【摘要】：目的:基于交感神經(jīng)皮膚反應(yīng)(SSR)評價芪黃通絡(luò)湯治療尿毒癥周圍神經(jīng)病變(UPN)的臨床療效,并對尿毒癥毒素和致炎細(xì)胞因子水平的影響方面探討其作用機(jī)制。方法:將154例尿毒癥患者隨機(jī)分為觀察組和對照組。兩組患者均給予血液透析+血液灌流治療;對照組采用三維B注射液,肌肉注射,2 mL/次,3次/周;和甲鈷胺片,口服,0.5 mg/次,3次/d。觀察組在對照組治療的基礎(chǔ)上加服芪黃通絡(luò)湯,1劑/d。兩組療程均為3個月。采用肌電誘發(fā)電位儀測量起始潛伏期(Lat)和峰-峰波幅值(Amp),測量脛神經(jīng)、腓總神經(jīng)和腓腸神經(jīng)的感覺神經(jīng)傳導(dǎo)速度,治療前后各評價1次;進(jìn)行治療前后脾腎氣虛,瘀血阻滯證評分;檢測治療前后甲狀旁腺激素(PTH),β2-微球蛋白(β2-MG),瘦素(LP),同型半胱氨酸(Hcy)等尿毒癥毒素水平;檢測治療后腫瘤壞死因子-α(TNF-α),血清C反應(yīng)蛋白(CRP),白細(xì)胞介素-6(IL-6)和IL-8等致炎細(xì)胞因子水平。結(jié)果:觀察組中醫(yī)證候療效總有效率為93.06%,高于對照組的74.29%(χ~2=9.212,P0.01);治療后觀察組上、下肢Lat均短于對照組,上、下肢Amp均高于對照組(P0.01);治療后觀察組SSR異常率為26.39%,低于治療前的66.67%,(χ~2=23.471,P0.01),并低于治療后對照組的44.29%(χ~2=4.983,P0.05);治療后觀察組脛神經(jīng)、腓總神經(jīng)和腓腸神經(jīng)的感覺神經(jīng)傳導(dǎo)速度均快于對照組(P0.05,P0.01);治療后觀察組患者血清PTH,β2-MG,LP和Hcy水平均低于對照組(P0.01);治療后觀察組患者血清TNF-α,CRP,IL-6和IL-8水平均低于對照組(P0.01)。結(jié)論:采用芪黃通絡(luò)湯治療UPN患者,能改善患者神經(jīng)功能,促進(jìn)周圍神經(jīng)功能的恢復(fù),其作用機(jī)制可能與清除尿毒癥毒素和減輕炎癥反應(yīng)有關(guān)。
[Abstract]:Objective: to evaluate the clinical efficacy of Qihuang Tongluo decoction (QYT) in the treatment of uremic peripheral neuropathy (UPN) based on sympathetic skin reaction (SSR), and to explore the mechanism of its effect on the levels of uremic toxin and inflammatory cytokines. Methods: 154 patients with uremia were randomly divided into observation group and control group. The patients in the two groups were treated with hemodialysis and hemoperfusion; the control group were treated with 3D B injection, intramuscular injection, 2 mL/, 3 times a week, and mecobalamin tablets, oral, 0.5 mg/, 3 times a day. Observation group in the control group on the basis of treatment plus Qihuang Tongluo decoction, 1 dose per day. The course of treatment was 3 months in both groups. The initial latency (Lat) and peak to peak amplitude (Amp),) of tibial nerve, common peroneal nerve and sural nerve were measured by EMG potentiometer, and the sensory nerve conduction velocity of tibial nerve, common peroneal nerve and sural nerve were evaluated once before and after treatment. Spleen and kidney Qi deficiency and blood stasis block were scored before and after treatment, and the levels of uremic toxins such as parathyroid hormone (PTH), 尾 2-microglobulin (尾 2-MG) and leptin (LP), homocysteine (Hcy) were detected before and after treatment. The levels of tumor necrosis factor- 偽 (TNF- 偽), serum C-reactive protein (CRP), interleukin-6 (IL-6) and IL-8 were measured after treatment. Results: the total effective rate of TCM syndromes in the observation group was 93.06, which was higher than that in the control group (74.29%), the Lat of the upper and lower limbs in the observation group was shorter than that in the control group (P0.01), and the Amp of the upper and lower limbs in the observation group was higher than that in the control group (P0.01). After treatment, the abnormal rate of SSR in the observation group was 26.39, lower than that before treatment (66.67) (蠂 ~ 2 + 23.471), and it was lower than that in the control group (44.29%) (蠂 ~ (2) 4.983 (P0.05). After treatment, the sensory nerve conduction velocities of tibial nerve, common peroneal nerve and sural nerve in the observation group were faster than those in the control group (P0.05, P0.01), and the levels of serum PTH, 尾 2-MGG LP and Hcy in the observation group were lower than those in the control group (P0.01). After treatment, the serum levels of TNF- 偽, CRP,IL-6 and IL-8 in the observation group were lower than those in the control group (P0.01). Conclusion: Qihuang Tongluo decoction can improve the nerve function and promote the recovery of peripheral nerve function in patients with UPN, and its mechanism may be related to removing uremic toxin and reducing inflammatory reaction.
【作者單位】： 山東省胸科醫(yī)院;四川省醫(yī)學(xué)科學(xué)院四川省人民醫(yī)院;山東大學(xué)齊魯醫(yī)院;
【基金】：山東省中醫(yī)藥科技發(fā)展計劃項目(2011-202)
【分類號】：R277.5

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