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背景:大量基础研究和临床观察证明银杏提取物与潘生丁复方制剂有明显的改善微循环的作用,甲钴胺是临床上常用的神经修复剂,将两者联合治疗糖尿病周围神经病变疗效更佳。目的:观察银杏提取物与潘生丁复方制剂与甲钴胺联合应用对糖尿病周围神经病变患者腓总神经神经传导速度和血液流变学的改善效果。设计:以患者为观察对象,随机对照设计的验证性实验。单位:华中科技大学同济医学院附属同济医院综合科。对象:选择2002-01/2005-01在华中科技大学同济医学院附属同济医院综合科住院的2型糖尿病并发周围神经病变患者120例,随机(投币)分为治疗组和对照组各60例,患者对治疗均知情同意。方法:治疗组应用银杏提取物与潘生丁复方制剂(贵州益佰制药有限公司生产)25mL+生理盐水250mL静脉滴注,1次/d,同时应用甲钴胺(日本卫材株式会社产品)500μg肌肉注射,1次/d,连续应用4周;对照组用甲钴胺500μg肌肉注射,1次/d,连续应用4周。主要观察指标:治疗前1d及治疗4周后两组患者腓神经的神经传导速度,血液流变学指标(包括血黏度、红细胞压积和血小板聚集率)。结果:120例全部进入结果分析。①运动神经传导速度:治疗组治疗后快于治疗前和对照组治疗后[(45.6±4.3),(38.5±3.8),(41.4±6.2)m/s,t=9.585,4.312,P<0.01];感觉神经传导速度:治疗组治疗后快于治疗前和对照组治疗后[(45.8±4.2),(36.7±4.8),(38.2±4.9)m/s,t=11.047,9.120,P<0.01]。②治疗组治疗后全血黏度高切、低切和血浆黏度均显著低于治疗前和对照组治疗后(P<0.01)。③治疗组治疗后红细胞压积显著低于治疗前和对照组治疗后[(41.32±3.56)%,(46.32±3.43)%,(44.32±4.49)%,t=7.834,4.05,P<0.01]。④治疗组治疗后血小板聚集率显著低于治疗前和对照组治疗后[(31.35±2.11)%,(48.44±2.68)%,(45.91±3.54)%,t=38.810,27.367,P<0.01]。结论:银杏提取物与潘生丁复方制剂与甲钴胺联合应用可提高神经传导速度,降低血黏度和血小板聚集率,是治疗糖尿病周围神经病变的有效方法。
BACKGROUND: A large amount of basic research and clinical observation have proved that the compound preparation of ginkgo extract and dipyridamole can obviously improve the microcirculation. Mecobalamin is a commonly used nerve repair agent in clinical practice, and the combination of the two in the treatment of diabetic peripheral neuropathy is more effective. Objective: To observe the effect of Ginkgo biloba extract combined with dipyridamole and mecobalamin on the peroneal nerve nerve conduction velocity and hemorheology in patients with diabetic peripheral neuropathy. Design: Patient observation, randomized controlled design of the confirmatory experiment. Unit: Huazhong University of Science and Technology Tongji Medical College Affiliated Tongji Hospital Comprehensive Section. PARTICIPANTS: 120patients with type 2 diabetes mellitus and peripheral neuropathy hospitalized in Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from January 2002 to January 2005 were randomly divided into treatment group (60 cases) and control group (60 cases) , Patients are informed consent to treatment. Methods: The treatment group was treated with intravenous drip of Ginkgo biloba extract and dipyridamole compound (produced by Guizhou YiBai Pharmaceutical Co., Ltd.) 25mL + 250mL normal saline once per day, and 500μg intramuscular injection of methylcobalamin (Nippon Shiba Co., Ltd.) , Once daily for 4 weeks. The control group was injected intramuscularly with 500μg mecobalamin once a day for 4 weeks. MAIN OUTCOME MEASURES: The nerve conduction velocity and hemorheology indexes (including blood viscosity, hematocrit and platelet aggregation rate) of the peroneal nerve in two groups before treatment and 4 weeks after treatment. Results: All of the 120 patients entered the result analysis. (1) Motor nerve conduction velocity was faster in the treatment group than before treatment and in the control group [(45.6 ± 4.3), (38.5 ± 3.8), (41.4 ± 6.2) m / s, t = 9.585, The sensory nerve conduction velocity was faster in the treatment group than before treatment and in the control group [(45.8 ± 4.2), (36.7 ± 4.8), (38.2 ± 4.9) m / s, t = 11.047,9.120, P < 0.01]. ② After treatment, the whole blood viscosity in the treatment group was significantly lower than that before treatment and in the control group (P <0.01). ③ After treatment, the hematocrit in the treatment group was significantly lower than that before treatment and in the control group [(41.32 ± 3.56)%, (46.32 ± 3.43)%, (44.32 ± 4.49)%, t = 7.834, . ④ After treatment, the platelet aggregation rate in the treatment group was significantly lower than that before treatment and in the control group [(31.35 ± 2.11)%, (48.44 ± 2.68)%, (45.91 ± 3.54)%, t = 38.810,27.367, P <0.01] . Conclusion: The combination of Ginkgo biloba extract and dipyridamole compound preparation and mecobalamin can increase nerve conduction velocity, reduce blood viscosity and platelet aggregation rate, which is an effective method for the treatment of diabetic peripheral neuropathy.