α-硫辛酸联合甲钴胺治疗糖尿病周围神经病变的疗效观察及与血浆同型半胱氨酸、超敏C反应蛋白的相关性分析

摘要

目的 观察α-硫辛酸联合甲钴胺治疗糖尿病神经病变(DPN)的疗效及与血浆同型半胱氨酸(Hcy)、超敏C反应蛋白(hs-CRP)的相关性.方法 将160例2型糖尿病合并DPN患者随机分为对照组和联合治疗组,每组各80例.单用甲钴胺组(对照组):给予甲钴胺500 μg,静脉推注,每日1次.硫辛酸联合甲钴胺治疗组(联合治疗组):在对照组的基础上加用α-硫辛酸0.6加入生理盐水250ml,静脉滴注,每日1次,两组疗程均为14天.观察两组患者治疗前后临床症状的改善情况,同时监测其神经传导速度与血浆Hcy、hs-CRP水平在治疗前后的变化.结果 硫辛酸联合甲钴胺治疗组的临床症状改善情况明显优于单用甲钴胺治疗组,其TSS评分比较差异有统计学意义(P＜0.05),神经传导速度亦明显增加(P＜0.05);两组患者治疗后血浆Hcy及hs-CRP水平均明显降低,差异有统计学意义(P＜0.05);但联合治疗组血浆hs-CRP较对照组降低更明显,具有统计学意义(P ＜0.05);Hcy水平低于对照组,但差异无统计学意义(P＞0.05).结论 α-硫辛酸联合甲钴胺可显著改善DPN患者的临床症状,疗效优于单独使用甲钴胺,其作用机制可能与硫辛酸抗炎症损伤、抗氧化应激及保护血管内皮作用有关.%Objective To observe the effect of α-lipoic acid(ALA) combined with mecobalamin in the treatment of diabetic peripheral neuropathy(DPN) patients and its influence on the level of homocysteine(Hcy) and high-sensitivity C-reactive protein(hs-CRP).Methods 160 DPN patients were randomly divided into control group and treatment group with each group of 80 cases,control group receiving mecobalamin 500 μg iv,qd.and the tratment group was additionally given ALA 0.6 g in salin 250 ml given by inrtavenous drip infusion once a day.Both groups were treated 14 days.The clinical symptoms,nerve conduction velocity,TSS score and the peripheral blood level of Hcy and hs-CRP were compared between two groups.Results The TSS score,the level of Hcy and hs-CRP were significantly reduced (P ＜ 0.05)and the nerve conduction velocity was obviously increased (P ＜ 0.05) in both group after two weeks' treatment,and there were significant differences on the levels in TSS score,hs-CRP and the nerve conduction velocity between two groups after treatment.In spite of decresing of Hcy level were observed in ALA treatment group after treatment,but there were no significant difference (P ＞ 0.05).Conclusion ALA combined with mecobalamin can significantly improve the symptoms and the effect is better than a single use of mecobalamin.Decrease the level of Hcy and hs-CRP of the DPN patients,its mechanism may be related to lipoic acid resistance,resistance to oxidative stress and inflammation injury is related to vascular endothelial function.