目的 探讨α-硫辛酸联合甲钴胺治疗糖尿病周围神经病变的临床疗效及可能机制。方法 收集2013年3月—2014年3月解放军三二三医院收治的患者188例,随机分为对照组和治疗组,每组94例。两组均给予常规治疗。对照组将甲钴胺1.0 mg加入250 mL生理盐水中静脉滴注,1次/d。治疗组在对照组的基础上静脉滴注注射用硫辛酸,0.45 g加入生理盐水250 mL中,1次/d。两组均连续治疗3周。比较两组的周围神经传导速度、缺氧诱导因子-1α(HIF-1α)和血管内皮生长因子(VEGF)、多伦多临床评分(TCSS)。结果 与对照组相比,治疗组胫前神经的运动神经传导速度(MNCV)、感觉神经传导速度(SNCV)和腓总神经的MNCV提高更为显著,差异具有统计学意义(P < 0.05)。治疗后治疗组HIF-1α和VEGF、对照组HIF-1α均明显降低,与治疗前相比差异具有统计学意义(P < 0.01);与对照组相比,治疗组HIF-1α和VEGF变化更为显著,差异具有统计学意义(P < 0.01)。治疗后两组的TCSS评分均明显降低,与治疗前相比差异具有统计学意义(P < 0.01),与对照组相比,治疗组下降更为显著,两组比较差异具有统计学意义(P < 0.01)。结论 α-硫辛酸联合甲钴胺能够提高糖尿病周围神经病变的临床疗效,其作用机制可能与其诱导HIF-1α表达有关。

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.