目的探究参芪降糖颗粒联合甲钴胺对糖尿病周围神经病变（diabetic peripheral neuropathy，DPN）的疗效，及其对血清胱抑素C（Cys-C）、胰岛素样生长因子-1（IGF-1）、C肽（C-P）水平的影响。方法选取2018年8月-2020年4月重庆市涪陵中心医院诊治的DPN患者90例为研究对象，按照治疗药物的不同分为中药组、西药组及联合组，每组各30例。中药组患者口服参芪降糖颗粒，3 g/次，3次/d；西药组口服甲钴胺片，500 μg/次，3次/d；联合组使用参芪降糖颗粒联合甲钴胺片治疗，方案同上。3组患者均连续治疗12个月。观察各组患者的临床疗效，同时比较各组治疗前后的神经传导速度及Cys-C、IGF-1、C-P水平。结果治疗后，治疗总有效率中药组<西药组<联合组，3组差异无统计学意义。治疗3、6、12个月后，3组患者正中神经、腓总神经的运动神经传导速度（MNCV）、感觉神经传导速度（SNCV）均有不同程度的提高，并呈时间相关性（P<0.05），且中药组<西药组<联合组（P<0.05）。治疗后，3组患者Cys-C水平显著降低，IGF-1及C-P水平显著升高（P<0.05），并呈时间相关性；治疗3、6、12个月后，Cys-C水平中药组>西药组>联合组（P<0.05），IGF-1及C-P水平中药组<西药组<联合组（P<0.05）。结论参芪降糖颗粒联合甲钴胺治疗DPN的疗效显著，其可有效改善患者神经传导速度，且其作用机制可能与血清Cys-C水平的降低及神经营养因子水平的升高有关。

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

重庆市卫生计生委中医药科技项目（ZY201802139）