心身同治法治疗糖尿病痛性神经病变合并抑郁症临床研究  

Clinical effect of psychosomatic treatment on pooled painful diabetic peripheral neuropathy and depression

作　　者：房小双 徐铁岩 冯占荣 赵乾 潘青松 丁颖 孙潇潇[1] FANG Xiaoshuang;XU Tieyan;FENG Zhanrong;ZHAO Qian;PAN Qingsong;DING Ying;SUN Xiaoxiao(Department of Endocrinology,Shuyang Affiliated Hospital,Nanjing University of Traditional Chinese Medicine,Shuyang,Jiangsu 223600;Xishan District Yangjian Town Community Health Service Center,Wuxi,Jiangsu 214107)

机构地区：[1]南京中医药大学沭阳附属医院内分泌科,江苏沭阳223600 [2]江苏省无锡市锡山区羊尖镇社区卫生服务中心,江苏无锡214107

出　　处：《河北中医》2022年第8期1277-1281,共5页Hebei Journal of Traditional Chinese Medicine

基　　金：江苏省宿迁市科学技术局2018年度第一批市级指导性科技计划项目(编号:Z2018023)。

摘　　要：目的观察基于心身同治法采用柴胡加龙骨牡蛎汤治疗糖尿病痛性神经病变(DPNP)合并抑郁症的临床疗效。方法将60例DPNP合并抑郁症患者按照随机数字表法分为2组,对照组30例予盐酸氟西汀胶囊治疗,治疗组30例在对照组治疗基础上加柴胡加龙骨牡蛎汤口服。4周后观察2组临床疗效,比较2组治疗前后17项汉密尔顿抑郁量表(HAMD-17)评分,疼痛视觉模拟评分(VAS),上肢正中神经和下肢腓总神经的运动神经传导速度(MCV)和感觉神经传导速度(SCV),空腹血糖(FPG)、餐后2 h血糖(2 hPG)、糖化血红蛋白(HbA_(1)c)及总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)水平。结果治疗组总有效率90.0%(27/30),对照组总有效率73.3%(22/30),治疗组总有效率高于对照组(P<0.05)。治疗后,2组HAMD-17评分、疼痛VAS及FPG、2 hPG、HbA_(1)c水平均较本组治疗前降低(P<0.05),且治疗组均低于对照组(P<0.05)。治疗后,2组正中神经、腓总神经MCV和SCV均较本组治疗前提高(P<0.05),且治疗组均高于对照组(P<0.05)。治疗后,治疗组TC、TG、LDL-C水平均较本组治疗前下降(P<0.05),HDL-C水平较本组治疗前升高(P<0.05),且LDL-C水平低于对照组(P<0.05),HDL-C水平高于对照组(P<0.05)。治疗后,对照组TG、LDL-C水平均较本组治疗前下降(P<0.05),HDL-C水平较本组治疗前升高(P<0.05)。结论基于心身同治法采用柴胡加龙骨牡蛎汤治疗DPNP合并抑郁症患者疗效显著,可改善患者糖脂代谢、抑郁状态,缓解疼痛,提高神经传导速度。Objective To observe the clinical effect of Chaihu Longgu Muli Decoction with psychosomatic treatment on pooled painful diabetic peripheral neuropathy(PDPN)and depression.Methods Totally 60 PDPN patients with depression were randomly assigned to the treatment group and control group,with 30 per group.All patients were managed by fluoxetine hydrochloride capsules,and those in the treatment group were additionally treated with oral Chaihu Longgu Muli Decoction.After 4 weeks of the treatment,17-item Hamilton Depression Scale(HAMD-17),visual analogue scale(VAS)for pain,motor conduction velocity(MCV)and sensory conduction velocity(SCV)of median nerve(MN)of upper limb and common peroneal nerve(CPN)of lower extremity,fasting plasma glucose(FPG),2-h postprandial glucose(2 hPG),glycosylated hemoglobin(HbA_(1)c),total cholesterol(TC),triglyceride(TG),low density lipoprotein-cholesterol(LDL-C),high density lipoprotein-cholesterol(HDL-C)were included as comparators;the curative effect was assessed.Results The overall effective rate was 90.0%(20/30)in the treatment group,higher than that of 73.3%(8/30)in the control group(P<0.05).After treatment,HAMD-17 scores,VAS,FPG,2 hPG,HbA_(1)c in groups were decreased(P<0.05),which decreased in the treatment group compared with the control group(P<0.05);MCV and SCV of MN and CPN in groups were increased(P<0.05),improvement of which in the treatment group were significantly better(P<0.05);decreased TC,TG,LDL-C and elevated HDL-C in the treatment group were found(all P<0.05);lower LDL-C level,and higher HDL-C level were detected in the treatment group than those in the control group(all P<0.05);decreased TG,LDL-C and increased HDL-C were measured in the control group(all P<0.05).Conclusion For PDPN patients with depression,Chaihu Longgu Muli Decoction with psychosomatic treatment has significant curative effect,can improve glucose and lipid metabolism,depression,relieve pain,and improve nerve conduction velocity.

关 键 词：糖尿病神经病变 神经痛 抑郁 身心疗法 柴胡加龙骨牡蛎汤 

分 类 号：R587.250.5[医药卫生—内分泌]