氧化平衡紊乱介导糖尿病周围神经病变及硫辛酸的临床疗效分析  

The clinical effects of α-lipoic acid on the diabetic peripheral neuropathy due to oxidative balance disorder

作　　者：朱岚[1] 金剑虹[1] 魏燕[1] 徐新鹏[1] 洪郁芝[1] 

机构地区：[1]杭州市中医院内分泌科,浙江省杭州310007

出　　处：《中国慢性病预防与控制》2016年第11期824-827,共4页Chinese Journal of Prevention and Control of Chronic Diseases

摘　　要：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 determine the effects of α-lipoic acid （ALA） on the diabetic peripheral neuropathy （DPN） due to oxidative balance disorder and to provide the basis of treating DPN. Methods From July of 2011 to July of 2015, according to the disease history, symptoms and signs and blood glucose level, 90 inpatients with DPN treated by 600 mg ALA for 2 weeks served as the subjects, 90 healthy cases served as the control groups. The oxidation/anti-oxidation levels of the subjects and controls were observed. The t test and X2 test were used to analyze the data. The used software was SPSS 19.0 software. Results Before treatment, the levels of serum iNOS, MDA, NO and ROS in the subjects were （45.01± 11.70） U/ml, （8.44± 1.42） nmol/L, （13.63± 3.27） μmol/L and （850.25±73.26） U/ml, respectively, which were significantly higher than those （26.42±8.23 U/ml, 4.24± 1.03 nmol/L, 7.53±2.51 μmol/L and 326.23±32.66 U/ml） in controls （P〈0.05）; the levels of serum GSH-PX, SOD, T-AOC, vitamin C and vitamin E were （ 131.82 ±20.81 ） μmol/L, （ 102.59 ±21.75 ） NU/ml, （43.17 ±7.23 ） U/ml, （ 2.13 ±0.64 ） μg/ml and （12.49±4.03） μg/ml, respectively, which were significantly lower than those （164.29±21.04 μmol/L, 185.95±22.74 NU/ml, 88.31±6.93 U/ml, 4.62±0.81 μg/ml and 17.24±4.83 μg/ml） in controls （P〈0.05）. After treatment of ALA, in DPN patients the oxidation levels significantly reduced and the anti-oxidation levels significantly enhanced as compared with those before treatment （/9〈0.05）. After treatment of ALA, the symptoms and signs （ numbness, burning, pain, MCV and SCV ） were improved. There were 62 cases with excellence, 21 cases with effectiveness and 7 cases without effectiveness. The total effective rate was 92.22%. Conclusion The main cause of DPN may be oxidative balance disorder, ALA can improve the oxidative balance disorder and relieve the symptoms and signs in DPN patients. ALA may be useful for clinical treating DPN.

关 键 词：糖尿病周围神经病变 Α硫辛酸 氧化平衡紊乱 

分 类 号：R589.1[医药卫生—内分泌]