糖尿病痛性神经病变诊疗研究进展  

A review on the diagnosis and treatment of painful diabetic peripheral neuropathy

作　　者：陈蕾 魏婉冰 胡天赤 CHEN Lei;WEI Wanbing;HU Tianchi

机构地区：[1]福建中医药大学,福建福州350108 [2]福建中医药大学附属厦门中医院,福建福州361000

出　　处：《中医临床研究》2023年第27期80-84,共5页Clinical Journal Of Chinese Medicine

摘　　要：糖尿病痛性神经病变是糖尿病较为常见的一种并发症,部分患者因早期疼痛可忍受而延误诊治,随着病情进展患者疼痛较为剧烈,严重影响工作生活。为缓解糖尿病痛性神经病变患者的症状,提高其生活质量,文章对目前国内外关于糖尿病痛性神经病变的机制和治疗进行研究,期望能指导临床,为糖尿病痛性神经病变的治疗提供更多的思路。目前国外多从周围神经炎症反应、离子通道改变、中枢敏化和外周敏化、小胶质细胞活化等方面研究糖尿病痛性神经病变发病机制,治疗多从阻断离子通道、抗氧化、营养神经方面联合止痛药物对症处理,能产生一定的止痛效果,但长期使用效果不佳且不良反应较明显。中医将糖尿病痛性神经病变归为“消渴痛痹”范畴,治疗长短期效果较好,中医认为“久病入络”,疼痛的产生以血瘀为主要机制,治疗以通瘀为大法,佐以益气、温阳、化痰、养阴等,综合达到气血阴阳平衡的状态。治疗多采用中药汤剂口服以及穴位贴敷、浴足、放血等方法,内外合治以提高疗效。但由于中医各家对于糖尿病痛性神经病变发生的机制有不同的看法,对于通瘀药物选择及配伍也各不相同,目前尚没有明确的中医诊疗规范,笔者综各家辨证思路及临床用药经验,以期为该病中医临床治疗提高可靠的方法。Painful diabetic peripheral neuropathy(PDPN)is a relatively common complication of diabetes.Some patients delay diagnosis and treatment due to tolerable pain in the early stages,and as the condition progresses,the pain becomes severe and seriously affects work and life.In order to alleviate the symptoms of painful diabetic peripheral neuropathy patients and improve their quality of life,this article reviews the mechanism and treatment of PDPN in China and abroad with the hope of providing more ideas for clinical treatment.At present,the pathogenesis of PDPN in foreign countries is mostly studied from the aspects of peripheral nerve inflammation,ion channel changes,central and peripheral sensitization,and microglia activation,etc.The treatment is mostly from the aspects of blocking ion channels,antioxidant and nutritional nerve combined with symptomatic treatment of analgesics,which can produce certain analgesic effects,but the long-term use effect is not good and the adverse reactions are obvious.TCM classifies PDPN into the category of“Xiaoke Tongbi(消渴痛痹)”,and the treatment effect is good in the long and short term.TCM believes that“chronic disease enters collaterals”,and blood stasis is the main mechanism for pain.The treatment mainly focuses on promoting blood circulation,which is supplemented with Qi(气)tonification,Yang(阳)warming,phlegm resolving,and Yin(阴)nourishing,to achieve a balance between Qi and blood and Yin and Yang comprehensively.Treatment often involves TCM decoctions for oral administration,acupoint application,foot bath,bloodletting,etc.,to achieve better therapeutic effects.However,because different schools of traditional Chinese medicine have different views on the mechanism of PDPN,and the selection and combination of blood-activating drugs also vary greatly,there is no clear TCM diagnosis and treatment standard at present.The author summarizes the syndrome differentiation ideas and clinical medication experience of various TCM schools,in order to improve the reliable me

关 键 词：糖尿病痛性神经病变 消渴病痛痹 中医 疼痛机制 

分 类 号：R587.1[医药卫生—内分泌]