糖尿病周围神经病变的治疗药物与联合用药

2020-02-21 高丽丽 医学之声

糖尿病周围神经病变(DPN)是在排除其他原因的情况下,糖尿病者出现周围神经功能障碍相关的症状和/或体征,常见症状为肢体麻木、疼痛、灼热或其他异常感觉,远端对称性多发性神经病变(DSPN)是DPN的常见类型,吸烟、年龄>40岁及血糖控制不佳的糖尿病者更易发生DPN。

糖尿病周围神经病变(DPN)是在排除其他原因的情况下,糖尿病者出现周围神经功能障碍相关的症状和/或体征,常见症状为肢体麻木、疼痛、灼热或其他异常感觉,远端对称性多发性神经病变(DSPN)是DPN的常见类型,吸烟、年龄>40岁及血糖控制不佳的糖尿病者更易发生DPN。

一.糖尿病周围神经病变的治疗药物

糖尿病周围神经病变(DPN)的对因治疗包括代谢控制(控制血糖、血压、血脂)、抗氧化应激、改善微循环、抑制醛糖还原酶和神经修复等。DPN的对症治疗主要是改善疼痛症状,治疗药物有抗抑郁药物、抗惊厥药物和阿片类镇痛药物等。



二.糖尿病周围神经病变的联合用药

①前列腺素E1脂微球载体制剂联合硫辛酸
两者联合治疗DPN,临床效果和神经传导速度的改善均明显优于单一用药,且无严重不良反应发生。

②前列腺素E1脂微球载体制剂联合甲钴胺
荟萃分析结果显示,两者联用对糖尿病周围神经病变者症状和体征改善的总有效率和对平均运动神经传导速度的改善均优于单用甲钴胺。

③依帕司他联合ɑ-硫辛酸
两者联合治疗DPN,临床效果明显优于单一用药,可改善神经传导速。其值得临床借鉴,但临床使用需谨慎考虑。

④度洛西汀联合普瑞巴林
镇痛效果和改善生活质量要优于单一药物的治疗。

⑤利多卡因5%贴剂联合加巴喷丁
利多卡因5%贴剂辅助加巴喷丁治疗,可得到更好的镇痛效果。

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    2020-02-21 misszhang

    谢谢MedSci提供最新的资讯

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目前尚缺乏有效措施促使T1DM患者的胰岛素不足及代谢稳定性得以恢复,故T1DM患者常需要终生接受胰岛素治疗,因此,T1DM的早期识别和预防尤为重要。既往研究显示T1DM在无症状期仅存在胰岛β细胞自身抗体而无高血糖,那么,通过胰岛β细胞自身抗体筛查是否可以将T1DM识别再度提前?根据JAMA发表的一项最新研究结果,T1DM无症状期增加了2~5岁儿童罹患临床T1DM的风险,胰岛自身抗体筛查可早期识别这

Circulation:因病致贫,中青年糖尿病患者的经济压力巨大

糖尿病治疗的总开支和自付开支呈不断上升的趋势,给各国患者带来了经济困难的风险,也对医疗及非医疗需求构成威胁。近期,发表于《循环:心血管质量与结局杂志》(Circulation:Cardiovascular Quality and Outcomes)发布一项研究,旨在描述国家层面上来自非老年糖尿病患者医疗费用和财政困难之间的权衡。

BMJ:罗格列酮与心血管事件风险

研究认为,罗格列酮治疗导致心血管风险增加,特别是心衰风险

Cell Death Dis:PARP-1缺失可缓解糖尿病性动脉粥样硬化进展

动脉粥样硬化钙化作用加快是斑块形成的主要原因,尤其是在糖尿病患者中。但糖尿病患者的动脉粥样硬化钙化作用的调控机制目前还知之甚少。研究人员发现PARP-1(一种在多种代谢并发症中的主要酶)的缺失可以减缓糖尿病患者的动脉粥样硬化的钙化过程,并通过抑制Runx2的表达来延缓小鼠的血管硬化过程。具体而言,PARP-1缺失可以通过调节Stat1介导的血管平滑肌细胞的综合表型转换及巨噬细胞极化来减慢糖尿病患者

JACC:结合珠蛋白基因型会影响强化降糖治疗对心血管预后的影响

糖化血红蛋白与心血管疾病风险是否存在直接相关性尚存争议。结合珠蛋白(Hp)基因位点的常见多态性在高血糖的情况下与心血管疾病发生相关,尤其是冠心病。本研究旨在确定在ACCORD(糖尿病心血管风险控制措施)研究中,强化降糖治疗与标准降糖治疗对心血管疾病风险的治疗差异是否取决于Hp表型。本研究对ACCORD临床研究中的5806名参与者进行了Hp基因型的鉴定,与标准治疗相比,强化治疗在Hp2-2患者中与更