一例糖尿病外周神經病變患者的循證治療_《中國循證醫學雜志》

作者：

李俊峰 ,  文重遠

武漢大學人民醫院內分泌科;

關鍵詞：

糖尿病外周神經病變醛糖還原酶抑制劑神經生長因子 α- 硫辛酸三環類抗抑郁藥復方辣椒堿乳膏循證治療

DOI：

10.7507/1672-2531.20090021

視頻：

導出 下載 收藏 掃碼 引用

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

目的　針對一例糖尿病外周神經病變患者，檢索當前最佳證據，為患者選擇藥物治療方案提供依據，減輕患者癥狀，提高生活質量。
方法　根據循證臨床實踐的方法，提出問題，檢索證據，對所獲證據進行評價，并結合患者意愿制定治療方案。
結果　共納入15個隨機對照試驗，14個系統評價/Meta分析和1個臨床指南。證據結果表明：① 穩定而良好的血糖控制是治療糖尿病神經病變的基礎；② 不推薦醛糖還原酶抑制劑、神經生長因子用于治療糖尿病神經病變；③ α-硫辛酸能改善糖尿病神經病變患者癥狀；④ 三環類抗抑郁藥，抗驚厥藥，5-羥色胺和去甲腎上腺素攝取抑制劑可減輕糖尿病神經病變患者疼痛；⑤ B族維生素與復方辣椒堿乳膏可用于治療糖尿病神經病變。結合患者情況，應用證據治療3月后，患者血糖水平保持正常，癥狀緩解。
結論　采用循證治療的方法，為糖尿病外周神經病變患者制定合理的治療方案，可有效提高治療效果。

引用本文： 李俊峰,文重遠. 一例糖尿病外周神經病變患者的循證治療. 中國循證醫學雜志, 2009, 09(1): 107-112. doi: 10.7507/1672-2531.20090021 復制

1.	Standards of Medical Care in Diabetes—2008 DIABETES CARE, VOLUME 31, SUPPLEMENT 1, JANUARY 2008.
2.	Effect of intensive diabetes treatment on nerve conduction in the Diabetes Control and Complications Trial. Ann Neurol, 1995, 38(6): 869-880.
3.	Tesfaye S, Stevens LK, Stephenson JM, et al. Prevalence of diabetic peripheral neuropathy and its relation to glycaemic control and potential risk factors: the EURODIAB IDDM Complications Study. Diabetologia, 1996, 39(11): 1377-1384.
4.	Boulton AJ, Vinik AI, Arezzo JC, et al. Diabetic neuropathies: a statement by the American Diabetes Association. Diabetes Care, 2005, 28: 956-962.
5.	Hotta N, Kawamori R, Atsumi Y, et al. Stratified analyses for selecting appropriate target patients with diabetic peripheral neuropathy for long-term treatment with an aldose reductase inhibitor, epalrestat ADCT Study Group. Diabet Med, 2008, 25(7): 818-825.
6.	Hotta N, Akanuma Y, Kawamori R, et al. Long-term clinical effects of epalrestat, an aldose reductase inhibitor, on diabetic peripheral neuropathy: the 3-year, multicenter, comparative Aldose Reductase Inhibitor-Diabetes Complications Trial. Diabetes Care, 2006, 29: 1538-1544.
7.	Chalk C, Benstead TJ, Moore F. Aldose reductase inhibitors for the treatment of diabetic polyneuropathy. Cochrane Database Syst Rev, 2007, 17(4): CD004572.
8.	Ziegler D, Hanefeld M, Ruhnau KJ, et al. Treatment of symptomatic diabetic peripheral neuropathy with alpha- lipoic acid. A 3-week multicentre randomized controlled trial (ALADIN Study). Diabetologia, 1995, 38(12): 1425-1433.
9.	Reljanovic M, Reichel G, Rett K, et al. Treatment of diabetic polyneuropathy with the antioxidant thioctic acid (alpha-lipoic acid): a two year multicenter randomized double-blind placebo-controlled trial (ALADIN II). Alpha Lipoic Acid in Diabetic Neuropathy. Free Radic Res, 1999, 31(3): 171-179.
10.	Ziegler D, Hanefeld M, Ruhnau KJ, et al. Treatment of symptomatic diabetic polyneuropathy with the antioxidant alpha-lipoic acid: a 7-month multicenter randomized controlled trial (ALADIN III Study). ALADIN III Study Group. Alpha-Lipoic Acid in Diabetic Neuropathy. Diabetes Care, 1999, 22(8): 1296-1301.
11.	Ametov AS, Barinov A, Dyck PJ, et al. SYDNEY Trial Study Group. The sensory symptoms of diabetic polyneuropathy are improved with alpha-lipoic acid: the SYDNEY trial. Diabetes Care, 2003, 26(3): 770-776. Erratum in: Diabetes Care, 2003, 26(7): 2227.
12.	Ziegler D, Ametov A, Barinov A, et al. Oral treatment with alphalipoic acid improves symptomatic diabetic polyneuropathy: the SYDNEY 2 trial. Diabetes Care, 2006, 29(11): 2365-2370.
13.	Ziegler D, Nowak H, Kempler P, et al. Treatment of symptomatic diabetic polyneuropathy with the antioxidant alpha-lipoic acid: a meta-analysis. Diabet Med, 2004, 21(2): 114-121.
14.	Apfel SC, Schwartz S, Adornato BT, et al. Efficacy and safety of recombinant human nerve growth factor in patients with diabetic polyneuropathy: A randomized controlled trial. J Am Med Assoc, 2000, 284(17): 2215-2221.
15.	Collins SL, Moore RA, McQuay HJ, et al. Antidepressants and anticonvulsants for diabetic neuropathy and postherpetic neuralgia: a quantitative systematic review. Journal of Pain and Symptom Management, 2000, 20(6): 449-458.
16.	Joss JD. Tricyclic antidepressant use in diabetic neuropathy. Ann Pharmacother, 1999, 33(9): 996-1000.
17.	McQuay HJ, Tramèr M, Nye BA, et al. A systematic review of antidepressants in neuropathic pain. Pain, 1996, 68(2-3): 217-227.
18.	Rull JA, Quibrera R, Gonzalez-Millan H, et al. Symptomatic treatment of peripheral diabetic neuropathy with carbamazepine (Tegretol): double blind crossover trial. Diabetologia, 1969, 5(4): 215-218.
19.	Backonja M, Beydoun A, Edwards KR, et al. Gabapentin for the symptomatic treatment of painful neuropathy in patients with diabetes mellitus: a randomized controlled trial. JAMA, 1998, 280(21): 1831-1836.
20.	Wiffen PJ, McQuay HJ, Edwards JE, et al. Gabapentin for acute and chronic pain. Cochrane Database Syst Rev, 2005, 20(3): CD005452.
21.	Hemstreet B, Lapointe M. Evidence for the use of gabapentin in the treatment of diabetic peripheral neuropathy. Clin Ther, 2001, 23(4): 520-531.
22.	Frampton JE, Scott LJ. Pregabalin: in the treatment of painful diabetic peripheral neuropathy. Drugs, 2004, 64(24): 2813-2820; discussion 2821.
23.	Freeman R, Durso-Decruz E, Emir B. Efficacy, safety, and tolerability of pregabalin treatment for painful diabetic peripheral neuropathy: findings from seven randomized, controlled trials across a range of doses. Diabetes Care, 2008, 31(7): 1448-1454.
24.	Arezzo JC, Rosenstock J, Lamoreaux L, et al. Efficacy and safety of pregabalin 600 mg/d for treating painful diabetic peripheral neuropathy: a double-blind placebo-controlled trial. BMC Neurol, 2008, 16(8): 33.
25.	Chong MS, Hester J. Diabetic painful neuropathy: current and future treatment options. Drugs, 2007, 67(4): 569-585.
26.	Kajdasz DK, Iyengar S, Desaiah D, et al. Duloxetine for the management of diabetic peripheral neuropathic pain: evidence-based findings from post hoc analysis of three multicenter, randomized, double-blind, placebo-controlled, parallel-group studies. Clin Ther, 2007, 29: 2536-2546.
27.	Ang Cynthia D, Alviar Maria Jenelyn M, Dans Antonio L.Vitamin B for treating peripheral neuropathy. Cochrane Database of Systematic Reviews, Issue 3, 2008.
28.	Stracke H, Lindemann A, Federlin K. A benfotiamine-vitamin B combination in treatment of diabetic polyneuropathy. Exp Clin Endocrinol Diabetes, 1996, 104(4): 311-316.
29.	Sun Y, Lai MS, Lu CJ. Effectiveness of vitamin B12 on diabetic neuropathy: systematic review of clinical controlled trials. Acta Neurol Taiwan, 2005, 14(2): 48-54.
30.	Sindrup SH, Jensen TS. Efficacy of pharmacological treatments of neuropathic pain: an update and effect related to mechanism of drug action. Pain, 1999, 83(3): 389-400.
31.	Biesbroeck R, Bril V, Hollander P, et al. A double-blind comparison of topical capsaicin and oral amitriptyline in painful diabetic neuropathy. Adv Ther, 1995, 12(2): 111-120.
32.	Mason L, Moore R A, Derry S, et al. Systematic review of topical capsaicin for the treatment of chronic pain. BMJ, 2004, 328(7446): 991.

1. Standards of Medical Care in Diabetes—2008 DIABETES CARE, VOLUME 31, SUPPLEMENT 1, JANUARY 2008.
2. Effect of intensive diabetes treatment on nerve conduction in the Diabetes Control and Complications Trial. Ann Neurol, 1995, 38(6): 869-880.
3. Tesfaye S, Stevens LK, Stephenson JM, et al. Prevalence of diabetic peripheral neuropathy and its relation to glycaemic control and potential risk factors: the EURODIAB IDDM Complications Study. Diabetologia, 1996, 39(11): 1377-1384.
4. Boulton AJ, Vinik AI, Arezzo JC, et al. Diabetic neuropathies: a statement by the American Diabetes Association. Diabetes Care, 2005, 28: 956-962.
5. Hotta N, Kawamori R, Atsumi Y, et al. Stratified analyses for selecting appropriate target patients with diabetic peripheral neuropathy for long-term treatment with an aldose reductase inhibitor, epalrestat ADCT Study Group. Diabet Med, 2008, 25(7): 818-825.
6. Hotta N, Akanuma Y, Kawamori R, et al. Long-term clinical effects of epalrestat, an aldose reductase inhibitor, on diabetic peripheral neuropathy: the 3-year, multicenter, comparative Aldose Reductase Inhibitor-Diabetes Complications Trial. Diabetes Care, 2006, 29: 1538-1544.
7. Chalk C, Benstead TJ, Moore F. Aldose reductase inhibitors for the treatment of diabetic polyneuropathy. Cochrane Database Syst Rev, 2007, 17(4): CD004572.
8. Ziegler D, Hanefeld M, Ruhnau KJ, et al. Treatment of symptomatic diabetic peripheral neuropathy with alpha- lipoic acid. A 3-week multicentre randomized controlled trial (ALADIN Study). Diabetologia, 1995, 38(12): 1425-1433.
9. Reljanovic M, Reichel G, Rett K, et al. Treatment of diabetic polyneuropathy with the antioxidant thioctic acid (alpha-lipoic acid): a two year multicenter randomized double-blind placebo-controlled trial (ALADIN II). Alpha Lipoic Acid in Diabetic Neuropathy. Free Radic Res, 1999, 31(3): 171-179.
10. Ziegler D, Hanefeld M, Ruhnau KJ, et al. Treatment of symptomatic diabetic polyneuropathy with the antioxidant alpha-lipoic acid: a 7-month multicenter randomized controlled trial (ALADIN III Study). ALADIN III Study Group. Alpha-Lipoic Acid in Diabetic Neuropathy. Diabetes Care, 1999, 22(8): 1296-1301.
11. Ametov AS, Barinov A, Dyck PJ, et al. SYDNEY Trial Study Group. The sensory symptoms of diabetic polyneuropathy are improved with alpha-lipoic acid: the SYDNEY trial. Diabetes Care, 2003, 26(3): 770-776. Erratum in: Diabetes Care, 2003, 26(7): 2227.
12. Ziegler D, Ametov A, Barinov A, et al. Oral treatment with alphalipoic acid improves symptomatic diabetic polyneuropathy: the SYDNEY 2 trial. Diabetes Care, 2006, 29(11): 2365-2370.
13. Ziegler D, Nowak H, Kempler P, et al. Treatment of symptomatic diabetic polyneuropathy with the antioxidant alpha-lipoic acid: a meta-analysis. Diabet Med, 2004, 21(2): 114-121.
14. Apfel SC, Schwartz S, Adornato BT, et al. Efficacy and safety of recombinant human nerve growth factor in patients with diabetic polyneuropathy: A randomized controlled trial. J Am Med Assoc, 2000, 284(17): 2215-2221.
15. Collins SL, Moore RA, McQuay HJ, et al. Antidepressants and anticonvulsants for diabetic neuropathy and postherpetic neuralgia: a quantitative systematic review. Journal of Pain and Symptom Management, 2000, 20(6): 449-458.
16. Joss JD. Tricyclic antidepressant use in diabetic neuropathy. Ann Pharmacother, 1999, 33(9): 996-1000.
17. McQuay HJ, Tramèr M, Nye BA, et al. A systematic review of antidepressants in neuropathic pain. Pain, 1996, 68(2-3): 217-227.
18. Rull JA, Quibrera R, Gonzalez-Millan H, et al. Symptomatic treatment of peripheral diabetic neuropathy with carbamazepine (Tegretol): double blind crossover trial. Diabetologia, 1969, 5(4): 215-218.
19. Backonja M, Beydoun A, Edwards KR, et al. Gabapentin for the symptomatic treatment of painful neuropathy in patients with diabetes mellitus: a randomized controlled trial. JAMA, 1998, 280(21): 1831-1836.
20. Wiffen PJ, McQuay HJ, Edwards JE, et al. Gabapentin for acute and chronic pain. Cochrane Database Syst Rev, 2005, 20(3): CD005452.
21. Hemstreet B, Lapointe M. Evidence for the use of gabapentin in the treatment of diabetic peripheral neuropathy. Clin Ther, 2001, 23(4): 520-531.
22. Frampton JE, Scott LJ. Pregabalin: in the treatment of painful diabetic peripheral neuropathy. Drugs, 2004, 64(24): 2813-2820; discussion 2821.
23. Freeman R, Durso-Decruz E, Emir B. Efficacy, safety, and tolerability of pregabalin treatment for painful diabetic peripheral neuropathy: findings from seven randomized, controlled trials across a range of doses. Diabetes Care, 2008, 31(7): 1448-1454.
24. Arezzo JC, Rosenstock J, Lamoreaux L, et al. Efficacy and safety of pregabalin 600 mg/d for treating painful diabetic peripheral neuropathy: a double-blind placebo-controlled trial. BMC Neurol, 2008, 16(8): 33.
25. Chong MS, Hester J. Diabetic painful neuropathy: current and future treatment options. Drugs, 2007, 67(4): 569-585.
26. Kajdasz DK, Iyengar S, Desaiah D, et al. Duloxetine for the management of diabetic peripheral neuropathic pain: evidence-based findings from post hoc analysis of three multicenter, randomized, double-blind, placebo-controlled, parallel-group studies. Clin Ther, 2007, 29: 2536-2546.
27. Ang Cynthia D, Alviar Maria Jenelyn M, Dans Antonio L.Vitamin B for treating peripheral neuropathy. Cochrane Database of Systematic Reviews, Issue 3, 2008.
28. Stracke H, Lindemann A, Federlin K. A benfotiamine-vitamin B combination in treatment of diabetic polyneuropathy. Exp Clin Endocrinol Diabetes, 1996, 104(4): 311-316.
29. Sun Y, Lai MS, Lu CJ. Effectiveness of vitamin B12 on diabetic neuropathy: systematic review of clinical controlled trials. Acta Neurol Taiwan, 2005, 14(2): 48-54.
30. Sindrup SH, Jensen TS. Efficacy of pharmacological treatments of neuropathic pain: an update and effect related to mechanism of drug action. Pain, 1999, 83(3): 389-400.
31. Biesbroeck R, Bril V, Hollander P, et al. A double-blind comparison of topical capsaicin and oral amitriptyline in painful diabetic neuropathy. Adv Ther, 1995, 12(2): 111-120.
32. Mason L, Moore R A, Derry S, et al. Systematic review of topical capsaicin for the treatment of chronic pain. BMJ, 2004, 328(7446): 991.

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一例糖尿病外周神經病變患者的循證治療

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《中國循證醫學雜志》

一例糖尿病外周神經病變患者的循證治療

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