独活寄生汤对气虚血瘀型糖尿病周围神经病变患者一氧化氮和内皮素的影响

目的:观察应用独活寄生汤治疗气虚血瘀型糖尿病周围神经病变患者时血清一氧化氮(NO)和血浆内皮素-1(ET-1)水平变化及其临床意义。方法:选取石家庄市第二医院门诊和住院治疗的气虚血瘀型糖尿病周围神经病变患者128例,在常规降糖治疗的基础上,按随机数字表法将患者分为中药口服治疗组和中药熏蒸治疗组,中药口服治疗组62例给予独活寄生汤口服治疗,每日1剂,水煎取汁400 m L,2次/日温服;中药熏蒸治疗组66例给予独活寄生汤熏蒸治疗,每日1剂,水煎取汁1 L,2次/日外用熏蒸治疗。两组均以10 d为1个疗程,3个疗程后观察并比较两组治疗前后血清NO和ET-1水平变化,应用临床症状积分有效率及感觉神经电流阈值(CPT)定量检测判定临床疗效,同时监测不良反应发生状况。结果:与本组治疗前比较,独活寄生汤口服治疗或熏蒸治疗均可明显升高气虚血瘀型糖尿病周围神经病变患者血清NO水平(P0.05),降低其血浆ET-1水平(P0.05)。中药口服治疗组与中药熏蒸治疗组临床症状积分降低的总有效率分别为83.9%,86.4%;双侧正中神经及腓肠神经的电流阈值(CPT)均明显降低(P0.05);两组疗效比较无显著性差异。结论:独活寄生汤可明显升高血清NO水平并降低血浆ET-1水平,这可能是其治疗糖尿病周围神经病变有效的机制之一,为临床治疗气虚血瘀型糖尿病周围神经病变提供新的方法。

Effect of Duhuo Jisheng Tang on Levels of Nitric Oxide and Endothelin of Patients With Diabetic Peripheral Neuropathy

Objective: To observe the variation of nitric oxide(NO) in serum and endothelin-1 (ET-1) in the plasma in patients with diabetic peripheral neuropathy treated by Duhuo Jisheng Tang and evaluate its clinical significance. Method: On the basis of routine blood glucose control, 128 outpatients and inpatients with diabetic peripheral neuropathy were randomly divided into traditional Chinese medicine(TCM) oral treatment group (62 cases) and TCM steaming group (66 cases). The patients in TCM oral treatment group orally took Duhuo Jisheng Tang, 1 dose/day, 400 mL, bid; the patients in TCM steaming group were treated with Duhuo Jisheng Tang steamed externally,1 dose/day, 1 L, bid. One treatment course was 10 days and the patients in both groups received 3 treatment courses. The changes NO in serum and ET-1 levels in plasma before and after treatment were observed and compared between two groups; percentage of clinical symptom scores reduction and current perception threshold (CPT) were used for quantitative detection and determination of clinical efficacy. Meanwhile, the adverse reactions were monitored. Result: Both oral administration and streaming treatment of Duhuo Jisheng Tang can significantly increase the level of NO in serum (P<0.05)and decrease the level of ET-1 in the serum of patients with diabetic peripheral neuropathy(P<0.05). The total effective rate for clinical symptom scores reduction was 83.9%and 86.4%respectively in TCM oral treatment group and TCM steaming treatment group. The CPT values of bilateral median nerves and gastrocnemius nerves were significantly reduced in both groups(P<0.05), but there was no significant difference between two groups. Conclusion: Duhuo Jisheng Tang can significantly increase the level of NO in serum and decrease the level of ET-1 in the plasma of patients with diabetic peripheral neuropathy. This may be one of the effective mechanisms for the treatment of diabetic peripheral neuropathy,providing a novel therapy for diabetic peripheral neuropathy.