目的 探討α-硫辛酸聯(lián)合甲鈷胺治療糖尿病周圍神經(jīng)病變的臨床療效及可能機制。方法 收集2013年3月—2014年3月解放軍三二三醫(yī)院收治的患者188例,隨機分為對照組和治療組,每組94例。兩組均給予常規(guī)治療。對照組將甲鈷胺1.0 mg加入250 mL生理鹽水中靜脈滴注,1次/d。治療組在對照組的基礎上靜脈滴注注射用硫辛酸,0.45 g加入生理鹽水250 mL中,1次/d。兩組均連續(xù)治療3周。比較兩組的周圍神經(jīng)傳導速度、缺氧誘導因子-1α(HIF-1α)和血管內(nèi)皮生長因子(VEGF)、多倫多臨床評分(TCSS)。結果 與對照組相比,治療組脛前神經(jīng)的運動神經(jīng)傳導速度(MNCV)、感覺神經(jīng)傳導速度(SNCV)和腓總神經(jīng)的MNCV提高更為顯著,差異具有統(tǒng)計學意義(P < 0.05)。治療后治療組HIF-1α和VEGF、對照組HIF-1α均明顯降低,與治療前相比差異具有統(tǒng)計學意義(P < 0.01);與對照組相比,治療組HIF-1α和VEGF變化更為顯著,差異具有統(tǒng)計學意義(P < 0.01)。治療后兩組的TCSS評分均明顯降低,與治療前相比差異具有統(tǒng)計學意義(P < 0.01),與對照組相比,治療組下降更為顯著,兩組比較差異具有統(tǒng)計學意義(P < 0.01)。結論 α-硫辛酸聯(lián)合甲鈷胺能夠提高糖尿病周圍神經(jīng)病變的臨床療效,其作用機制可能與其誘導HIF-1α表達有關。

Objective To investigate curative effect and mechanism of the α-lipoic acid combined with mecobalamin in treatment of diabetic peripheral neuropathy. Methods The patients (188 cases) of the PLA 323 Hospital from March 2013 to March 2014 were were randomly divided into control and treatment groups, and each group had 94 cases. Two groups were both given conventional therapy. The patients in control group were iv administered with Mecobalamin Injection (1 mg diluted with 250 mL saline water), once daily. On the basis of control group, the patients in treatment group were iv administered with Thioctic Acid for Injection (0.45 g diluted with 250 mL saline water), once daily. The patients in two groups were treated for three weeks. Peripheral nerve conduction velocity, hypoxia inducible factor-1α (HIF-1α) and vascular endothelial growth factor (VEGF), and Toronto clinical scoring (TCSS) scores were compared between two group. Results Compared with the control group, Motor Nerve Conduction Velocity (MNCV) and Sensory Nerve Conduction Velocity (SNCV) of anterior tibial nerve and MNCV of nervus peroneus communis in treatment group were improved more with significant difference (P < 0.05). After treatment, VEGF, HIF-1α in treatment group and HIF-1α in control group were significantly increased, and there were significant difference between two groups (P < 0.01). Compared with the control group, changes of HIF-1α and VEGF in treatment group were more obviously with significant differences (P < 0.01). After treatment, TCSS scores in two groups decreased significantly (P < 0.01). Compared with the control group, TCSS scores in treatment group decreased more obviously with significant differences (P < 0.01). Conclusion α-Lipoic acid combined with mecobalamin can improve the clinical effect of diabetic peripheral neuropathy. The mechanism may be associated with induced expression of HIF-1α.