痛性糖尿病神经病变（PDN）的中西医治疗课件.ppt

Nuisance pain（滋扰疼痛） 类似运动后肌肉酸痛 Distracting pain 类似于痛经 Disabling pain 类似于持续牙痛 Worst possible pain 肾结石疼 * STENO-2 the Relative Risk of the Development or Progression of Nephropathy, Retinopathy, and Autonomic and Peripheral Neuropathy during the Average Follow-up of 7.8 Years in the Intensive-Therapy Group, as Compared with the Conventional-Therapy Group * 依达拉奉(Edaravone)：是 一 种 具有捕获经自由基活性的抗氧化剂，可对抗自由 基与铁离子引起的脂质过氧化活性，抑制血管内皮细胞损 害，减轻组织缺血及损伤，改善神经缺氧，改善微循环尤其改 善神经传导，从而减轻神经功能损害。近来国内有研究显示 依达拉奉对DPN有一定疗效〔”〕，提示自由基参与了DPN的 病理生理过程。 * * 奥力宝?治通过清除自由基、减少自由基生成、再生其他抗氧化剂机制发挥抗氧化应激作用。 1.清除自由基；α-硫辛酸可清除如反应氧簇的OH-、H2O2和反应氮簇的NO-，还原型硫辛酸可清除α-硫辛酸无法清除的自由基，如超氧自由基和ROO-等； 2.螯合金属离子而减少氧自由基生成； 3.再生其它抗氧化剂，如谷胱甘肽、vitC，从而进一步清除更多的自由基。 奥力宝缓解DPN的症状和体征。 症状：疼痛、烧灼痛、感觉异常、麻木（来自于TSS评分），尤其是刺痛、烧灼痛、感觉异常。体征：针刺感、触压感、踝反射（来自下肢的NIS评分） 群多普利(trandalopril) * Benfotiamine高生物利用度的脂溶性维生素B1，，在鼠模型中被证实可以通过磷酸戊糖途径减少AGE 形成，并能增加神经血流量和神经传导速度，通过增加NO生 成尚具有扩张血管作用[CameronN E,G ibsonT M，NangleM R,et a l.Inhibitor sof advance d g lycatione nd productf ormationa ndn eurovasculard ysfun ct ion i ne xperimentald iabetes仁J].A nnN YA cadS ci.2005, 10 43 :7 84-792.l。近来，Haupt E等的一个随机对照 双盲两中心临床试验研究发现应用benfotiamine可以降低搪 尿病多发神经病变的症状评分[4]HauptE ,L edermannH ,K opckeW .B enfotiaminei nt het reatme nt o fd iabeticp olyneuropathy-at hree-weed randomized,co ntro lle d pilots tudy(BEDIP study)[J〕.IntJ C lin Pharmacol Th er ,2 005,43(6):304.l * Targets for Controlling Neuropathic Pain Now there are multiple neurotransmitters and different channels that mediate the electrical activity in the afferent pathways, and many of these are at least a potential target for controlling neuropathic pain. Gamma-aminobutyric acid (GABA) is an inhibitory neurotransmitter, and one would imagine that if one can increase inhibition in the pain pathways, you might reduce pain. Tackling GABA has been a bit disappointing, I must say, but it, at least, is a potential target for neuropathic pain. The sodium channels on the axons can also be blocked, reducing both peripheral and centr