The Clinical Effect Of α-lipoic Acid Combined With Epalrestat On The Type 2 Diabetic Patients With Painful Neuropathy

Objective To observe the clinical effect of α-lipoic acid combined with epalrestat on the Type 2 Diabetic Patients with Painful Neuropathy(PDN).Methods A analysis of the clinical data of 294 type 2 diabetic patients with painful neuropathy treated in our hospital during the period from January 2011 to January 2015.All of the patients were assigned into α-lipoic acid group(Group A),epalrestat(Group B)and combined group(Group C)with 98 cases in each group respectively treated with α-lipoic acid(0.6g/d,ivgtt 2weeks,per os 2 weeks),epalrestat(50mg/time,3 times/d)and combination therapy for 4 weeks.The abnormal foot plantar pressure,MNSI symptom questionnaire and foot examination score,MCV and SCV of median nerve and common peroneal nerve,SF-36 survival quality score and total effective rate of three groups were compared.Results(1)comparison of clinical data between three groups of diabetes: Data on age,Type 2 Diabetes Mellitus(T2DM)gender,Diabetic Painful Neuropathy(PDN)course,Body mass index(BMI),Glycosylated hemoglobin(Hb A1c),Fasting Blood Glucose(FPG),2-hour Post-meal Blood Glucose(2h PG),Total cholesterol(TC),Triglyceride(TG),High Density Lipoprotein Cholesterol(HDL-C),Low density lipoprotein cholesterol(LDL-C),Blood Urea Nitrogen(BUN),Uric Acid(UA),Urinary Albumin to Creatinine Ratio(UACR)had no statistical significant difference among three groups(P>0.05).(2)Three groups before and after treatment foot pressure feel abnormal points and MNSI score comparison:(1)Before the treatment,the foot pressure abnormal points of the three groups respectively are: 13.52±2.3、13.48±2.10、14.03±2.20.Thus,the foot pressure abnormal points of the three groups had no statistical difference(P > 0.05);After the treatment,the foot pressure abnormal points of the three groups are: 8.01±1.24、8.13±1.23、5.61±0.75.So,the foot pressure abnormal points decreased,and the its data of C group was obviously lower than that of group A and group B,the difference was statistically significant(P< 0.01).(2)Before the treatment,the questionnaire score of the three groups of patients with symptoms of MNSI respectively are as follows: 10.97±1.13、11.14±1.13、11.03±1.14,foot examination score: 5.33±1.02、5.53±1.01、5.24±0.99.Their questionnaire scores and foot examination score had no statistical difference(P> 0.05);After the treatment,their questionnaire scores changed to: 7.01±0.71、6.84±0.68、5.66±0.55,and foot examination score changed to: 4.13±0.77、4.07±0.78、2.35±0.66.As a result,the questionnaire scores and foot examination score were both significantly reduced,and the reduction was more obvious in Group C.Also,the difference was statistically significant(P < 0.01).However,in group A and group B,there is no statistical significant difference(P value> 0.05).(3)Three groups of emg indexes before and after treatment comparison: Before treatment,three groups of median nerve MCV conduction velocity respectively are: 40.23±1.69、40.47±1.66、40.55±1.67,the median nerve SCV conduction velocity respectively as follows: 40.12±1.57、40.16±1.55、39.87±1.53,sural total nerve MCV conduction velocity respectively are: 36.01±1.34、35.89±1.32、35.78±1.33,sural total nerve SCV conduction velocity respectively are: 40.07±1.56、40.19±1.57、40.13±1.55,three groups of median nerve and sural nerve MCV and SCV transmission speed is always no statistical difference(P>0.05);After treatment,three groups of median nerve MCV conduction velocity respectively are: 44.98±1.93、45.13±1.93、51.37±1.92,the median nerve SCV conduction velocity respectively are: 44.63±1.91、44.99±1.93、48.89±2.01,sural total nerve MCV conduction velocity respectively as follows: 44.73±1.90、45.01±1.89、49.57±1.88,sural total nerve SCV conduction velocity respectively are: 48.02±2.03、48.21±2.01、51.42±2.13,the three groups of median nerve and sural total nerve MCV and SCV conduction velocity was increased,the group C and median nerve and sural total nerve MCV and SCV conduction velocity were higher than in group A and group B,the difference was statistically significant(P< 0.01).(4)Comparison of three groups of quality of life scores before and after treatment: before treatment,the quality of life score of the three groups for reproductive health respectively are:77.26±3.32、77.31±3.33、77.39±3.31,Physiological function score respectively are: 42.01±5.33、42.14±5.31、41.88±5.32,Body pain score respectively are:46.33±4.49、46.84±4.55、46.21±4.57,For dynamic state score respectively are:64.03±2.31、63.70±2.30、63.91±2.33,Social function score respectively are: 47.17±5.47、47.23±5.51、47.01±5.54,Emotional reasons score respectively are: 47.83±5.95、47.72±5.91、47.62±6.01,Mental health score respectively are: 67.07±3.21、67.14±3.17、66.88±3.22,Overall health score respectively are:36.98±2.10、37.03±2.08、37.09±2.01,three sets of quality of life score no statistical difference(P> 0.05);After treatment,three groups of quality of life score for reproductive health respectively are: 88.55±3.56、89.03±3.61、89.24±3.87,Physiological function score respectively are: 53.47±5.41、54.01±5.47、65.33±5.51,Body pain score respectively are69.54±4.97、70.74±4.93、82.01±5.01,For dynamic state score respectively are:77.92±2.58、77.79±2.54、78.33±2.61,Social function score respectively are: 59.87±5.79、60.14±5.81、60.05±5.82,Emotional reasons score respectively are: 60.13±6.01、58.96±5.93、59.09±6.03,Mental health score respectively are: 81.55±4.12、81.09±4.03、81.47±4.01,Overall health score respectively are: 47.02±2.49、46.63±2.51、46.98±2.53,the three groups of eight dimensions of quality of life score were higher compared with the previous,and the group C rise more group A and group B.The top four dimensions of group C compared with group A and group B after treatment effect is better,the difference was statistically significant(P < 0.01),after the four dimensions of three groups after treatment no statistical difference(P > 0.05).(5)Comparison of three groups of clinical curative effect: Total effective rate is respectively: 77.55%、79.59%、91.34%.There was no statistical significant difference between Group A and Group B(P value> 0.05).The total effective rate of group C was higher than that of group A and group B,and the difference was statistically significant(P value< 0.01).Conclusions According to the observation,α-lipoic acid and Epalrestat both work effectively during the PDN treatment on patients.Also,compared with single-drug treatment,a combination therapy is more efficient and is associated with the improvement of patients’ clinical symptoms、the nerve conduction velocity and their quality of life.