黄芪桂枝五物汤合四藤一仙汤加减治疗糖尿病周围神经病变的临床观察
发布时间：2019-05-28 01:57
【摘要】：目的:通过观察黄芪桂枝五物汤合四藤一仙汤加减对气虚血瘀型糖尿病周围神经病变(Diabetic Peripheral Neuropathy,DPN)患者的中医症候评分、密歇根神经病变筛查表(Michigan Neuropathy Screening Instrument,MNSI)体格检查评分、震动感觉阈值、踝臂指数(Ankle-Brachial Index,ABI)的变化分析本治疗方案对患者临床症状及神经体征的改善效果,以此评价黄芪桂枝五物汤合四藤一仙汤加减对气虚血瘀型DPN的疗效,为其在临床应用提供依据。方法:本课题研究符合入选标准的患者共68名,随机分为治疗组与对照组,分别为34名,均给予糖尿病相关宣教、糖尿病基础治疗,治疗组在此基础上予黄芪桂枝五物汤合四藤一仙汤加减口服,对照组予甲钴胺片口服治疗,总疗程为12周。观察患者治疗前后的中医症候评分、MNSI体格检查评分、ABI、震动感觉阈值、空腹血糖(Fasting Plasma Glucose,FPG)、餐后2小时血糖(2 hours Postprandial Blood Glucose,2hPG)、糖化血红蛋白(Glycated hemoglobin,HbA1c)、肝肾功能等相关指标,并予系统分析相关数据。结果:1、脱落率:本课题共纳入患者68名,两组各34名,而治疗组共计32名患者完成本次研究,脱落2名,脱落率为6%;对照组完成研究者共计30名,脱落4名,脱落率12%,两组脱落率比较无明显差异,不影响研究结果(P0.05)。2、中医症候疗效总有效率:治疗组为90.63%,对照组为70.00%,差异具有统计学意义(P0.05)。3、中医症候评分:经治疗后两组患者中医症候总分和各分项评分均较治疗前下降(P0.05),而治疗组麻木、疼痛、发凉分项评分及总分下降更为明显(P0.05),两组在感觉异常及全身症状分项评分无明显差异(P0.05)。4、MNSI体格检查评分:两组患者治疗后MNSI体格检查评分较治疗前明显减少(P0.05),而治疗组下降更为明显(P0.05)。5、ABI:经治疗后两组患者的ABI均较治疗前上升(P0.05),同时治疗组上升幅度较对照组更为明显(P0.05)。6、震动感觉阈值测量:经治疗后,两组患者震动感觉阈值与治疗前相比较均明显下降(P0.05),而治疗组改善程度较对照组更为明显(P0.05)。7、血糖水平:经治疗后,两组患者FPG、2h PG、HbA1c水平均较治疗前下降(P0.05),但两组间比较无明显差异(P0.05)。8、安全性:两组均未发现药物因素导致生命体征异常、肝肾功能受损及严重不良反应等情况。研究结论:黄芪桂枝五物汤合四藤一仙汤加减能明显改善气虚血瘀型DPN患者的临床症状及神经体征,促进下肢血液循环,增加感觉敏感性,且用药安全性良好,为临床应用提供参考。
[Abstract]:Objective: to observe the TCM syndrome score of Huangqi Guizhi Wuwu decoction combined with Siteng Yixian decoction in the treatment of diabetic peripheral neuropathy with qi deficiency and blood stasis type (Diabetic Peripheral Neuropathy,DPN). Michigan neuropathy screening table (Michigan Neuropathy Screening Instrument, was used to observe the score of TCM syndrome in patients with diabetic peripheral neuropathy due to qi deficiency and blood stasis. MNSI) the changes of physical examination score, vibration sensory threshold and ankle arm index (Ankle-Brachial Index,ABI) were analyzed to improve the clinical symptoms and neurological signs of the patients. To evaluate the curative effect of Huangqi Guizhi Wuwu decoction combined with Siteng Yixian decoction on DPN of qi deficiency and blood stasis type, and to provide the basis for its clinical application. Methods: a total of 68 patients in this study were randomly divided into treatment group (n = 34) and control group (n = 34). All patients were given diabetes related education and basic treatment of diabetes mellitus. On this basis, the treatment group was given Huangqi Guizhi Wuwu decoction combined with Siteng Yixian decoction, while the control group was treated with mecobalamin tablets for 12 weeks. The scores of TCM symptoms, MNSI physical examination, ABI, vibration threshold, fasting blood glucose (Fasting Plasma Glucose,FPG), postmeal blood glucose (2 hours Postprandial Blood Glucose,2hPG) and glycosylated hemoglobin (Glycated hemoglobin,HbA1c) were observed before and after treatment. The related indexes such as liver and kidney function were analyzed systematically. Results: 1. Drop rate: there were 68 patients in this subject, 34 patients in each group, while 32 patients in the treatment group completed the study, 2 patients fell off, the drop rate was 6%; In the control group, there were 30 researchers, 4 researchers, 12%. There was no significant difference in the drop rate between the two groups, which did not affect the results of the study (P 0.05). 2, the total effective rate of TCM syndrome in the treatment group was 90.63%. The control group was 70.00%, the difference was statistically significant (P05). 3, TCM syndrome score: after treatment, the total score of TCM syndrome and the scores of each item in the two groups were lower than those before treatment (P05), while in the treatment group, numbness and pain, The score and total score of cool items decreased more significantly (P 0.05), but there was no significant difference between the two groups in the scores of sensory abnormalities and systemic symptoms (P 0.05). MNSI physical examination score: after treatment, the MNSI physical examination score of the two groups was significantly lower than that before treatment (P 0.05), and the decrease of MNSI physical examination score was more obvious in the treatment group (P 0.05). After ABI: treatment, the ABI of both groups was higher than that before treatment (P 0.05), and the increase of ABI in the treatment group was more obvious than that in the control group (P 0.05). 6. measurement of vibration sensory threshold: after treatment, The vibration sensory threshold of the two groups was significantly lower than that before treatment (P 0.05), and the improvement degree of the treatment group was more obvious than that of the control group (P 0.05). 7. Blood glucose level: after treatment, the FPG,2h PG, of the two groups was significantly lower than that of the control group. The level of HbA1c was lower than that before treatment (P 0.05), but there was no significant difference between the two groups (P 0.05). 8. Safety: no abnormal vital signs, damage of liver and kidney function and serious adverse reactions were found in both groups. Conclusion: Huangqi Guizhi Wuwu decoction combined with Siteng Yixian decoction can obviously improve the clinical symptoms and neurological signs of DPN patients with qi deficiency and blood stasis type, promote lower extremity blood circulation, increase sensory sensitivity, and the safety of the drug is good. It provides a reference for clinical application.
【学位授予单位】：广西中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R259
本文编号：2486632
[Abstract]:Objective: to observe the TCM syndrome score of Huangqi Guizhi Wuwu decoction combined with Siteng Yixian decoction in the treatment of diabetic peripheral neuropathy with qi deficiency and blood stasis type (Diabetic Peripheral Neuropathy,DPN). Michigan neuropathy screening table (Michigan Neuropathy Screening Instrument, was used to observe the score of TCM syndrome in patients with diabetic peripheral neuropathy due to qi deficiency and blood stasis. MNSI) the changes of physical examination score, vibration sensory threshold and ankle arm index (Ankle-Brachial Index,ABI) were analyzed to improve the clinical symptoms and neurological signs of the patients. To evaluate the curative effect of Huangqi Guizhi Wuwu decoction combined with Siteng Yixian decoction on DPN of qi deficiency and blood stasis type, and to provide the basis for its clinical application. Methods: a total of 68 patients in this study were randomly divided into treatment group (n = 34) and control group (n = 34). All patients were given diabetes related education and basic treatment of diabetes mellitus. On this basis, the treatment group was given Huangqi Guizhi Wuwu decoction combined with Siteng Yixian decoction, while the control group was treated with mecobalamin tablets for 12 weeks. The scores of TCM symptoms, MNSI physical examination, ABI, vibration threshold, fasting blood glucose (Fasting Plasma Glucose,FPG), postmeal blood glucose (2 hours Postprandial Blood Glucose,2hPG) and glycosylated hemoglobin (Glycated hemoglobin,HbA1c) were observed before and after treatment. The related indexes such as liver and kidney function were analyzed systematically. Results: 1. Drop rate: there were 68 patients in this subject, 34 patients in each group, while 32 patients in the treatment group completed the study, 2 patients fell off, the drop rate was 6%; In the control group, there were 30 researchers, 4 researchers, 12%. There was no significant difference in the drop rate between the two groups, which did not affect the results of the study (P 0.05). 2, the total effective rate of TCM syndrome in the treatment group was 90.63%. The control group was 70.00%, the difference was statistically significant (P05). 3, TCM syndrome score: after treatment, the total score of TCM syndrome and the scores of each item in the two groups were lower than those before treatment (P05), while in the treatment group, numbness and pain, The score and total score of cool items decreased more significantly (P 0.05), but there was no significant difference between the two groups in the scores of sensory abnormalities and systemic symptoms (P 0.05). MNSI physical examination score: after treatment, the MNSI physical examination score of the two groups was significantly lower than that before treatment (P 0.05), and the decrease of MNSI physical examination score was more obvious in the treatment group (P 0.05). After ABI: treatment, the ABI of both groups was higher than that before treatment (P 0.05), and the increase of ABI in the treatment group was more obvious than that in the control group (P 0.05). 6. measurement of vibration sensory threshold: after treatment, The vibration sensory threshold of the two groups was significantly lower than that before treatment (P 0.05), and the improvement degree of the treatment group was more obvious than that of the control group (P 0.05). 7. Blood glucose level: after treatment, the FPG,2h PG, of the two groups was significantly lower than that of the control group. The level of HbA1c was lower than that before treatment (P 0.05), but there was no significant difference between the two groups (P 0.05). 8. Safety: no abnormal vital signs, damage of liver and kidney function and serious adverse reactions were found in both groups. Conclusion: Huangqi Guizhi Wuwu decoction combined with Siteng Yixian decoction can obviously improve the clinical symptoms and neurological signs of DPN patients with qi deficiency and blood stasis type, promote lower extremity blood circulation, increase sensory sensitivity, and the safety of the drug is good. It provides a reference for clinical application.
【学位授予单位】：广西中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R259
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