目的探究參芪降糖顆粒聯(lián)合甲鈷胺對(duì)糖尿病周圍神經(jīng)病變（diabetic peripheral neuropathy，DPN）的療效，及其對(duì)血清胱抑素C（Cys-C）、胰島素樣生長(zhǎng)因子-1（IGF-1）、C肽（C-P）水平的影響。方法選取2018年8月-2020年4月重慶市涪陵中心醫(yī)院診治的DPN患者90例為研究對(duì)象，按照治療藥物的不同分為中藥組、西藥組及聯(lián)合組，每組各30例。中藥組患者口服參芪降糖顆粒，3 g/次，3次/d；西藥組口服甲鈷胺片，500 μg/次，3次/d；聯(lián)合組使用參芪降糖顆粒聯(lián)合甲鈷胺片治療，方案同上。3組患者均連續(xù)治療12個(gè)月。觀察各組患者的臨床療效，同時(shí)比較各組治療前后的神經(jīng)傳導(dǎo)速度及Cys-C、IGF-1、C-P水平。結(jié)果治療后，治療總有效率中藥組<西藥組<聯(lián)合組，3組差異無(wú)統(tǒng)計(jì)學(xué)意義。治療3、6、12個(gè)月后，3組患者正中神經(jīng)、腓總神經(jīng)的運(yùn)動(dòng)神經(jīng)傳導(dǎo)速度（MNCV）、感覺(jué)神經(jīng)傳導(dǎo)速度（SNCV）均有不同程度的提高，并呈時(shí)間相關(guān)性（P<0.05），且中藥組<西藥組<聯(lián)合組（P<0.05）。治療后，3組患者Cys-C水平顯著降低，IGF-1及C-P水平顯著升高（P<0.05），并呈時(shí)間相關(guān)性；治療3、6、12個(gè)月后，Cys-C水平中藥組>西藥組>聯(lián)合組（P<0.05），IGF-1及C-P水平中藥組<西藥組<聯(lián)合組（P<0.05）。結(jié)論參芪降糖顆粒聯(lián)合甲鈷胺治療DPN的療效顯著，其可有效改善患者神經(jīng)傳導(dǎo)速度，且其作用機(jī)制可能與血清Cys-C水平的降低及神經(jīng)營(yíng)養(yǎng)因子水平的升高有關(guān)。

Objective To investigate the effect of Shenqi Jiangtang Granules combined with mecobalamin on diabetic peripheral neuropathy (DPN) and its effect on serum levels of Cys-C, IGF-1, and C-P. Methods Ninety cases of DPN patients treated in Chongqing Fuling Central Hospital from August 2018 to April 2020 were selected as the research subjects, and divided into Chinese medicine group, western medicine group and combined group according to the different treatment drugs, with 30 cases in each group. Patients in the Chinese medicine group were po administered with Shenqi Jiangtang Granules, 3 g/time, three times daily; Western medicine group po administered with Mecobalamin Tablets, 500 μg/time, three times daily; combined group was treated with Shenqi Jiangtang Granules and Mecobalamin Tablets, with the same regimen as above. All the three groups were treated for 12 months continuously. Clinical efficacy of each group was observed, and nerve conduction velocity and levels of Cys-C, IGF-1 and CP before and after treatment were compared in each group. Results After treatment, the total effective rate of the Chinese medicine group < the western medicine group < the combined group, and there was no statistical significance among three groups. After 3, 6 and 12 months of treatment, the motor nerve conduction velocity (MNCV) and sensory nerve conduction velocity (SNCV) of median nerve and common peroneal nerve in three groups were increased to varying degrees, and showed a time correlation (P < 0.05), and the Chinese medicine group < the western medicine group < the combined group (P < 0.05). After treatment, the levels of Cys-C in three groups were significantly decreased, while the levels of IGF-1 and C-P were significantly increased (P < 0.05), and showed time correlation. After 3, 6 and 12 months of treatment, the levels of Cys-C in Chinese medicine group > in western medicine group > combined group (P < 0.05), IGF-1 and C-P in Chinese medicine group < western medicine group < combined group (P < 0.05). Conclusion Shenqi Jiangtang Granules combined with mecobalamin has significant efficacy in treatment of DPN, which can effectively improve the nerve conduction velocity of patients, and the mechanism of action may be related to the increase of serum Cys-C and the lack of neurotrophic factors.

R977

重慶市衛(wèi)生計(jì)生委中醫(yī)藥科技項(xiàng)目（ZY201802139）