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糖尿病周围神经病变（diabetic peripheral neuropathy，DPN）是糖尿病最常见的慢性并发症之一，起病隐匿，发病率高，预后差，因此早期诊断尤为重要。

目的探讨高频超声用于评价2型糖尿病合并周围神经病变患者下肢股神经和隐神经异常改变的临床价值。方法共81例2型糖尿病患者分为无周围神经病变组（40例）和合并周围神经病变组（41例），通过彩色多普勒超声观察股神经和隐神经内部回声及连续性，测量并比较神经宽径、厚径和横截面积。结果正常对照组受试者股神经和隐神经横切面扫描呈略高回声，内部呈细小筛网格状，纵切面扫描内部呈条状低回声和平行线样排列的条状略高回声；无周围神经病变组患者内部回声略减低，细小筛网格状结构模糊，纵切面条状低回声结构欠清晰；合并周围神经病变组患者内部回声明显减低，细小筛网格状结构显示不清，纵切面条状低回声结构模糊。与正常对照组相比，糖尿病组患者股神经宽径（均P=0．000）、厚径（P=0．023，0．036）和横截面积（均P=0．000）增大；隐神经宽径（P=0．010，0．014）、厚径（均P=0．001）和横截面积（P=0．002，0．004）增大；合并周围神经病变组患者股神经和隐神经厚径（P=O．048，0．012）和横截面积（P=0．03I，0．034）较无周围神经病变组增大。结论高频超声可以清晰地显示2型糖尿病合并周围神经病变患者股神经和隐神经主干内部回声及各径线的异常改变，为临床诊断提供客观依据，具有重要临床意义。

目的探讨2型糖尿病患者经皮氧分压（TcPO2）与神经传导功能测定（NCS）结果的相关性。方法收集第三军医大学西南医院2012年1-7月年龄匹配的2型糖尿病住院患者381例,根据NCS是否异常以及有无糖尿病周围神经病变（DPN）症状分为4组：1组（有NCS异常,无DPN症状）129例、2组（无NCS异常,有DPN症状）50例、3组（有NCS异常,有DPN症状）122例、4组（无NCS异常,无DPN症状）80例,其中1、3组为DPN组,2组为疑似DPN组,4组为无DPN组。分析TcPO2立位、卧位、立卧位差值等33项指标的组间差异以及TcPO2与NCS各参数的相关性。结果与无DPN组比较,DPN组、疑似DPN组TcPO2立位、卧位值降低,立卧位差值增高（P〈0.05）。TcPO2立位值与NCS的正中神经运动传导速度、远端潜伏期、复合肌肉动作电位波幅等26项参数均相关（P〈0.05）,TcPO2卧位值与除F波最短潜伏期以外的25项参数相关,TcPO2立卧位差值则与其中11项参数相关（P〈0.05）。结论 TcPO2与NCS有很好的相关性,有望成为DPN的有效检测手段。

目的观察氢气对链脲霉素致糖尿病周围神经病变模型大鼠坐骨神经功能和疼痛行为学的影响,并探讨其可能的作用机制。方法腹腔注射链脲霉素(65 mg/kg)建立糖尿病大鼠模型,6周后腹腔注射富氢生理盐水(5 ml/kg),连续治疗2周后观察不同处理组大鼠坐骨神经功能和疼痛行为学变化,并检测坐骨神经炎性因子[肿瘤坏死因子α(TNFα)和白细胞介素6(IL 6)]及核因子κB(NFκB)p65亚基表达变化。结果 (1)与正常对照组相比,模型制备成功第8周时模型组大鼠体质量降低、血糖水平升高(均P=0.000);与模型组相比,氢气治疗组大鼠体质量和血糖水平无明显改善(均P>0.05)。(2)与正常对照组相比,模型制备成功第8周时模型组大鼠坐骨神经传导速度减慢、热痛阈和机械性痛阈降低(均P=0.000);而与模型组相比,氢气治疗后大鼠坐骨神经传导速度增加、热痛阈和机械性痛阈提高(均P=0.000)。(3)经氢气治疗后,大鼠坐骨神经TNFα和IL 6表达水平降低(均P=0.000),NFκB p65亚基阳性细胞数目减少(P=0.000)。结论糖尿病周围神经病变与炎症反应有关,而氢气可以通过抑制NFκB及其下游炎性因子的表达而发挥对糖尿病周围神经损害的保护作用。

Background We assessed the efficacy and safety of the Xiaoketongbi Formula (XF) vs. pregabalin in patients with painful diabetic neuropathy (PDN). Methods Patients with PDN (n = 68) were included in a single‐center, randomized, single‐blind, double‐dummy, parallel controlled clinical trial. The primary outcome was the change in the Brief Pain Inventory for Diabetic Peripheral Neuropathy (BPI‐DPN). Secondary outcomes evaluated included the reduction of BPI‐DPN >50%, changes in the numeric rating scale‐11 (NRS‐11) score for pain, Daily Sleep Interference Diary (DSID), Patient Global Impression of Change (PGIC), nerve conduction velocity (NCV), and adverse events. Results After 10 weeks of treatment, the BPI‐DPN score reduced from 42.44 ± 17.56 to 26.47 ± 22.22 and from 52.03 ± 14.30 to 37.85 ± 17.23 in the XF and pregabalin group (Ps < 0.001), respectively. The difference in the absolute change in BPI‐DPN score between both groups was −1.79 (95% CI: −9.09, 5.50; p = 0.625). In the XF and pregabalin groups, 44.1% (15/34) and 20.6% (7/34) of patients reported a BPI‐DPN reduction >50% (p = 0.038), respectively. There were no significant differences between groups in NRS‐11 and DSID (Ps > 0.05). A significantly greater number of patients in the XF group felt “significantly improved” or “improved” than in the pregabalin group (35.3% (12/34) vs. 11.8% (4/34), p = 0.045). The absolute change in motor nerve conduction velocity of the right median nerve was significantly different between both groups (XF group 0.7 ± 2.3 vs. pregabalin group −2.2 ± 4.1, p = 0.004). No serious adverse events were reported in either group. Conclusions XF is equivalent to pregabalin in reducing pain symptoms and improves the quality of life in patients with PDN. In addition, XF has the potential to improve nerve function by increasing NCV. 摘要 目的 比较消渴通痹方(XF)与普瑞巴林治疗痛性糖尿病神经病变(PDN)的疗效和安全性。 方法 对68例PDN患者进行单中心, 随机, 单盲, 双模拟, 平行对照临床试验。主要结果是糖尿病周围神经病变的简明疼痛问卷(BPI‐DPN)的变化。次要结果包括BPI‐DPN下降>50%, 疼痛数字评定量表‐11(NRS‐11)评分的变化, 日常睡眠干预日记(DSID), 患者总体变化印象(PGIC), 神经传导速度(NCV)和不良事件。 结果 治疗10周后, XF组和普瑞巴林组的BPI‐DPN评分分别从42.44±17.56降至26.47±22.22和52.03±14.30降至37.85±17.23(P<0.001)。两组间BPI‐DPN评分绝对值变化差异为‐1.79(95%CI:‐9.09, 5.50, P=0.625)。XF组和普瑞巴林组分别有44.1%(15/34)和20.6%(7/34)的患者报告BPI‐DPN下降>50%(P=0.038)。两组间NRS‐11和DSID评分差异无统计学意义(P>0.05)。与普瑞巴林组相比, XF组有显著改善或改善的患者数量显著增加(35.3%(12/34)比11.8%(4/34), P=0.045)。两组右侧正中神经运动传导速度绝对值变化差异有统计学意义(XF组0.70±2.3vs.普瑞巴林组‐2.2±4.1, P=0.004)。两组均未报告严重不良事件。 结论 XF在减轻PDN患者疼痛症状, 提高生活质量方面与普瑞巴林相当。此外, XF还有可能通过增加神经传导速度来改善神经功能。 Highlights This is the first randomized, single‐blind, double‐dummy, parallel controlled clinical trial collecting data on the efficacy and safety of Chinese herbal medicines compared to that of pregabalin in patients with painful diabetic neuropathy. The Xiaoketongbi Formula is an effective treatment that can relieve pain symptoms, improve quality of life, and potentially improve nerve conduction velocity in patients suffering from painful diabetic neuropathy.

摘要 目的 比较消渴通痹方(XF)与普瑞巴林治疗痛性糖尿病神经病变(PDN)的疗效和安全性。 方法 对68例PDN患者进行单中心, 随机, 单盲, 双模拟, 平行对照临床试验。主要结果是糖尿病周围神经病变的简明疼痛问卷(BPI‐DPN)的变化。次要结果包括BPI‐DPN下降>50%, 疼痛数字评定量表‐11(NRS‐11)评分的变化, 日常睡眠干预日记(DSID), 患者总体变化印象(PGIC), 神经传导速度(NCV)和不良事件。 结果 治疗10周后, XF组和普瑞巴林组的BPI‐DPN评分分别从42.44±17.56降至26.47±22.22和52.03±14.30降至37.85±17.23(P<0.001)。两组间BPI‐DPN评分绝对值变化差异为‐1.79(95%CI:‐9.09, 5.50, P=0.625)。XF组和普瑞巴林组分别有44.1%(15/34)和20.6%(7/34)的患者报告BPI‐DPN下降>50%(P=0.038)。两组间NRS‐11和DSID评分差异无统计学意义(P>0.05)。与普瑞巴林组相比, XF组有显著改善或改善的患者数量显著增加(35.3%(12/34)比11.8%(4/34), P=0.045)。两组右侧正中神经运动传导速度绝对值变化差异有统计学意义(XF组0.70±2.3vs.普瑞巴林组‐2.2±4.1, P=0.004)。两组均未报告严重不良事件。 结论 XF在减轻PDN患者疼痛症状, 提高生活质量方面与普瑞巴林相当。此外, XF还有可能通过增加神经传导速度来改善神经功能。

目的探讨度洛西汀联合神经妥乐平对糖尿病痛性神经病变（PDPN）的疗效和安全性.方法将2012年5月-2014年10月内蒙古医科大学附属医院收治的100例糖尿病并发痛性神经病变的患者随机分为度洛西汀联合神经妥乐平组（研究组）和单用神经妥乐平组（对照组）各50例,前者给予度洛西汀联合神经妥乐平治疗,后者单用神经妥乐平治疗,疗程8周.分别于治疗前和治疗2、4、8周后进行疼痛强度简易评述量表（VRS）、数字疼痛强度量表（NRS）评定,采用焦虑自评量表（SAS）及抑郁自评量表（SDS）评定焦虑和抑郁状态,于治疗2周、8周后测定正中神经及腓肠神经传导速度.结果治疗2、4、8周后,两组VRS、NRS评分比较差异有统计学意义（P〈0.05）,组间SAS和SDS评分比较差异均有统计学意义（P〈0.05）,两组治疗8周后与治疗前感觉神经传导速度比较差异均有统计学意义（P〈0.05）.结论度洛西汀联合神经妥乐平治疗PDPN的效果和安全性可能优于单用神经妥乐平.

Objective To study the clinical effect of acupuncture combined with methylcobalamin in the treatment of diabetic peripheral neuropathy. Methods Seventy-five diabetic patients complicated with peripheral neuropathies were included and randomly allocated into a treatment group (40 cases) and a control group (35 cases). The patients in the treatment group all received acupuncture therapy plus methylcobalamin. In the control group, patients only received methylcobalamin for treatment. The therapeutic effect was evaluated 4 weeks later. Results Both of the two groups presented improvement in nervous symptoms, signs and nerve conduction, and the improvement of the treatment group was significantly better than that of the control group ( P <0.05). Conclusion The therapy of acupuncture in combination with methylcobalamin is more effective than the monotherapy with methylcobalamin in the treatment of diabetic peripheral neuropathy.

Objective To observe the clinical efficacy of warm acupuncture in the treatment of diabetic peripheral neuropathy and its effects on the conduction velocity of the tibial nerve and common fibular nerve. Methods Fifty-two subjects were evenly randomized into two groups and treated by conventional therapy; in addition, the control group was given mecobalamin injection at 500 μg, once a day for four weeks, and treatment group was given warm acupuncture, 6 times a week for 4 weeks. The clinical efficacy and the conduction velocity of the tibial nerve and common fibular nerve were observed and compared between the two groups. Results After four-week treatments, the total effective rate was 88.5% in the treatment group and 61.5% in the control group, with a higher rate in the treatment group than in the control group ( P <0.05); the conduction velocity of tibial nerve and common fibular nerve was higher in both groups ( P <0.05), with higher conduction velocity in the treatment group than in the control group ( P <0.05). Conclusion Warm acupuncture is quite effective to treat diabetic peripheral neuropathy and to improve nerve velocity.