摘要
目的:基于脉络学说探讨针刺联合黄芪桂枝五物汤对2型糖尿病周围神经病变(DPN)的临床疗效以及对患者微血管内皮细胞功能的影响.方法:2019年8月～2022年12月于我院接受中医治疗的100例DPN患者为研究对象,按照完全随机法将研究对象分为研究组50例,对照组50例.对照组在常规疗法基础上实施针刺穴位治疗,研究组在常规疗法基础上实施黄芪桂枝五物汤联合针刺穴位治疗.对比两组患者治疗后临床疗效的差异,比较治疗前后两组患者血糖水平[空腹血糖(FPG)、餐后2h血糖(2hPG)、糖化血红蛋白(HbA1c)]、正中感觉神经传导速度(SNCV)和运动神经传导速度(MNCV)、腓总神经SNCV和MNCV、血脂水平[总胆固醇(TC),甘油三酯(TG),高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)水平]、血管内皮细胞功能相关指标[一氧化氮(NO)、内皮素-1(ET-1)、血管内皮生长因子(VEGF)、肱动脉内皮依赖性血管舒张功能(FMD)、肱动脉非内皮依赖性血管舒张功能(NMD)]的差异,并观察治疗后不良反应.结果:治疗后,临床疗效总有效率研究组明显高于对照组(P＜0.05);治疗后,研究组FBG、2hBG、HbA1c、TC、TG、LDL-C、ET-1、VEGF水平低于治疗前,且明显低于对照组治疗后(P＜0.05);正中神经和腓总神经SNCV和MNCV、HDL-C、NO、FMD、NMD高于治疗前,且明显高于对照组治疗后(P＜0.05).两组患者在治疗过程中均未出现明显的不良反应.结论:基于脉络学说通过针刺联合黄芪桂枝五物汤治疗DPN,可明显改善患者血糖、血脂水平,加快神经传导速度,调节微血管内皮细胞功能,可在临床推广应用.
Abstract
Objective:To explore the clinical efficacy of acupuncture combined with Huangqi Guizhi Wuwu decoction in the treatment of type 2diabetic peripheral neuropathy(DPN)based on channels and collaterals theory and the influence on microvas-cular endothelial cell function of patients.Methods:100 patients with DPN who received traditional Chinese medicine treatment in our hospital from August 2019 to December 2022 were selected as the study subjects.According to the complete randomization method,the study subjects were divided into 50 cases in study group and 50cases in control group.The control group was treated with acupoint acupuncture on the basis of conventional therapy,and the study group was given Huangqi Guizhi Wuwu decoction combined with acupoint acupuncture on the basis of conventional therapy.The difference in clinical efficacy after treatment and differences in blood glucose indicators[fasting plasma glucose(FPG),2h postprandial blood glucose(2hPG),glycosylated he-moglobin(HbA1c)],median nerve sensory nerve conduction velocity(SNCV)and motor nerve conduction velocity(MNCV),common peroneal nerve SNCV and MNCV,blood lipids[total cholesterol(TC),triglyceride(TG),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C)]and vascular endothelial cell function-related indicators[nitric oxide(NO),endothelin-1(ET-1),vascular endothelial growth factor(VEGF),brachial artery flow-mediated dilation(FMD),brachial artery nitroglycerin-mediated dilation(NMD)]before and after treatment were compared between both groups of patients,and the adverse reactions after treatment were observed.Results:After treatment,the total effective rate of clinical ef-ficacy in study group was significantly higher than that in control group(P＜0.05).The levels of FBG,2hBG,HbA1c,TC,TG,LDL-C,ET-1and VEGF in study group after treatment were lower than those before treatment,and were significantly lower than those in control group after treatment(P＜0.05).The SNCV and MNCV of median nerve and common peroneal nerve,HDL-C,NO,FMD and NMD were higher than those before treatment,and were significantly higher than after treatment in control group(P＜0.05).There were no obvious adverse reactions during treatment in both groups.Conclusion:Acupuncture combined with Huangqi Guizhi Wuwu Decoction in treating DPN based on channels and collaterals theory can significantly improve the blood glu-cose and blood lipids,accelerate the nerve conduction velocity,and regulate the microvascular endothelial cell function.
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