低于对照组,两组比较差异具有统计学意义(P0.05)。结论注射用鼠神经生长因子联合银杏叶胶囊治疗糖尿病周围神经病变具有较好的临床疗效,可改善血液流变学等指标,提升患者生活质量,具有一定的临床推广应用价值。