Lian Xiaoyang, Wang Ming, Yuan Mengqian, Li Xiaojie, Chen Dong, Zhong Jingchen, Liu Chengyong, Xu Bin
Department of Acupuncture and Rehabilitation, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, Jiangsu Province, China.
Department of Acupuncture and Tuina, Jiangsu Provincial Government Hospital.
Zhongguo Zhen Jiu. 2024 May 12;44(5):503-12. doi: 10.13703/j.0255-2930.20230711-k0007.
To observe the clinical effect on diabetic peripheral neuropathy (DPN) treated with acupuncture combined with medication and explore its effect mechanism.
Sixty-two patients of DPN were randomly divided into a combined therapy group (31 cases) and a medication group (31 cases, 2 cases dropped out); besides, 20 healthy subjects were recruited as a normal group. On the base of routine intervention, in the medication group, thioctic acid capsules were administrated orally, 0.2 g each time, 3 times a day. In the combined therapy group, besides the medication as the medication group, acupuncture was performed on bilateral Quchi (LI 11), Waiguan (TE 5), Hegu (LI 4), Tianshu (ST 25), Zusanli (ST 36), Sanyinjiao (SP 6) and Taichong (LR 3) and the needles were retained for 30 min, acupuncture was delivered once daily, 6 times a week. The duration of treatment was 4 weeks in the two groups. The score of Toronto clinical scoring system (TCSS), the nerve conduction velocity of median nerve (MN) and common peroneal nerve (CPN) were observed before and after treatment in the two intervention groups; and the serum lipid metabolism was detected before and after treatment in the two intervention groups and the normal group.
Compared with that before treatment, the scores of TCSS were reduced in the combined therapy group and the medication group (<0.05) after treatment, and the score decrease in the combined therapy group was larger than that of the medication group (<0.001). The motor nerve conduction velocity and the sensory nerve conductive velocity of MN and CPN after treatment all increased in the combined therapy group and the medication group compared with those before treatment (<0.05), and the improvements in the combined therapy group were larger than those of the medication group (<0.001). Before treatment DPN patients had 365 differential lipid metabolites, including sphingosine (SPH, d18:0), involved in the inositol phosphate metabolism, compared with the subjects of the normal group. There were 103 differential lipid metabolites in the medication group before and after treatment, including lysophosphatidyl ethanolamine (LPE, 18:1/0:0), participated in glycerophospholipid metabolism. In the combined therapy group, before and after treatment, there were 99 differential lipid metabolites, including lysophosphatidylcholine (LPC, 18:0/0:0), participated in the neuroactive ligand-receptor interaction. Acupuncture greatly affected 50 lipid metabolites such as lysophosphatidic acid (LPA, 0:0/22:6), LPA(0:0/18:2) and LPC(O-18:0), which was mainly involved in glycerophospholipid metabolism.
Acupuncture combined with medication ameliorates the symptoms and the nerve conduction velocity in DPN patients, which may be related to the regulation of serum lipid metabolism.
观察针刺联合药物治疗糖尿病周围神经病变（DPN）的临床疗效，并探讨其作用机制。
将62例DPN患者随机分为联合治疗组（31例）和药物组（31例，2例脱落）；另选取20例健康受试者作为正常组。在常规干预基础上，药物组口服硫辛酸胶囊，每次0.2 g，每日3次。联合治疗组在药物组治疗基础上，针刺双侧曲池（LI 11）、外关（TE 5）、合谷（LI 4）、天枢（ST 25）、足三里（ST 36）、三阴交（SP 6）、太冲（LR 3），留针30分钟，每日1次，每周6次。两组治疗疗程均为4周。观察两组干预前后多伦多临床评分系统（TCSS）评分、正中神经（MN）和腓总神经（CPN）神经传导速度；检测两组干预前后及正常组血清脂质代谢情况。
与治疗前比较，联合治疗组和药物组治疗后TCSS评分均降低（<0.05），且联合治疗组评分降低幅度大于药物组（<0.001）。联合治疗组和药物组治疗后MN和CPN的运动神经传导速度及感觉神经传导速度均较治疗前增加（<0.05），且联合治疗组改善幅度大于药物组（<0.001）。治疗前DPN患者与正常组比较有365种差异脂质代谢产物，包括参与磷酸肌醇代谢的鞘氨醇（SPH，d18:0）。药物组治疗前后有103种差异脂质代谢产物，包括参与甘油磷脂代谢的溶血磷脂酰乙醇胺（LPE，18:1/0:0）。联合治疗组治疗前后有99种差异脂质代谢产物，包括参与神经活性配体-受体相互作用的溶血磷脂酰胆碱（LPC，18:0/0:0）。针刺对溶血磷脂酸（LPA，0:0/22:6）、LPA(0:0/18:2)和LPC(O-18:0)等50种脂质代谢产物有较大影响，主要涉及甘油磷脂代谢。
针刺联合药物可改善DPN患者症状及神经传导速度，其机制可能与调节血清脂质代谢有关。
