【摘要】：目的：觀察消麻止痛顆粒對(duì)氣陰兩虛夾瘀型糖尿病周圍神經(jīng)病變患者血中AR、N0和SOD活性及神經(jīng)傳導(dǎo)速度的影響,探討其作用機(jī)制。 方法：將我院2013年1月～2014年5月期間收治的102例氣陰兩虛夾瘀型糖尿病周圍神經(jīng)病變(DPN)患者納入研究對(duì)象,隨機(jī)分為對(duì)照組50例和治療組52例。對(duì)照組口服甲鈷胺片500mg和安慰劑,3次/d；治療組口服甲鈷胺片500mg,3次/d和消麻止痛顆粒15g,3次/d,連續(xù)治療4周為1療程。3個(gè)療程后評(píng)價(jià)療效。采用Srivastava法[1]檢測(cè)紅細(xì)胞醛糖還原酶(AR)活性,血清一氧化氮(NO)水平采用Gress重氮化反應(yīng)法測(cè)定,通過(guò)酶聯(lián)免疫吸附法(ELISA)檢測(cè)血清超氧化物歧化酶(SOD)水平。應(yīng)用肌電圖儀測(cè)量患者正中神經(jīng)、腓總神經(jīng)的運(yùn)動(dòng)神經(jīng)傳導(dǎo)速度(MNCV)和感覺神經(jīng)傳導(dǎo)速度SNCV)的變化。通過(guò)多倫多臨床評(píng)分系統(tǒng)(TCSS)癥狀評(píng)分和視覺模擬評(píng)分法(VAS)疼痛評(píng)分對(duì)病情進(jìn)行評(píng)估。 結(jié)果： 1.治療前后療效比較,治療組總有效率明顯優(yōu)于對(duì)照組(P0.05)。 2.經(jīng)治療后,兩組正中神經(jīng)、腓總神經(jīng)MNCV及SNCV較治療前均有提高。與對(duì)照組比較,治療組神經(jīng)傳導(dǎo)速度提升較明顯,其中正中神經(jīng)的傳導(dǎo)速度與對(duì)照組相比差異有統(tǒng)計(jì)學(xué)意義(P0.05)。 3.經(jīng)治療3個(gè)療程后,兩組神經(jīng)病變癥狀均有明顯改善(P0.05),VAS評(píng)分明顯降低(P0.05),且治療組TCSS和VAS疼痛評(píng)分低于對(duì)照組(P0.05)。 4.治療3個(gè)療程后,治療組及對(duì)照組AR含量均有下降,與治療前對(duì)比,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。治療組對(duì)AR的作用明顯優(yōu)于對(duì)照組(P0.05)。 5.治療3個(gè)療程后,兩組患者NO、SOD含量較治療前均有上升(P0.05)；與對(duì)照組比較,治療組可顯著提高M(jìn)O、SOD的含量,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論： 消麻止痛顆粒聯(lián)合甲鈷胺片可明顯抑制AR的表達(dá),提高體內(nèi)NO. SOD的含量,改善DPN患者的神經(jīng)傳導(dǎo)速度,這可能是消麻止痛顆粒發(fā)揮神經(jīng)保護(hù)作用的機(jī)制之一。
[Abstract]:Objective: to observe the effect of Xiaomaxitong granule on the activities of AR,N0 and SOD and nerve conduction velocity in patients with diabetic peripheral neuropathy with Qi and Yin deficiency and stasis. Methods: from January 2013 to May 2014, 102 patients with (DPN) of diabetes mellitus with deficiency of Qi and Yin and blood stasis were randomly divided into control group (n = 50) and treatment group (n = 52). The control group was given megalobalamin tablets 500mg and placebo 3 times a day, the treatment group was treated with megalobalamin tablet 500 mg / d 3 times a day and Xiaomaodong granule 15 g / d for 4 weeks as a course of treatment, and the curative effect was evaluated after 3 courses of treatment. The activity of Aldose reductase (AR) in erythrocytes was detected by Srivastava assay, the level of serum nitric oxide (NO) was determined by Gress diazotization reaction, and the level of serum superoxide dismutase (SOD) was detected by enzyme-linked immunosorbent assay (ELISA). The motor nerve conduction velocity (MNCV) and sensory nerve conduction velocity (SNCV) of median nerve and common peroneal nerve were measured by electromyography. The symptoms of the disease were evaluated by the Toronto Clinical scoring system (TCSS) and the Visual Analog scale (VAS). Results: 1. Before and after treatment, the total effective rate of the treatment group was significantly better than that of the control group (P0.05). 2. After treatment, MNCV and SNCV of median nerve, common peroneal nerve and peroneal nerve in both groups were higher than those before treatment. Compared with the control group, the nerve conduction velocity in the treatment group was significantly increased, and the median nerve conduction velocity was significantly higher than that in the control group (P0.05). 3. After three courses of treatment, the symptoms of neuropathy in both groups were significantly improved (P0.05), VAS score significantly decreased (P0.05), and the treatment group TCSS and VAS pain score was lower than the control group (P0.05). 4. After three courses of treatment, the content of AR in treatment group and control group were decreased, compared with before treatment, the difference was statistically significant (P0.05). The effect of AR in the treatment group was significantly better than that in the control group (P0.05). 5. After three courses of treatment, the content of NO,SOD in the two groups was higher than that before treatment (P0.05); compared with the control group, the treatment group could significantly increase the content of MO,SOD, the difference was statistically significant (P0.05). Conclusion: Xiaomaxitong granule combined with mecobalamin tablets can significantly inhibit the expression of AR and increase NO. in vivo. The content of SOD and the improvement of nerve conduction velocity in patients with DPN may be one of the mechanisms by which Xiaomaxitong granule plays a neuroprotective role.
【學(xué)位授予單位】：湖南中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R587.2

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