α—硫辛酸聯合甲鈷胺對糖尿病性周圍神經病變患者血清氧化應激水平的影響及療效觀察

劉丹英　王俊

[摘要] 目的 探討α-硫辛酸聯合甲鈷胺對糖尿病性周圍神經病變（DPN）患者血清氧化應激水平的影響及療效。方法 選擇2015年1月～2017年4月住院治療DPN患者76例，隨機分為觀察組和對照組各38例。兩組患者均予以飲食控制、適當體育鍛煉及口服降糖藥物或胰島素注射治療控制血糖，使得血糖達標。對照組在此基礎上加用甲鈷胺針肌注0.5 mg/次，1次/d，連用4周。觀察組在對照組基礎上加用α-硫辛酸針靜滴，600 mg/次，1次/d，連用4周。觀察兩組治療前后血清氧化應激指標[血清丙二醛（MDA）和超氧化物歧化酶（SOD）]，并評估其臨床療效及不良反應。 結果 治療4周后，兩組血清MDA和SOD指標分別較治療明顯下降或上升（P<0.05或P<0.01），觀察組變化幅度較對照組更明顯（P<0.05）；同時觀察組臨床總有效率較對照組更佳（χ2=4.15，P<0.05）。對照組與觀察組分別出現不良反應3例（7.89%）和6例（15.79%），癥狀較輕，均逐漸自行緩解，兩組比較差異無統計學意義（χ2=0.50，P>0.05）。 結論 α-硫辛酸結合甲鈷胺治療DPN的療效明顯優于單純的甲鈷胺治療，安全性佳，且作用機制與其能降低血清MDA指標，升高血清SOD指標，減輕氧自由基對神經損傷，對脂質過氧化損傷起保護作用密切相關。

[關鍵詞] 糖尿病性周圍神經病變；α-硫辛酸；甲鈷胺；氧化應激

[中圖分類號] R587.1 [文獻標識碼] B [文章編號] 1673-9701（2017）36-0109-04

[Abstract] Objective To investigate the effect of α-lipoic acid combined with mecobalamin on serum oxidative stress in patients with diabetic peripheral neuropathy（DPN） and its therapeutic effect. Methods A total of 76 patients with DPN in our hospital from January 2015 to April 2017 were randomly divided into observation group（n=38） and control group（n=38）. Two groups of patients were given diet control， appropriate physical exercise and oral hypoglycemic drugs or insulin injection treatment to control blood sugar， making the blood glucose reach the standard. And the control group was added with mecobalamin needle intramuscular injection 0.5 mg/times， 1/d， for 4 weeks. The observation group was added with α-lipoic acid needle intravenous， 600 mg/times， 1/d， for 4 weeks based on the treatment of the control group. Serum oxidative stress indicators including serum malondialdehyde（MDA） and superoxide dismutase （SOD） in the two groups were measured before and after treatment， and the clinical efficacy and adverse reactions were evaluated. Results After 4 weeks of treatment， the levels of serum MDA and SOD in the two groups were significantly lower or higher than those before treatment（P<0.05 or P<0.01）. And the magnitude of change in the observation group was more significant than that of he control group（P<0.05）. And the overall effective rate in the observation group was better than that of the control group（χ2=4.15， P<0.05）. There were 3 cases （7.89%） and 6 cases （15.79%） of the adverse reactions in the control group and the observation group， and the symptoms were mild and gradually alleviated. There was no significant difference between the two groups（χ2=0.50， P>0.05）. Conclusion The efficacy of α-lipoic acid combined with mecobalamin in the treatment of DPN is superior to that of methylcobalamin alone. And the safety of the combination therapy is good， and its mechanism is related with the decreasing of the serum MDA， increasing the serum SOD， reducing the oxygen free radicals and the protective effect of lipid peroxidation injury.

[Key words] Diabetic peripheral neuropathy； α-lipoic acid； Mecobalamin； Oxidative stress

糖尿病是中老年患者的常見內分泌疾病，神經病變是其常見的慢性并發癥之一，病變累及中樞及周圍和自主神經，尤其糖尿病周圍神經病變（DPN）最多見，主要表現為局部麻木刺痛，嚴重時肌肉萎縮等[1-3]。DPN的病因及發病機制很復雜，研究發現氧化應激的損傷引起的脂質過氧化損傷在DPN的發病過程中起及其重要的作用[4-6]。甲鈷胺是治療DPN常用藥，可加快修復受損的神經組織，促進受損軸突的修復再生，但是單獨使用的效果欠理想，遠期效果亦欠佳[7，8]。……