【作者】 高志生；

【导师】 王旭；

【作者基本信息】 南京中医药大学 ， 中医内科学， 2011， 硕士

【摘要】 糖尿病周围神经病变((diabetic peripheral neuropathy,DPN)是糖尿病最常见的并发症之一,其发病率高达50%以上,常引起感觉、运动和/或自主神经机能障碍,其病因及发病机制尚未阐明。同型半胱氨酸(homocysteine,Hcy)是一种反应性血管损伤氨基酸,近几年来许多研究表明,糖尿病和血浆高Hcy水平有关,发现Hcy不但是糖尿病大血管病变的独立危险因素,同时也是DPN的重要危险因素。目的：1、观察柔肝熄风通络汤联合甲钴胺治疗DPN患者的临床疗效及血浆Hcy水平的变化。2、探讨2型糖尿病(T2DM)患者学Hcy水平与中医证型的关系。方法：1、在良好控制血糖的基础上,将60例DPN患者随机分为两组(每组30例)。对照组予甲钴胺治疗,治疗组在对照基础上加服柔肝熄风通络汤。两组连续治疗8周后,观察所有病例的临床症状积分、神经传导速度、血糖、HbAlC、Hcy水平、肝肾功能的变化及有无毒副反应。2、将202例T2DM忠者辨证分为阴虚热盛型、气阴两虚型和阴阳两虚型3组,测定各组患者血Hcy水平,对不同中医证型T2DM患者和T2DM合并高Hcy血症患者间血Hcy水平进行比较,并作统计学分析。结果：1、治疗8周后,两组病例的症状积分、血Hcy水平均较治疗均前有显著性降低(P<0.01),神经传导速度较治疗前均明显提高(P<0.01)。而治疗组在症状积分、血Hcy水平、神经传导速度及治疗有效率等方面明显优于对照组(P<0.01)；两组治疗后其血糖均有所改善,但两组无统计学意义(P>0.05)；同时均未发现明显毒副反应。2、202例T2DM患者中有73.76%合并高Hcy血症,其中阴阳两虚组血Hcy水平最高,气阴两虚组次之,阴虚热盛组最低,差异有统计学意义(P<0.05)。对不同中医证型T2DM患者间血Hcy水平及T2DM合并高Hcy血症患者血Hcy水平进行分析比较,其结果均为：阴阳两虚组血Hcy水平最高,气阴两虚组次之,阴虚热盛组相对较低,差异均有统计学意义。结论：1、在良好控制血糖基础上运用柔肝熄风通络汤联合甲钻胺治疗DPN疗效较好、安全,切改善高Hcy血症优于单用甲钴胺。2、血Hcy水平在阴虚热盛、气阴两虚、阴阳两虚3个证型中呈现递增趋势,提示高Hcy血.症与T2DM及糖尿病慢性并发症的中医病因病机存在着一定的关联性,血Hcy水平可作为T2DM中医辨证的客观参考指标之一。更多还原

【Abstract】 Diabetic peripheral neuropathy(DPN) is one of the most common complications of diabetes mellitus, the incidence of which is up to about 50%, it causes sensory, motor, and/or autonomic dysfunction. However, the pathogenesis of DPN has still not been very clear. Homocysteine(Hcy)is regarded as a reactive vascular scathing amino acid. In recent years, many studies have demonstrated that diabetic is associated with hyperhomocysteinemia. Hey has been found that it is not only a major and independent risk factor for diabetic vascular disease but also an important risk factor for DPN.Objective:1、To observe the clinical therapeutic effects of Liver-Nourishing and Endogenous Wind-Stopping and Collateral-Unblocking Decoction combined with methylcobalamin in patients with DPN, and to study the changes of the plasma Hey level.2、To investigate the relationship between plasma Hey level and TCM patterns in patients with type 2 diabetes mellitus(T2DM).Methods:1、Based on intensive control of blood glucose, totally 60 patients with DPN were randomly divided into the control group and the study group.30 cases were treated with methylcobalamin as the control group, while 30 cases were treated with Liver-Nourishing and Endogenous Wind-Stopping and Collateral-Unblocking Decoction additionally as the study group. The two groups were both treated for 8 weeks. Before and after treatment, all patients underwent laboratory testing including blood glucose, HbAlC, plasma Hey level, and Biochemical targets(ALT and Scr). Neurologic symptoms integral was evaluated, nerve conduction velocity (NCV) of median nerve and common peroneal nerve were performed. Comparing the change of these targets. Adverse events were observed in two groups during treatment period.2、A total of 202 patients with T2DM was categorized into three pattern groups: yin-deficiency and excessive heat pattern, qi-yin deficiency pattern and yin-yang deficiency pattern. Plasma Hey levels of each group were detected and their relationships with the TCM patterns were given statistical analysis.Results:1、After 8 weeks treatment, neurologic symptoms integral and plasma Hey level were significantly lowered than those of before treatment in two groups (P<0.01). SNCV and MNCV of median nerve and common peroneal nerve were significantly increased than those of before treatment(P<0.01). Improvement of neurologic symptoms integral and NCV, decline of plasma Hcy level, the effective rate of treatment in the study group were superior to those in the control group(P<0.01). Blood glucose was decreased but not statistical significance (P>0.05). Furthermore, there was no obvious toxic side effect found in the two groups.2> There were 73.76%of 202 T2DM patients accompanied heperhomocysteinemia. Plasma Hcy levels in patients with T2DM and T2DM accompanied heperhomocysteinemia among different pattern groups were ranked from high to low as follows:yin-yang deficiency pattern, qi-yin deficiency pattern and yin-deficiency and excessive heat pattern, the difference was statistical significance. (P＜O.05)Conclusion:1、Based on intensive control of blood glucose, the treatment of Liver-Nourishing and Endogenous Wind-Stopping and Collateral-Unblocking Decoction combined with methylcobalamin has a good and safe effect in patients with DPN. Simultaneously, its effect is superior to only using methylcobalamin.2、There is certain correlation between plasma Hcy level and TCM patterns in patients with T2DM. Plasma Hcy level can be regarded as a objective index for Traditional Chinese Medicine(TCM)syndrome differentiation in T2DM.更多还原