Abstract:

Objective　To observe the effect of Qilong Tongluo Decoction and acupuncture in the treatment of patients with diabetic peripheral neuropathy (DPN). Methods　A total of 86 patients with DPN treated at Shaanxi Provincial Hospital of Traditional Chinese Medicine from September 2021 to September 2023 were selected for the randomized controlled trial, including 46 males and 40 females. They were 28-75 years old. Their DPN course was 1-10 years. Twenty cases had coronary heart disease, 32 hyperlipidemia, and 8 retinopathy. Their body mass index was 19.68-26.84 kg/m². They were divided into an acupuncture group and an acupuncture-drug group by the random number table method, with 43 cases in each group. Both groups were given symptomatic western medicine treatment. The acupuncture group took acupuncture on the Baliao and Bafeng points. The acupuncture-drug group were given Qilong Tongluo decoction and acupuncture on Baliao and Bafeng points. Both groups were treated for 4 weeks. The numbers of intestinal flora, the relative protein expressions of the kelch-like ECH-associated protein 1 (Keap1)/nuclear factor E2 related factor 2 (Nrf2)/antioxidant response element (ARE) of the mononuclear cell pathway, oxidative stress factors, common carotid artery pressure strain elastic modulus (Ep), nerve conduction, and scores of traditional Chinese medicine symptom were compared between the two groups by t test. Results　After the treatment, the number of the Fusobacterium flora in the acupuncture-drug group was higher than that in the acupuncture group [(10.25±1.20) cfu/g vs. (8.23±1.14) cfu/g; P<0.05], while the number of Bacteroides flora was lower [(7.57±0.61) cfu/g vs. (8.96±0.74) cfu/g; P<0.05]. After the treatment, the relative expressions of Nrf2, ARE, and NAD(P)H:quinone oxidoreductase 1 (NQO1) in the acupuncture-drug group were higher than those in the acupuncture group (1.39±0.31 vs. 1.10±0.28, 0.98±0.14 vs. 0.81±0.11, and 1.73±0.31 vs. 1.42±0.28; all P<0.05); the relative expression of Keap1 in the acupuncture-drug group was lower than that in the acupuncture group (0.43±0.12 vs. 0.59±0.14; P<0.05). After the treatment, the levels of superoxide dismutase (SOD) and glutathione peroxidase (GSH-PX) in the acupuncture-drug group were higher than those in the acupuncture group [(85.56±8.65) U/ml vs. (78.41±9.44) U/ml and (278.85±38.96) U/ml vs. (249.56±32.06) U/ml; both P<0.05]; the common carotid artery Ep, score of traditional Chinese medicine symptom, and level of malondialdehyde (MDA) in the acupuncture-drug group were lower than those in the acupuncture group [(115.12±5.98) kPa vs. (124.65±8.75) kPa, 9.44±1.46 vs. 13.25±2.14, and (4.15±0.53) μmol/L vs. (4.82±0.74) μmol/L; all P<0.05]. After the treatment, the sensory nerve conduction velocity (SNCV) and motor nerve conduction velocity (MNCV) of median nerve and common peroneal nerve in the acupuncture-drug group were higher than those in the acupuncture group [(53.47±4.22) m/s vs. (49.58±4.36) m/s, (50.97±3.06) m/s vs. (48.75±3.12) m/s, (52.89±4.26) m/s vs. (50.66±4.01) m/s, and (50.63±3.75) m/s vs. (48.79±3.14) m/s; all P<0.05]. Conclusion　The combination of Qilong Tongluo Decoction and acupuncture for patients with DPN can relieve their symptoms and improve their nerve conduction velocity, which may be related to the regulation of the Keap1/Nrf2/ARE pathway and intestinal flora.

Key words:

Qilong Tongluo , Decoction, Acupuncture, Oxidative stress, Nerve conduction velocity, Intestinal flora, Diabetic peripheral neuropathy

摘要：

目的　观察芪龙通络汤联合针刺治疗糖尿病周围神经病变（diabetic peripheral neuropathy，DPN）患者的效果。方法　选取2021年9月至2023年9月陕西省中医医院收治的DPN患者86例进行随机对照试验；其中，男46例，女40例；年龄28～75岁，DPN病程1～10年；其中，20例伴有冠心病，32例伴有高血脂症，8例伴有视网膜病变；体重指数19.68～26.84 kg/m²。采用随机数字表法将其分为针刺组和针药组，各43例。两组均给予西医对症治疗。针刺组在对症治疗基础上联合针刺八髎穴、八风穴治疗，针药组在对症治疗基础上给予芪龙通络汤联合针刺八髎穴、八风穴治疗。两组均连续治疗4周。比较两组肠道菌群总数、单个核细胞Kelch样ECH相关蛋白（kelch-like ECH-associated protein 1，Keap1）/转录因子核因子红细胞2相关因子2（nuclear factor E2 related factor 2，Nrf2）/抗氧化反应元件（antioxidant response element，ARE）通路的蛋白相对表达量、氧化应激因子、颈总动脉血管压力应变弹性模量（common carotid artery pressure strain elastic modulus，Ep）、神经传导情况、中医症状评分。采用t检验进行统计分析。结果　针药组治疗后梭杆菌属菌群总数高于针刺组［（10.25±1.20）cfu/g比（8.23±1.14）cfu/g，P<0.05］；针药组治疗后类杆菌属菌群总数低于针刺组［（7.57±0.61）cfu/g比（8.96±0.74）cfu/g，P<0.05］。针药组治疗后Nrf2、ARE、醌氧化还原酶1［NAD（P）H：quinone oxidoreductase 1，NQO1］相对表达量均高于针刺组（1.39±0.31比1.10±0.28、0.98±0.14比0.81±0.11、1.73±0.31比1.42±0.28，均P<0.05）；针药组治疗后Keap1相对表达量低于针刺组（0.43±0.12比0.59±0.14，P<0.05）。针药组治疗后超氧化物歧化酶（superoxide dismutase，SOD）、谷胱甘肽过氧化物酶（glutathione peroxidase，GSH-PX）水平均高于针刺组［（85.56±8.65）U/ml比（78.41±9.44）U/ml、（278.85±38.96）U/ml比（249.56±32.06）U/ml，均P<0.05］；针药组治疗后颈总动脉血管Ep、中医症状评分、MDA均低于针刺组［（115.12±5.98）kPa比（124.65±8.75）kPa、（9.44±1.46）分比（13.25±2.14）分、（4.15±0.53）μmol/L比（4.82±0.74）μmol/L，均P<0.05］。针药组治疗后正中神经与腓总神经的感觉神经传导速度（sensory nerve conduction velocity，SNCV）与运动神经传导速度（motor nerve conduction velocity，MNCV）均高于针刺组［（53.47±4.22）m/s比（49.58±4.36）m/s、（50.97±3.06）m/s比（48.75±3.12）m/s、（52.89±4.26）m/s比（50.66±4.01）m/s、（50.63±3.75）m/s比（48.79±3.14）m/s，均P<0.05］。结论　芪龙通络汤联合针刺治疗DPN患者可减轻症状，改善神经传导速度，可能与调节Keap1/Nrf2/ARE通路和肠道菌群有关。

关键词:

芪龙通络汤, 针刺, 氧化应激, 神经传导速度, 肠道菌群, 糖尿病周围神经病变