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黄芪桂枝五物汤加味治疗糖尿病周围神经病变34例临床观察
糖尿病周围神经病变是糖尿病常见的并发症之一,严重影响糖尿病患者的生活质量,目前其机理尚不明确,缺乏特异疗法.两年来笔者对54例糖尿病周围神经病变患者应用黄芪桂枝五物汤加味进行对照观察,现报告如下.
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Objective: To verify the effect of Jinmaitong composita (JMTC) on red blood cell aldose reductase activity (RBC-AR), red blood cell sorbitol (RBC-S) and nerve conductive velocity in diabetic peripheral neuropathy (DN) patients. Methods: Sixty-six patients with DN were randomly divided into two groups, 33 patients in the treated group treated with JMTC and 33 patients in the control group treated with Jingui Shenqi capsule (JGSQ). RBC-AR, RBC-S and nerve transmission speed were observed before and after three months treatment.Results: Level of RBC-AR, RBC-S apparently decreased and nerve conductive velocity increased (P<0.05, P<0.01) after JMTC treatment.Conclusion: JMTC can improve the nerve conductive velocity significantly with a lowering of RBC-AR and RBC-S and has a good result in treating diabetic peripheral neuropathy.
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中药对糖尿病周围神经修复再生的影响
糖尿病周围神经病变(diabetic peripheral neuropathy,DPN)是糖尿病常见的慢性并发症之一.DPN常见的病理表现为神经轴突萎缩、脱髓鞘、神经纤维丧失及神经纤维再生减缓.治疗糖尿病周围神经病变的目的不仅在于阻止神经变性和功能异常, 而且还要促进变性神经纤维的修复再生.
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一氧化氮与糖尿病周围神经病变及中药干预的研究
糖尿病周围神经病变(Diabetic Peripheral Neuropathy, DPN)是糖尿病(DM)常见的慢性并发症之一, 文献报道患病率在40%~90%不等.DPN的发展常导致糖尿病足的发生, 是造成糖尿病患者致残的主要原因之一[1].
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糖尿病周围神经痛发病机制的研究进展
糖尿病周围神经病变(diabetic peripheral neuropathy,DPN)是糖尿病常见并发症之一,在糖尿病患者中发病率约20%,占糖尿病神经病变的50%[1],其中糖尿病周围神经痛(painful diabetic peripheral neuropathy,PDN)发病率13%~26%[2].
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Quercetin can reverse high glucose-induced inhibition of neural cell proliferation, and therefore may have a neuroprotective effect in diabetic peripheral neuropathy. It is dififcult to obtain pri-mary Schwann cells and RSC96 cells could replace primary Schwann cells in studies of the role of autophagy in the mechanism underlying diabetic peripheral neuropathy. Here, we show that under high glucose conditions, there are fewer autophagosomes in immortalized rat RSC96 cells and primary rat Schwann cells than under control conditions, the proliferative activity of both cell types is signiifcantly impaired, and the expression of Beclin-1 and LC3, the molecular mark-ers for autophagy, is signiifcantly lower. After intervention with quercetin, the autophagic and proliferative activity of both cell types is rescued. These results suggest that quercetin can allevi-ate high glucose-induced damage to Schwann cells by autophagy.
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Early diagnosis of diabetic peripheral neuropathy is important for the successful treatment of diabetes mellitus. In the present study, we recruited 500 diabetic patients from the Fourth Afifl-iated Hospital of Kunming Medical University in China from June 2008 to September 2013: 221 cases showed symptoms of peripheral neuropathy (symptomatic group) and 279 cases had no symptoms of peripheral impairment (asymptomatic group). One hundred healthy control sub-jects were also recruited. Nerve conduction studies revealed that distal motor latency was longer, sensory nerve conduction velocity was slower, and sensory nerve action potential and amplitude of compound muscle action potential were signiifcantly lower in the median, ulnar, posterior tibial and common peroneal nerve in the diabetic groups compared with control subjects. More-over, the alterations were more obvious in patients with symptoms of peripheral neuropathy. Of the 500 diabetic patients, neural conduction abnormalities were detected in 358 cases (71.6%), among which impairment of the common peroneal nerve was most prominent. Sensory nerve abnormality was more obvious than motor nerve abnormality in the diabetic groups. The ampli-tude of sensory nerve action potential was the most sensitive measure of peripheral neuropathy. Our results reveal that varying degrees of nerve conduction changes are present in the early, as-ymptomatic stage of diabetic peripheral neuropathy.
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Iron overload can lead to cytotoxicity, and it is a risk factor for diabetic peripheral neuropathy. However, the underlying mechanism remains unclear. We conjectured that iron overload-induced neurotoxicity might be associated with oxidative stress and the NF-E2-related factor 2 (Nrf2)/ARE signaling pathway. As an in vitro cellular model of diabetic peripheral neuropathy, PC12 cells ex-posed to high glucose concentration were used in this study. PC12 cells were cultured with ferric ammonium citrate at different concentrations to create iron overload. PC12 cells cultured in ferric ammonium citrate under high glucose concentration had significantly low cellviability, a high rate of apoptosis, and elevated reactive oxygen species and malondialdehyde levels. These changes were dependent on ferric ammonium citrate concentration. Nrf2 mRNA and protein expression in the fer-ric ammonium citrate groups were inhibited markedly in a dose-dependent manner. Al changes could be inhibited by addition of deferoxamine. These results indicate that iron overload aggravates oxidative stress injury in neural cells under high glucose concentration and that the Nrf2/ARE sig-naling pathway might play an important role in this process.
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Angiogenin is associated with the pathogenesis of diabetic peripheral neuropathy. Here, we se-quenced the coding region of the angiogenin gene in genomic DNA from 207 patients with type 2 diabetes mel itus (129 diabetic peripheral neuropathy patients and 78 diabetic non-neuropathy pa-tients) and 268 healthy controls. Al subjects were from the Han population of northern China. No mutations were found. We then compared the genotype and allele frequencies of the angiogenin synonymous single nucleotide polymorphism rs11701 between the diabetic peripheral neuropathy patients and controls, and between the diabetic neuropathy and non-neuropathy patients, using a case-control design. We detected no statistical y significant genetic associations. Angiogenin may not be associated with genetic susceptibility to diabetic peripheral neuropathy in the Han population of northern China.
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糖尿病周围神经病变的药物治疗现况
糖尿病周围神经病变(diabetic:peripheral neu-ropathy,DPN)是常见的糖尿病微血管慢性并发症之一,英国糖尿病前瞻性研究发现超过11%的患者在糖尿病确诊的同时就已经存在明显的DPN.
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治疗重症抑郁和糖尿病周围神经病变的新药——度洛西汀
盐酸度洛西汀(duloxetine,商品名Cymbalta)为一种口服选择性5-羟色胺(5-HT)和去甲肾上腺素再摄取抑制剂(SS-NRI).由美国礼来制药公司出品[1],FDA于2004年8月3日批准本品上市治疗重症抑郁(MDD),2004年9月3日又批准用于治疗糖尿病周围神经病变(DPN)所致疼痛等症状.化学名称为(+)-(S)-N-甲基γ-(1-萘氧基)-2-噻吩丙胺盐酸盐,分子式为C18H19NOS·HCl,相对分子质量为333.88.结构式见图1.
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低能量He-Ne激光血管内照射对糖尿病性末梢神经损害治疗观察
糖尿病是由于各种因素引起的体内胰岛素分泌不足,从而导致多种物质代谢紊乱的综合征.糖尿病性神经病变(DNP)是糖尿病患者三大病变(视网膜病变,肾脏病变,神经病变)之一.既往的研究证实,低能量He-Ne激光血管内照射(ILLLI)能提高血氧饱和度,影响2型糖尿病胰岛素分泌,可激活多种酶类、纠正脂代谢异常、抗脂质过氧化损伤,并能改善血液流变学、血液动力学及微循环,减轻自由基对组织损伤,促进外周围神经局部再生.
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糖尿病周围神经病变诊断治疗的误区
糖尿病周围神经病变是糖尿病的常见并发症,也是周围神经病变重要的病因之一,严重影响患者的生活质量,甚至不乏因足部溃疡经久不愈而导致截肢者[1].尽管目前对糖尿病的认识不断提高,但是对糖尿病周围神经病变仍重视不够,在诊断治疗上存在不少误区,对此应充分加以认识.
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应重视糖尿病周围神经病变的早期诊断与治疗
糖尿病是常见的慢性疾病之一.随着人们生活水平的提高,人口老龄化以及肥胖发生率的增高,糖尿病的发病率呈逐年上升趋势.据中国疾病预防控制中心报告,目前全国约有4000余万例糖尿病患者,它已成为危害人民健康的重大社会问题.糖尿病可引起多种并发症,例如已熟知的三联症:糖尿病神经病变、糖尿病肾病及糖尿病视网膜病变等.在并发的神经系统病变中以周围神经病变更为多见,故本文将着重叙述糖尿病周围神经病变的诊断与治疗问题,并简略叙述应对之重视的原因.
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降纤酶治疗糖尿病周围神经病变的临床思路刍议
目的:观察丹红注射液联合降纤酶对糖尿病周围神经病变患者的治疗效果。方法:96例糖尿病周围神经病变患者被随机分为治疗组(丹红注射液联合降纤酶)和对照组(常规治疗),两组患者经治疗后进行疗效评定。结果:治疗组总有效率85.4%,对照组为68.8%,两组比较,差异有统计学意义(P<0.01)。结论:丹红注射液联合降纤酶治疗糖尿病周围神经病变近期疗效较好。
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糖尿病性周围神经病变治疗策略
周围神经各种类型的纤维及其神经元均可受高血糖及其代谢产物的影响而发生病变,人体内只要是受神经支配而发挥功能的组织、器官均有可能发生相应的病理生理变化,所以糖尿病性周围神经病(DPN)是一个需要多学科共同参与诊治的疾病体.其治疗涉及多个层面,包括针对病因和病理生理机制的治疗措施、症状控制的方案、预防和治疗因神经病变而引起的其他器官系统的并发症等.
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Objective To compare the curative effect of Epalrestat and mecobalamine .Methods Epalrestat to treat 48 pa-tionts in DPN and mecobalamine to treat 42,measuring blood sugar ,blood pressure, blood fat and body mass index (BMI) prior and post treatment ,and measuring the MCV and SCV of nervus medianus ,nervus peronaeus connunis and nervus tibialis with EMG .Re-sults The symptom of the two sets have all been improved after the treatment ,and the effective power of Epalrestat and mecobalamine is 92.7% and 80.5% respectively.mean while there is improvement in MCV and SCV of nervus medianus ,nervus peronaeus connunis and nervus tibialis,and is more obvious in the set of Epalrestat ( P <0.01).In the whole process of the treat of the two sets ,no one appear to have adverse reactions .Conclusions Epalrestat has significant curative effect with less adverse reactions , and deserves to be spreaded in clinic.
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代谢与内分泌疾病组系统评价摘要(6)
25醛糖还原酶抑制剂治疗糖尿病周围神经病变的有效性 The efficacy of aldose reductase inhibitors in the treatment of diabetic peripheral neuropathy系统评价者:Airey M,Bennett C,Nicolucci A,Williams R 目的:评价醛糖还原酶抑制剂在预防、逆转或延迟糖尿病周围神经病变进展中的有效性。