基于交感神经皮肤反应评价芪黄通络汤治疗尿毒症周围神经病变

发布时间：2019-02-21 17:45

【摘要】：目的:基于交感神经皮肤反应(SSR)评价芪黄通络汤治疗尿毒症周围神经病变(UPN)的临床疗效,并对尿毒症毒素和致炎细胞因子水平的影响方面探讨其作用机制。方法:将154例尿毒症患者随机分为观察组和对照组。两组患者均给予血液透析+血液灌流治疗;对照组采用三维B注射液,肌肉注射,2 mL/次,3次/周;和甲钴胺片,口服,0.5 mg/次,3次/d。观察组在对照组治疗的基础上加服芪黄通络汤,1剂/d。两组疗程均为3个月。采用肌电诱发电位仪测量起始潜伏期(Lat)和峰-峰波幅值(Amp),测量胫神经、腓总神经和腓肠神经的感觉神经传导速度,治疗前后各评价1次;进行治疗前后脾肾气虚,瘀血阻滞证评分;检测治疗前后甲状旁腺激素(PTH),β2-微球蛋白(β2-MG),瘦素(LP),同型半胱氨酸(Hcy)等尿毒症毒素水平;检测治疗后肿瘤坏死因子-α(TNF-α),血清C反应蛋白(CRP),白细胞介素-6(IL-6)和IL-8等致炎细胞因子水平。结果:观察组中医证候疗效总有效率为93.06%,高于对照组的74.29%(χ~2=9.212,P0.01);治疗后观察组上、下肢Lat均短于对照组,上、下肢Amp均高于对照组(P0.01);治疗后观察组SSR异常率为26.39%,低于治疗前的66.67%,(χ~2=23.471,P0.01),并低于治疗后对照组的44.29%(χ~2=4.983,P0.05);治疗后观察组胫神经、腓总神经和腓肠神经的感觉神经传导速度均快于对照组(P0.05,P0.01);治疗后观察组患者血清PTH,β2-MG,LP和Hcy水平均低于对照组(P0.01);治疗后观察组患者血清TNF-α,CRP,IL-6和IL-8水平均低于对照组(P0.01)。结论:采用芪黄通络汤治疗UPN患者,能改善患者神经功能,促进周围神经功能的恢复,其作用机制可能与清除尿毒症毒素和减轻炎症反应有关。
[Abstract]:Objective: to evaluate the clinical efficacy of Qihuang Tongluo decoction (QYT) in the treatment of uremic peripheral neuropathy (UPN) based on sympathetic skin reaction (SSR), and to explore the mechanism of its effect on the levels of uremic toxin and inflammatory cytokines. Methods: 154 patients with uremia were randomly divided into observation group and control group. The patients in the two groups were treated with hemodialysis and hemoperfusion; the control group were treated with 3D B injection, intramuscular injection, 2 mL/, 3 times a week, and mecobalamin tablets, oral, 0.5 mg/, 3 times a day. Observation group in the control group on the basis of treatment plus Qihuang Tongluo decoction, 1 dose per day. The course of treatment was 3 months in both groups. The initial latency (Lat) and peak to peak amplitude (Amp),) of tibial nerve, common peroneal nerve and sural nerve were measured by EMG potentiometer, and the sensory nerve conduction velocity of tibial nerve, common peroneal nerve and sural nerve were evaluated once before and after treatment. Spleen and kidney Qi deficiency and blood stasis block were scored before and after treatment, and the levels of uremic toxins such as parathyroid hormone (PTH), 尾 2-microglobulin (尾 2-MG) and leptin (LP), homocysteine (Hcy) were detected before and after treatment. The levels of tumor necrosis factor- 伪 (TNF- 伪), serum C-reactive protein (CRP), interleukin-6 (IL-6) and IL-8 were measured after treatment. Results: the total effective rate of TCM syndromes in the observation group was 93.06, which was higher than that in the control group (74.29%), the Lat of the upper and lower limbs in the observation group was shorter than that in the control group (P0.01), and the Amp of the upper and lower limbs in the observation group was higher than that in the control group (P0.01). After treatment, the abnormal rate of SSR in the observation group was 26.39, lower than that before treatment (66.67) (蠂 ~ 2 + 23.471), and it was lower than that in the control group (44.29%) (蠂 ~ (2) 4.983 (P0.05). After treatment, the sensory nerve conduction velocities of tibial nerve, common peroneal nerve and sural nerve in the observation group were faster than those in the control group (P0.05, P0.01), and the levels of serum PTH, 尾 2-MGG LP and Hcy in the observation group were lower than those in the control group (P0.01). After treatment, the serum levels of TNF- 伪, CRP,IL-6 and IL-8 in the observation group were lower than those in the control group (P0.01). Conclusion: Qihuang Tongluo decoction can improve the nerve function and promote the recovery of peripheral nerve function in patients with UPN, and its mechanism may be related to removing uremic toxin and reducing inflammatory reaction.
【作者单位】：山东省胸科医院;四川省医学科学院四川省人民医院;山东大学齐鲁医院;
【基金】：山东省中医药科技发展计划项目(2011-202)
【分类号】：R277.5

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