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目的探讨糖尿病周围神经病变(DPN)患者氧化-抗氧化平衡紊乱及α-硫辛酸(ALA)治疗DPN的临床疗效,为DPN的治疗提供依据。方法根据病史、体征、血糖水平等检查结果,选择2011年7月至2015年7月在杭州市中医院内分泌科住院的90例DPN患者为研究对象(病例组),并对90例DPN患者给予600 mg ALA加入250 ml 0.9%氯化钠注射液静脉滴注,1次/d,连续2周,并选择同期90名自愿体检者做为对照组,比较DPN患者血清氧化-抗氧化水平的变化和神经病变改善情况,用SPSS 19.0软件进行t检验和χ2检验。结果治疗前,DPN患者血清一氧化氮合酶(i NOS)[(45.01±11.70)U/ml]、丙二醛(MDA)[(8.44±1.42)nmol/L]、一氧化氮(NO)[(13.63±3.27)μmol/L]和活性氧(ROS)水平[(850.25±73.26)U/ml]均明显高于对照组[分别为(26.42±8.23)U/ml、(4.24±1.03)nmol/L、(7.53±2.51)μmol/L、(326.23±32.66)U/ml],差异均有统计学意义(P<0.05)。治疗前,DPN患者谷胱甘肽过氧化物酶(GSH-Px)[(131.82±20.81)μmol/L]、超氧化物歧化酶(SOD)[(102.59±21.75)NU/ml]、总抗氧化能力(T-AOC)[(43.17±7.23)U/ml]、维生素C[(2.13±0.64)μg/ml]和维生素E抗氧化水平[(12.49±4.03)μg/ml]均明显低于对照组[分别为(164.29±21.04)μmol/L、(185.95±22.74)NU/ml、(88.31±6.93)U/ml、(4.62±0.81)μg/ml、(17.24±4.83)μg/ml],差异均有统计学意义(P<0.05)。经ALA治疗后,DPN患者氧化水平明显降低,抗氧化水平明显升高,与治疗前比较,差异均有统计学意义(P<0.05)。ALA治疗后,能明显改善患者肢体感觉、麻木、灼热、疼痛等临床症状和运动神经传导速度(MCV)、感觉神经传导速度(SCV),显效62例,有效21例,无效7例,总有效率为92.22%。结论机体氧化平衡紊乱是导致糖尿病患者DPN的重要原因,ALA能改善DPN患者氧化-抗氧化平衡状态,有效缓解临床症状,治疗效果显著,值得临床进一步应用。
Objective To investigate the oxidative-anti-oxidative balance disorder in patients with diabetic peripheral neuropathy (DPN) and the clinical efficacy of α-lipoic acid (ALA) in the treatment of DPN, so as to provide a basis for the treatment of DPN. Methods 90 DPN patients admitted to Department of Endocrinology, Hangzhou Hospital of Traditional Chinese Medicine from July 2011 to July 2015 were selected as study subjects (case group) and 90 DPN patients were selected according to the examination results such as medical history, physical signs and blood glucose level. One hundred and sixty mg ALA was injected into 250 ml 0.9% sodium chloride injection once a day for 2 weeks, and 90 voluntary volunteers during the same period were selected as control group to compare the changes of serum oxidation and anti-oxidation in DPN patients And neurological improvement, using SPSS 19.0 software for t test and χ2 test. Results Before treatment, the serum levels of nitric oxide synthase (iNOS) [(45.01 ± 11.70) U / ml], MDA [(8.44 ± 1.42) nmol / L] [(13.63 ± 3.27) μmol / L] and reactive oxygen species (ROS) levels [(850.25 ± 73.26) U / ml] were significantly higher than those in the control group (26.42 ± 8.23 U / ml and 4.24 ± 1.03, nmol / L, (7.53 ± 2.51) μmol / L, (326.23 ± 32.66) U / ml] respectively. There were significant differences between the two groups (P <0.05). Before treatment, the total glutathione peroxidase (GSH-Px) [(131.82 ± 20.81) μmol / L], superoxide dismutase (SOD) [(102.59 ± 21.75) NU / ml] The levels of T-AOC [(43.17 ± 7.23) U / ml], vitamin C [(2.13 ± 0.64) μg / ml] and antioxidant levels of vitamin E [(12.49 ± 4.03) μg / ml] (164.29 ± 21.04) μmol / L, (185.95 ± 22.74) NU / ml, (88.31 ± 6.93) U / ml and (4.62 ± 0.81) μg / ml and (17.24 ± 4.83) μg / ml respectively) , The differences were statistically significant (P <0.05). After treatment with ALA, the level of oxidation was significantly decreased and the level of antioxidant activity was significantly increased in patients with DPN. The difference was statistically significant (P <0.05). After treatment with ALA, clinical symptoms, motor nerve conduction velocity (MCV) and sensory nerve conduction velocity (SCV) in limbs such as limb sensation, numbness, burning and pain were significantly improved, 62 cases were markedly effective, 21 effective and 7 ineffective. Efficiency is 92.22%. Conclusions The disorder of oxidative balance in the body is an important cause of DPN in diabetic patients. ALA can improve the oxidation-antioxidant balance of DPN patients and relieve the clinical symptoms effectively. It is worth further clinical application.