己酮可可碱与弥可保联合治疗糖尿病周围神经病变

目的探讨糖尿病周围神经病变(diabetic peripheral polyneuropathy,DPN)与血液流变学的关系以及己酮可可碱与弥可保联合治疗糖尿病周围神经病变的疗效。方法选取96例糖尿病周围神经病变患者,随机分为3组,分别为口服弥可保治疗组(DPN1组)、口服己酮可可碱治疗组(DPN2组)、弥可保+己酮可可碱治疗组(DPN3组)。同时选取正常对照组36例健康对照者,单纯糖尿病组40例患者。各组均进行血液流变学检测和糖化血红蛋白检测。同时对3个治疗组进行3个月的治疗,对其治疗前后进行血液流变学及肌电图的测定。结果1)单纯糖尿病患者的全血高切黏度、全血低切黏度、血浆黏度、纤维蛋白原、血小板最大聚集率、红细胞聚集指数均较正常对照组显著升高,差异均有统计学意义(P<0.01),治疗前DPN各组上述指标均高于单纯糖尿病组,差异有统计学意义(P<0.01);2)3个月治疗后,DPN1、2、3组与治疗前自身相比较,神经传导速度均有显著改善,差异有统计学意义(P<0.01)。其中DPN3组神经传导速度增快的程度最强,DPN2组神经传导速度增快比DPN1组明显,差异有统计学意义(P<0.01)。结论在糖尿病神经病变的发展过程中,血液流变学的异常是重要的致病因素。口服弥可保、己酮可可碱均能降低血液黏稠度,改善神经传导速度,二者联合治疗效果更为显著。

Clinical Study of Treatment for Diabetic Peripheral Neuropathy with Combination of Pentoxifylline and Microbalamin

Objective To investigate the correlation between diabetic peripheral neuropathy(DPN) and hemorrheology and to observe the efficacy effect of pentoxifylline and micobalamin for DPN. Methods 96 patients with DPN were divided into groups of DPN 1, DPN 2 and DPN 3 randomly. Patients of group DPN 1 were treated with micobalamin PO. Patients of group DPN 2 were admistered pentoxifylline PO. Patients of group DPN 3 were treated with both pentoxifylline and micobalamin. Control group are included 36 healthy persons and 40 DM patients without complication. Patients of group DPN 1, DPN 2, DPN 3 were treated for 3 months. Hemorheology and electromyogram were performed prior and post to treatment. Results 1) Whole blood hypsiviscosity, whole blood hypoviscosity, plasma viscosity, fibrinogen, max platelet packing fraction, erythrocyte aggregation of DM patients without complication were higher than healthy persons(P<0.01). Numerical value of prior treatment in group DPN 1, DPN 2 and DPN 3 were higher than DM patients without complication(P<0.01). 2) Nerve conduction velocity(NCV) of post-treatment in group DPN 1, DPN 2 and DPN 3 were improve obviously(P<0.01). In the improve degree of NCV group DPN 2 was better than group DPN 1, DPN 3 was better than group DPN 2(P<0.01). Conclusion Hemorrheology abnormality is an important pathogenic factor in the diabetic peripheral neuropathy. Pentoxifylline and micobalamin can reduce blood viscosity and improve NCV. Among all the therapies alliance is more utility.