Objective: To observe the clinical effect on diabetic peripheral neuropathy (DPN) treated with acupuncture combined with medication and explore its effect mechanism.
Methods: 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.
Results: Compared with that before treatment, the scores of TCSS were reduced in the combined therapy group and the medication group (P<0.05) after treatment, and the score decrease in the combined therapy group was larger than that of the medication group (P<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 (P<0.05), and the improvements in the combined therapy group were larger than those of the medication group (P<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.
Conclusion: 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.
目的：观察针药结合治疗糖尿病周围神经病变（DPN）的临床疗效，探讨其作用机制。方法：将62例DPN患者随机分为针药结合组（31例）和药物组（31例，脱落2例），并招募20例健康受试者作为正常组。在常规治疗基础上，药物组口服硫辛酸胶囊，每次0.2 g，每日3次；在药物组治疗基础上，针药结合组采用针刺治疗，穴取双侧曲池、外关、合谷、天枢、足三里、三阴交、太冲，留针30 min，每日1次，每周6次。两组均治疗4周。观察针药结合组和药物组患者治疗前后多伦多临床评分系统（TCSS）评分及正中神经（MN）和腓总神经（CPN）的神经传导速度；检测针药结合组、药物组患者治疗前后和正常组健康受试者血清脂质代谢。结果：治疗后，针药结合组和药物组患者TCSS评分均较治疗前降低（P<0.05），且针药结合组降低幅度大于药物组（P<0.001）；针药结合组和药物组患者MN、CPN的运动神经传导速度与感觉神经传导速度均较治疗前提高（P<0.05），且针药结合组提高幅度大于药物组（P<0.001）。DPN患者治疗前与正常组健康受试者共有365个差异脂质代谢物，包括鞘氨醇（SPH，d18:0）等，参与肌醇磷酸代谢等通路；药物组治疗前后有103个差异脂质代谢物，包括溶血磷脂酰乙醇胺（LPE，18:1/0:0）等，参与甘油磷脂代谢等通路；针药结合组治疗前后共有99个差异脂质代谢物，包括溶血磷脂酰胆碱（LPC，18:0/0:0）等，参与神经活性配体-受体相互作用等通路。溶血磷脂酸（LPA，0:0/22:6）、LPA（0:0/18:2）、LPC（O-18:0）等50个脂质代谢物受针刺影响较大，主要参与甘油磷脂代谢等通路。结论：针药结合可改善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。.
Keywords: acupuncture combined with medication; diabetic peripheral neuropathy; lipid metabolism; nerve conduction velocity.