黃芪桂枝五物湯合四藤一仙湯加減治療糖尿病周圍神經(jīng)病變的臨床觀察
發(fā)布時(shí)間：2019-05-28 01:57
【摘要】：目的:通過(guò)觀察黃芪桂枝五物湯合四藤一仙湯加減對(duì)氣虛血瘀型糖尿病周圍神經(jīng)病變(Diabetic Peripheral Neuropathy,DPN)患者的中醫(yī)癥候評(píng)分、密歇根神經(jīng)病變篩查表(Michigan Neuropathy Screening Instrument,MNSI)體格檢查評(píng)分、震動(dòng)感覺(jué)閾值、踝臂指數(shù)(Ankle-Brachial Index,ABI)的變化分析本治療方案對(duì)患者臨床癥狀及神經(jīng)體征的改善效果,以此評(píng)價(jià)黃芪桂枝五物湯合四藤一仙湯加減對(duì)氣虛血瘀型DPN的療效,為其在臨床應(yīng)用提供依據(jù)。方法:本課題研究符合入選標(biāo)準(zhǔn)的患者共68名,隨機(jī)分為治療組與對(duì)照組,分別為34名,均給予糖尿病相關(guān)宣教、糖尿病基礎(chǔ)治療,治療組在此基礎(chǔ)上予黃芪桂枝五物湯合四藤一仙湯加減口服,對(duì)照組予甲鈷胺片口服治療,總療程為12周。觀察患者治療前后的中醫(yī)癥候評(píng)分、MNSI體格檢查評(píng)分、ABI、震動(dòng)感覺(jué)閾值、空腹血糖(Fasting Plasma Glucose,FPG)、餐后2小時(shí)血糖(2 hours Postprandial Blood Glucose,2hPG)、糖化血紅蛋白(Glycated hemoglobin,HbA1c)、肝腎功能等相關(guān)指標(biāo),并予系統(tǒng)分析相關(guān)數(shù)據(jù)。結(jié)果:1、脫落率:本課題共納入患者68名,兩組各34名,而治療組共計(jì)32名患者完成本次研究,脫落2名,脫落率為6%;對(duì)照組完成研究者共計(jì)30名,脫落4名,脫落率12%,兩組脫落率比較無(wú)明顯差異,不影響研究結(jié)果(P0.05)。2、中醫(yī)癥候療效總有效率:治療組為90.63%,對(duì)照組為70.00%,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。3、中醫(yī)癥候評(píng)分:經(jīng)治療后兩組患者中醫(yī)癥候總分和各分項(xiàng)評(píng)分均較治療前下降(P0.05),而治療組麻木、疼痛、發(fā)涼分項(xiàng)評(píng)分及總分下降更為明顯(P0.05),兩組在感覺(jué)異常及全身癥狀分項(xiàng)評(píng)分無(wú)明顯差異(P0.05)。4、MNSI體格檢查評(píng)分:兩組患者治療后MNSI體格檢查評(píng)分較治療前明顯減少(P0.05),而治療組下降更為明顯(P0.05)。5、ABI:經(jīng)治療后兩組患者的ABI均較治療前上升(P0.05),同時(shí)治療組上升幅度較對(duì)照組更為明顯(P0.05)。6、震動(dòng)感覺(jué)閾值測(cè)量:經(jīng)治療后,兩組患者震動(dòng)感覺(jué)閾值與治療前相比較均明顯下降(P0.05),而治療組改善程度較對(duì)照組更為明顯(P0.05)。7、血糖水平:經(jīng)治療后,兩組患者FPG、2h PG、HbA1c水平均較治療前下降(P0.05),但兩組間比較無(wú)明顯差異(P0.05)。8、安全性:兩組均未發(fā)現(xiàn)藥物因素導(dǎo)致生命體征異常、肝腎功能受損及嚴(yán)重不良反應(yīng)等情況。研究結(jié)論:黃芪桂枝五物湯合四藤一仙湯加減能明顯改善氣虛血瘀型DPN患者的臨床癥狀及神經(jīng)體征,促進(jìn)下肢血液循環(huán),增加感覺(jué)敏感性,且用藥安全性良好,為臨床應(yīng)用提供參考。
[Abstract]:Objective: to observe the TCM syndrome score of Huangqi Guizhi Wuwu decoction combined with Siteng Yixian decoction in the treatment of diabetic peripheral neuropathy with qi deficiency and blood stasis type (Diabetic Peripheral Neuropathy,DPN). Michigan neuropathy screening table (Michigan Neuropathy Screening Instrument, was used to observe the score of TCM syndrome in patients with diabetic peripheral neuropathy due to qi deficiency and blood stasis. MNSI) the changes of physical examination score, vibration sensory threshold and ankle arm index (Ankle-Brachial Index,ABI) were analyzed to improve the clinical symptoms and neurological signs of the patients. To evaluate the curative effect of Huangqi Guizhi Wuwu decoction combined with Siteng Yixian decoction on DPN of qi deficiency and blood stasis type, and to provide the basis for its clinical application. Methods: a total of 68 patients in this study were randomly divided into treatment group (n = 34) and control group (n = 34). All patients were given diabetes related education and basic treatment of diabetes mellitus. On this basis, the treatment group was given Huangqi Guizhi Wuwu decoction combined with Siteng Yixian decoction, while the control group was treated with mecobalamin tablets for 12 weeks. The scores of TCM symptoms, MNSI physical examination, ABI, vibration threshold, fasting blood glucose (Fasting Plasma Glucose,FPG), postmeal blood glucose (2 hours Postprandial Blood Glucose,2hPG) and glycosylated hemoglobin (Glycated hemoglobin,HbA1c) were observed before and after treatment. The related indexes such as liver and kidney function were analyzed systematically. Results: 1. Drop rate: there were 68 patients in this subject, 34 patients in each group, while 32 patients in the treatment group completed the study, 2 patients fell off, the drop rate was 6%; In the control group, there were 30 researchers, 4 researchers, 12%. There was no significant difference in the drop rate between the two groups, which did not affect the results of the study (P 0.05). 2, the total effective rate of TCM syndrome in the treatment group was 90.63%. The control group was 70.00%, the difference was statistically significant (P05). 3, TCM syndrome score: after treatment, the total score of TCM syndrome and the scores of each item in the two groups were lower than those before treatment (P05), while in the treatment group, numbness and pain, The score and total score of cool items decreased more significantly (P 0.05), but there was no significant difference between the two groups in the scores of sensory abnormalities and systemic symptoms (P 0.05). MNSI physical examination score: after treatment, the MNSI physical examination score of the two groups was significantly lower than that before treatment (P 0.05), and the decrease of MNSI physical examination score was more obvious in the treatment group (P 0.05). After ABI: treatment, the ABI of both groups was higher than that before treatment (P 0.05), and the increase of ABI in the treatment group was more obvious than that in the control group (P 0.05). 6. measurement of vibration sensory threshold: after treatment, The vibration sensory threshold of the two groups was significantly lower than that before treatment (P 0.05), and the improvement degree of the treatment group was more obvious than that of the control group (P 0.05). 7. Blood glucose level: after treatment, the FPG,2h PG, of the two groups was significantly lower than that of the control group. The level of HbA1c was lower than that before treatment (P 0.05), but there was no significant difference between the two groups (P 0.05). 8. Safety: no abnormal vital signs, damage of liver and kidney function and serious adverse reactions were found in both groups. Conclusion: Huangqi Guizhi Wuwu decoction combined with Siteng Yixian decoction can obviously improve the clinical symptoms and neurological signs of DPN patients with qi deficiency and blood stasis type, promote lower extremity blood circulation, increase sensory sensitivity, and the safety of the drug is good. It provides a reference for clinical application.
【學(xué)位授予單位】：廣西中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R259
本文編號(hào)：2486632
[Abstract]:Objective: to observe the TCM syndrome score of Huangqi Guizhi Wuwu decoction combined with Siteng Yixian decoction in the treatment of diabetic peripheral neuropathy with qi deficiency and blood stasis type (Diabetic Peripheral Neuropathy,DPN). Michigan neuropathy screening table (Michigan Neuropathy Screening Instrument, was used to observe the score of TCM syndrome in patients with diabetic peripheral neuropathy due to qi deficiency and blood stasis. MNSI) the changes of physical examination score, vibration sensory threshold and ankle arm index (Ankle-Brachial Index,ABI) were analyzed to improve the clinical symptoms and neurological signs of the patients. To evaluate the curative effect of Huangqi Guizhi Wuwu decoction combined with Siteng Yixian decoction on DPN of qi deficiency and blood stasis type, and to provide the basis for its clinical application. Methods: a total of 68 patients in this study were randomly divided into treatment group (n = 34) and control group (n = 34). All patients were given diabetes related education and basic treatment of diabetes mellitus. On this basis, the treatment group was given Huangqi Guizhi Wuwu decoction combined with Siteng Yixian decoction, while the control group was treated with mecobalamin tablets for 12 weeks. The scores of TCM symptoms, MNSI physical examination, ABI, vibration threshold, fasting blood glucose (Fasting Plasma Glucose,FPG), postmeal blood glucose (2 hours Postprandial Blood Glucose,2hPG) and glycosylated hemoglobin (Glycated hemoglobin,HbA1c) were observed before and after treatment. The related indexes such as liver and kidney function were analyzed systematically. Results: 1. Drop rate: there were 68 patients in this subject, 34 patients in each group, while 32 patients in the treatment group completed the study, 2 patients fell off, the drop rate was 6%; In the control group, there were 30 researchers, 4 researchers, 12%. There was no significant difference in the drop rate between the two groups, which did not affect the results of the study (P 0.05). 2, the total effective rate of TCM syndrome in the treatment group was 90.63%. The control group was 70.00%, the difference was statistically significant (P05). 3, TCM syndrome score: after treatment, the total score of TCM syndrome and the scores of each item in the two groups were lower than those before treatment (P05), while in the treatment group, numbness and pain, The score and total score of cool items decreased more significantly (P 0.05), but there was no significant difference between the two groups in the scores of sensory abnormalities and systemic symptoms (P 0.05). MNSI physical examination score: after treatment, the MNSI physical examination score of the two groups was significantly lower than that before treatment (P 0.05), and the decrease of MNSI physical examination score was more obvious in the treatment group (P 0.05). After ABI: treatment, the ABI of both groups was higher than that before treatment (P 0.05), and the increase of ABI in the treatment group was more obvious than that in the control group (P 0.05). 6. measurement of vibration sensory threshold: after treatment, The vibration sensory threshold of the two groups was significantly lower than that before treatment (P 0.05), and the improvement degree of the treatment group was more obvious than that of the control group (P 0.05). 7. Blood glucose level: after treatment, the FPG,2h PG, of the two groups was significantly lower than that of the control group. The level of HbA1c was lower than that before treatment (P 0.05), but there was no significant difference between the two groups (P 0.05). 8. Safety: no abnormal vital signs, damage of liver and kidney function and serious adverse reactions were found in both groups. Conclusion: Huangqi Guizhi Wuwu decoction combined with Siteng Yixian decoction can obviously improve the clinical symptoms and neurological signs of DPN patients with qi deficiency and blood stasis type, promote lower extremity blood circulation, increase sensory sensitivity, and the safety of the drug is good. It provides a reference for clinical application.
【學(xué)位授予單位】：廣西中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R259
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