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目的探讨度洛西汀联合硫辛酸对糖尿病痛性神经病变的疗效和安全性。方法将2010年1月-2012年12月我院120例2型糖尿病伴有糖尿病痛性神经病变的患者随机分为度洛西汀组、加巴喷丁组、传统治疗组和对照组各30例,分别于治疗前和治疗后1周、4周、8周测量正中神经感觉传导速度、腓肠神经感觉传导速度及其VRS、NRS的评分和评级,并对结果进行比较分析。结果治疗1周后,度洛西汀组、加巴喷丁组、传统治疗组的正中神经感觉传导速度、腓肠神经感觉传导速度较对照组有改善,差异有统计学意义(P<0.05),三组组间比较无明显差异(P>0.05);各组间的VRS、NRS存在组间差异(P<0.05),疼痛改善程度依次降低的顺序为度洛西汀组、加巴喷丁组、传统治疗组和对照组。治疗4周后,度洛西汀组、加巴喷丁组、传统治疗组的正中神经感觉传导速度、腓肠神经感觉传导速度持续改善,三组间无差异(P>0.05),对照组仍无明显变化。而组间的VRS、NRS对比时,度洛西汀组与加巴喷丁组无显著性差异(P>0.05),度洛西汀和加巴喷丁组优于传统治疗组和对照组(P<0.05),且疼痛改善程度度洛西汀组及加巴喷丁组优于传统治疗组和对照组,对照组中患者疼痛加剧。治疗8周后,度洛西汀组、加巴喷丁组、传统治疗组的正中神经感觉传导速度、腓肠神经感觉传导速度已接近正常值,三组间无差异(P>0.05);传统治疗组优于对照组(P<0.05),各组间的VRS、NRS对比时,度洛西汀组与加巴喷丁组无显著性差异(P>0.05),度洛西汀和加巴喷丁组优于传统治疗组和对照组(P<0.05)。结论度洛西汀的止痛效果优于加巴喷丁,度洛西汀联合硫辛酸治疗DNPN效果好,安全性高,可作为DNPN的首选治疗方案。
Objective To investigate the efficacy and safety of duloxetine and lipoic acid in the treatment of diabetic pain neuropathy. Methods From January 2010 to December 2012, 120 patients with type 2 diabetes mellitus complicated with diabetic neuropathies in our hospital were randomly divided into duloxetine group, gabapentin group, conventional treatment group and control group, with 30 cases each The median nerve sensory conduction velocity, sural nerve sensory conduction velocity and VRS, NRS score and grade were measured before treatment and 1 week, 4 weeks and 8 weeks after treatment. The results were compared and analyzed. Results After 1 week of treatment, median nerve sensory conduction velocity and sural nerve sensory conduction velocity in duloxetine group, gabapentin group and traditional treatment group were significantly improved compared with those in control group (P <0.05). Three groups There was no significant difference between the two groups (P> 0.05). There were significant differences in VRS and NRS between the two groups (P <0.05). The decreasing order of pain was duloxetine, gabapentin, traditional treatment and Control group. After 4 weeks of treatment, median nerve sensory conduction velocity and sural nerve sensory conduction velocity in duloxetine group, gabapentin group and traditional treatment group continued to improve, there was no difference among the three groups (P> 0.05), but there was no significant change in the control group . However, there was no significant difference between duloxetine group and gabapentin group when comparing VRS and NRS between the two groups (P> 0.05). Duloxetine and gabapentin groups were superior to the traditional treatment group and the control group (P <0.05) The degree of pain improvement was better in the duloxetine group and the gabapentin group than in the traditional treatment group and the control group, and the patients in the control group experienced more pain. After 8 weeks of treatment, median nerve sensory conduction velocity and sural nerve sensory conduction velocity of duloxetine group, gabapentin group and traditional treatment group were close to normal value, there was no difference among the three groups (P> 0.05) There was no significant difference between duloxetine group and gabapentin group in the control group (P <0.05). When comparing VRS and NRS in each group, duloxetine and gabapentin showed no significant difference (P> 0.05) Control group (P <0.05). Conclusion Duloxetine is superior to gabapentin in analgesic efficacy. Duloxetine and lipoic acid are effective and safe for DNPN treatment, which may be the first choice of DNPN treatment.