基础胰岛素联合二甲双胍治疗早期糖尿病周围神经病变的疗效及分子生物学机制探讨

摘要

Objective: To investigate the efficacy and molecular biological mechanism of basal insulin plus metformin treatment for diabetic peripheral neuropathy patients. Methods:98 cases of diabetic peripheral neuropathy were recruited and given metformin (Glucophage tablet, 0.5 bid initial) plus glargine (0.1u/kg initial) treatment adjusting to diabetic goal and lasting to12 weeks. The nerve conduction velocity of peroneal nerve, median nerve and the inflammatory factors including Leptin, Nerve growth factor, IL-6,TNF-α and NGF were tested and compared. Results:After treatment, 98 cases of early diabetic peripheral neuropathy re-sulted in blood glucose at target rate 77.6 (76/98) and total efficacy rate 81.6%(80/98). Furthermore effica-cy rate of blood glucose at target cases showed statistically difference compared to failed cases (χ2=8.407, P=0.007) . While motion and sense nerve conduction velocity of median and peroneal nerve after treatment were improved significantly compared to before ( P<0.05) . And also after the treatment inflammatory factors in ser-um including LP ( t=15.390, P=0.003) , NGF ( t=13.471 P=0.009) , IL-6 ( t=12.373, P=0.010) and TNF-α ( t=14.437, P=0.001) were decreased significantly ( P<0.05) . Conclusion:Basal insulin plus met-formin for early diabetic peripheral neuropathy could inhibit microinflammation caused by hyper glucose, im-prove diabetic peripheral nerve injuries, which should deserve further attention in clinic.%目的：：研究基础胰岛素联合二甲双胍治疗对早期糖尿病周围神经病变的治疗效果及分子生物学机制。方法：以我院收集的2型糖尿病合并早期糖尿病周围神经病变98例为研究对象,予甘精胰岛注射液0.1u/kg1次/d皮下注射,二甲双胍肠溶片(0.52次/d)调控血糖,总疗程12周。比较血糖控制达标与不达标患者周围神经病变及炎症因子水平。结果：98例患者血糖控制达标率77.6(76/98),治疗有效率81.6％(80/98)；血糖达标患者总有效率86.8％(66/78)与血糖未达标者59.1％(13/22)比较,差异有统计学意义(χ2＝8.407,P＝0.007)。治疗后与治疗前比较,腓神经运动传导( t＝13.258,P＝0.008)、感觉传导( t＝11.319,P＝0.001),正中神经运动传导( t＝14.219,P＝0.005)、感觉传导( t＝11.164,P＝0.009),差异均具有统计学意义(P<0.05)。治疗后与治疗前比较,炎症相关因子LP(t＝15.390,P＝0.003)、NGF(t＝13.471,P＝0.009)、IL－6(t＝12.373,P＝0.010)、TNF－α(t＝14.437,P＝0.001)差异均具有统计学意义( P<0.05)。结论：早期糖尿病周围神经病变应用基础胰岛素联合二甲双胍治疗控制血糖达标能够降低机体炎症因子水平,改善神经损害。