加味黄芪鳖甲汤联合耳穴压豆治疗糖尿病周围神经病变气阴两虚证的疗效及对血清MyD88/IκB信号通路的影响  

Effect of Modified Huangqi Biejiatang Combined with Auricular Acupressure on Diabetic Peripheral Neuropathy of Qi-Yin Deficiency Syndrome and Serum MyD88/IκB Signaling Pathway

作　　者：姚玉红[1] 张华[1] 李健[2] 张君普 孙新宇[1] YAO Yu-hong;ZHANG Hua;LI Jian;ZHANG Jun-pu;SUN Xin-yu(Henan Province Hospital of Traditional Chinese Medicine(TCM),Zhengzhou 450002,China;The First Affiliated Hospital of Henan University of TCM,Zhengzhou 450008,China;Third Affiliated Hospital of Henan University of TCM,Zhengzhou 450003,China)

机构地区：[1]河南省中医院,郑州450002 [2]河南中医药大学第一附属医院,郑州450008 [3]河南中医药大学第三附属医院,郑州450003

出　　处：《中国实验方剂学杂志》2021年第11期98-105,共8页Chinese Journal of Experimental Traditional Medical Formulae

基　　金：河南省中医药科学研究专项课题(2019JDZY090)。

摘　　要：目的:观察加味黄芪鳖甲汤联合耳穴压豆治疗糖尿病周围神经病变气阴两虚证的疗效及对髓样分化因子(MyD88)/核转录因子-κB抑制蛋白(IκB)信号通路的影响。方法:140例患者随机分为观察组和对照组,各70例。均给予患者饮食指导,控制空腹血糖、血压等基础治疗,观察组给予加味黄芪鳖甲汤联合耳穴压豆治疗,对照组给予甲钴胺治疗,疗程均为4周。治疗前后分别观察两组多伦多临床神经病变量表(TCSS),中医证候,运动及感觉神经(正中神经、腓总神经、胫神经、尺神经)传导速度,糖代谢指标[空腹血浆葡萄糖(FPG),餐后2 h血浆葡萄糖(2 hPG),糖化血红蛋白(HbA1c)],肠道菌群(毛梭菌、布劳氏菌、拟杆菌、粪杆菌),血清MyD88/IκB信号通路[MyD88,IκBα,磷酸化核转录因子-κB抑制蛋白α(p-IκBα)]的水平。比较两组临床疗效及安全性。结果:观察组总有效率85.3%(58/68),高于对照组的48.5%(32/66)(χ^(2)=6.143,P<0.05)。与对照组治疗后比较,观察组TCSS,中医证候,FPG,2 hPG,HbA1c,毛梭菌,布劳氏菌,MyD88,p-IκBα降低(P<0.05),运动及感觉神经(正中神经、腓总神经、胫神经、尺神经)传导速度加快(P<0.05),拟杆菌,粪杆菌,IκBα升高(P<0.05)。观察组不良反应发生率1.5%(1/68),低于对照组的12.1%(8/66)(χ^(2)=4.328,P<0.05)。结论:加味黄芪鳖甲汤联合耳穴压豆可明显改善糖尿病周围神经病变气阴两虚证患者的临床疗效,其作用机制可能与调节血清MyD88/IκB信号通路有关。Objective: To observe the effects of modified Huangqi Biejiatang combined with auricular acupressure on diabetic peripheral neuropathy(DPN) due to Qi and Yin deficiency and serum myeloid differentiation factor 88/inhibitor of nuclear factor-κB(MyD88/IκB)signaling pathway. Method: One hundred and forty cases were randomly divided into an observation group(n=70)and a control group(n=70). In addition to routine treatments like dietary intervention and the regulation of fasting blood glucose(FBG)and blood pressure,the modified Huangqi Biejiatang combined with auricular acupressure was further provided in the observation group,while mecobalamine was administered in the control group. After four-week intervention,the toronto clinical scoring system(TCSS) score, traditional Chinese medicine(TCM) syndrome score, the conduction velocities of motor and sensory nerves(median nerve,common peroneal nerve,tibial nerve,and ulnar nerve),glucose metabolism indexes [fasting plasma glucose(FPG),2 h postprandial blood glucose(2 hPG),and hemoglobin A1c(HbA1c)],intestinal genera(Clostridium,Prauserella,Bacteroides,and Faecalibacterium),as well as the serum MyD88,IκBα,and phosphorylated IκBα(p-IκBα)levels in the MyD88/IκB signaling pathway before and after treatment were observed in the two groups,for comparing their clinical efficacy and safety. Result:The total effective rate of the observation group was 85.3%(58/68),which was higher than 48.5%(32/66)of the control group(χ^(2)=6.143,P<0.05). The comparison with the control group revealed that the scores of TCSS and TCM syndrome,the levels of FPG,2 hPG,HbA1c,MyD88,and p-IκBα,as well as the abundances of Clostridium and Prauserella in the observation group were decreased(P<0.05),while the conduction velocities of motor and sensory nerves(median nerve,common peroneal nerve,tibial nerve,and ulnar nerve)were significantly accelerated(P<0.05). Besides,the abundances of Bacteroides and Faecalibacterium and IκBα level were significantly elevated(P<0.05). The incidence of advers

关 键 词：加味黄芪鳖甲汤 耳穴压豆 糖尿病周围神经病变(DPN) 气阴两虚证 髓样分化因子(MyD88)/核转录因子-κB抑制蛋白(IκB)信号通路 

分 类 号：R22[医药卫生—中医基础理论] R242[医药卫生—中医学]