一例糖尿病外周神经病变患者的循证治疗_《中国循证医学杂志》

作者：

李俊峰 ,  文重远

武汉大学人民医院内分泌科;

关键词：

糖尿病外周神经病变醛糖还原酶抑制剂神经生长因子 α- 硫辛酸三环类抗抑郁药复方辣椒碱乳膏循证治疗

DOI：

10.7507/1672-2531.20090021

视频：

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摘要 全文 图表 视频 参考文献 施引文献 补充材料

目的　针对一例糖尿病外周神经病变患者，检索当前最佳证据，为患者选择药物治疗方案提供依据，减轻患者症状，提高生活质量。
方法　根据循证临床实践的方法，提出问题，检索证据，对所获证据进行评价，并结合患者意愿制定治疗方案。
结果　共纳入15个随机对照试验，14个系统评价/Meta分析和1个临床指南。证据结果表明：① 稳定而良好的血糖控制是治疗糖尿病神经病变的基础；② 不推荐醛糖还原酶抑制剂、神经生长因子用于治疗糖尿病神经病变；③ α-硫辛酸能改善糖尿病神经病变患者症状；④ 三环类抗抑郁药，抗惊厥药，5-羟色胺和去甲肾上腺素摄取抑制剂可减轻糖尿病神经病变患者疼痛；⑤ B族维生素与复方辣椒碱乳膏可用于治疗糖尿病神经病变。结合患者情况，应用证据治疗3月后，患者血糖水平保持正常，症状缓解。
结论　采用循证治疗的方法，为糖尿病外周神经病变患者制定合理的治疗方案，可有效提高治疗效果。

引用本文： 李俊峰,文重远. 一例糖尿病外周神经病变患者的循证治疗. 中国循证医学杂志, 2009, 09(1): 107-112. doi: 10.7507/1672-2531.20090021 复制

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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一例糖尿病外周神经病变患者的循证治疗

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《中国循证医学杂志》

一例糖尿病外周神经病变患者的循证治疗

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