陈立英 陈佩怡 赵梁艳 陈文苑

【摘要】 目的：觀察中药热奄包联合胰激肽原酶对社区早期2型糖尿病患者震动感觉阈值（VPT）的影响，总结临床治疗经验。方法：选取2017年10月-2019年2月本院周边的4个社区中确诊为早期2型糖尿病患者60例，按照随机数字表法分为观察组和对照组，各30例。两组均给予常规糖尿病对症治疗，在此基础上，对照组进行胰激肽原酶治疗，观察组在对照组基础上联合中药热奄包外敷治疗。观察并比较两组干预前和干预1个月后的多伦多临床症状评分（TCSS）、足部VPT、下肢缺血改善情况及中医症候积分。结果：干预前，两组TCSS评分、中医症候积分、左侧和右侧下肢VPT比较，差异均无统计学意义（P>0.05）;干预1个月后，两组TCSS评分、中医症候积分、左侧和右侧下肢VPT均低于干预前（P<0.05），且观察组TCSS评分、中医症候积分、左侧和右侧下肢VPT均低于对照组（P<0.05）;观察组下肢缺血改善总有效率明显高于对照组（P<0.05）。结论：与单用胰激肽原酶治疗比较，中药热奄包联合胰激肽原酶可更加有效地降低社区早期2型糖尿病患者VPT，改善下肢缺血及下肢感觉神经功能，缓解临床症状，值得临床合理推广。

【关键词】 中药热奄包 胰激肽原酶 2型糖尿病 震动感觉阈值

[Abstract] Objective： To observe the effect of Chinese herbal medicine hot-pack combined with Pancreatic Kallikrein on the vibration perception threshold （VPT） of early type 2 diabetes in community and summarize the experience of clinical treatment. Method： From October 2017 to February 2019， 60 patients with early type 2 diabetes mellitus from 4 communities around our hospital were selected. They were divided into observation group and control group according to the random number table method， 30 cases in each group. Both groups were treated with routine symptomatic treatment for diabetes mellitus. The control group was treated with Pancreatic Kallikrein. The observation group was treated with Chinese herbal medicine hot-pack external application on the basis of the control group. The Toronto clinical symptom score （TCSS）， foot VPT， lower limb ischemia improvement and TCM syndrome score before and 1 month after intervention were observed and compared between the two groups. Result： Before intervention， there were no significant differences in TCSS score， TCM syndrome score， left and right lower limb VPT between the two groups （P>0.05）. After 1 month of intervention， TCSS score， TCM syndrome score， left and right lower limb VPT in both groups were lower than those before intervention （P<0.05）. The TCSS score， TCM syndrome score， left and right lower limb VPT in the observation group were lower than those in the control group （P<0.05）. The total effective rate of lower limb ischemia improvement in the observation group was significantly higher than that in the control group （P<0.05）. Conclusion： Compared with Pancreatic Kallikrein alone， Chinese herbal medicine hot-pack combined with Pancreatic Kallikrein can effectively reduce the VPT of early type 2 diabetes in community， improve lower limb ischemia and sensory nerve function of lower limbs， alleviate clinical symptoms， which is worthy of clinical rational promotion.

[Key words] Chinese herbal medicine hot-pack Pancreatic Kallikrein Type 2 diabetes Vibration perception threshold

First-authors address： Haizhu District Hospital of Traditional Chinese Medicine， Guangzhou 510220， China

doi：10.3969/j.issn.1674-4985.2019.35.038

糖尿病周围神经病变（DPN）是最为常见的2型糖尿病慢性并发症之一，对患者的生活质量造成严重影响。DPN的发生是由于微血管功能障碍致使神经元和许旺细胞遭到破坏，最终发展至外周神经病变，其发展与神经滋养血管减少导致外周神经灌注量降低密切相关，临床上，常采用震动感觉阈值（VPT）作为早期诊断DPN的便捷手段[1]。胰激肽原酶是一种含有唾液酸的糖蛋白，可松弛血管平滑肌，扩张血管，加快血流速度，增加组织的血流灌注，还可抑制血小板聚集，降低血液黏度，从而改善微循环，是临床上用于治疗DPN的安全可靠药物之一。糖尿病在祖国医学中属消渴症，主要病机在于燥热偏胜、阴津亏损，津伤气耗，阴阳不足则血脉不充，血行不畅，瘀血内生，四肢经脉为瘀血所阻，故见肢体麻木、疼痛[2]。本研……