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Article(id=1322927676704555509, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322926217711726961, articleNumber=null, orderNo=null, doi=10.13193/j.issn.1673-7717.2025.08.041, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=null, receivedDateStr=null, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793340136934, onlineDateStr=2026-10-30, pubDate=1754755200000, pubDateStr=2025-08-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793340136934, onlineIssueDateStr=2026-10-30, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793340136934, creator=13701087609, updateTime=1793340136934, updator=13701087609, issue=Issue{id=1322926217711726961, tenantId=1146029695717560320, journalId=1255847919539208197, year='2025', volume='43', issue='8', pageStart='1', pageEnd='258', issueExtLink='null', onlineDate='null', pubDate='1754755200000', pubDateStr='2025-08-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1793339789083, creator='13701087609', updateTime=1793340517761, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1322929274071679978, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322926217711726961, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1322929274071679979, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322926217711726961, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=211, endPage=214, ext={EN=ArticleExt(id=1322927676914270710, articleId=1322927676704555509, tenantId=1146029695717560320, journalId=1255847919539208197, language=EN, title=Effect of Huangqi Guizhi Wuwu Decoction（黄芪桂枝五物汤）on MiR-146a and MyD88/IκB Signaling Pathway in Diabetic Peripheral Neuropathy Patients, columnId=1256183365644968140, journalTitle=Chinese Archives of Traditional Chinese Medicine, columnName=Platform of Provincial Project, runingTitle=null, highlight=null, articleAbstract=
Objective

To investigate the effects of Huangqi Guizhi Wuwu Decoction（黄芪桂枝五物汤）on microRNA-146a（miR-146a），myeloid differentiation factor 88（MyD88）/inhibitor of nuclear factor-κB inhibitory protein（IκB）signaling pathway in diabetic peripheral neuropathy（DPN）patients.

Methods

A total of 108 DPN patients were selected and divided into treatment group and control group by random number table method，with 54 cases in each group.The control group was treated with mecobalamine and vitamin B1，and the treatment group was treated with Huangqi Guizhi Wuwu Decoction.The course of treatment in both groups was 3 months.The clinical efficacy of the two groups was evaluated.Traditional Chinese medicine（TCM）syndrome score，sensory nerve conduction velocity（SNCV），motor nerve conduction velocity（MNCV），Toronto Clinical Scoring System（TCSS）score，the levels of miR-146a，MyD88 protein，IκBαprotein and phosphorylated-IκBα（p-IκBα）protein before and after treatment and the occurrence of adverse reactions were compared between the two groups.

Results

The total effective rate of the treatment group was 92.59%（50/54），which was significantly better than 77.78%（42/54）of the control group（P<0.05）.After treatment，the scores of TCM syndrome in both groups were improved compared with those before treatment（P<0.05），and the treatment group was better than the control group（P<0.05）.After treatment，the total knee SNCV，median SNCV，total knee MNCV，median MNCV and TCSS scores of both groups were improved compared with those before treatment（P<0.05），and the treatment group was better than the control group（P<0.05）.After treatment，the levels of miR-146a，MyD88 protein，IκBαprotein and p-IκBαprotein in the treatment group were improved compared with those before treatment（P<0.05），and the treatment group was better than the control group（P<0.05）.There was no difference in the incidence of adverse reactions between the two groups（P>0.05）.

Conclusion

Huangqi Guizhi Wuwu Decoction has good efficacy in DPN.It can effectively reduce clinical symptoms，improve nerve conduction velocity，inhibit the expressions of miR-146a and MyD88/IκB signaling pathway，and has high safety.

, authors=Yuru JIA, Lei LIU, Yueling DING, authorsList=Yuru JIA, Lei LIU, Yueling DING, authorCompany=null, correspAuthors=Yueling DING, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1322927679510544896, articleId=1322927676704555509, tenantId=1146029695717560320, journalId=1255847919539208197, language=CN, title=黄芪桂枝五物汤对糖尿病周围神经病变患者miR-146a、MyD88/IκB信号通路的影响, columnId=1256183369033965799, journalTitle=中华中医药学刊, columnName=省级项目平台, runingTitle=null, highlight=null, articleAbstract=
目的

探讨黄芪桂枝五物汤对糖尿病周围神经病变（Diabetic peripheral neuropathy，DPN）患者微小RNA-146a（Microrna RNA-146a，miR-146a）、髓样分化因子88（Myeloid differentiation factor 88，MyD88）/核转录因子-κB抑制蛋白（Inhibitory subunit of NF kappa B，IκB）信号通路的影响。

方法

选取DPN患者108例，以随机数字表法分为治疗组与对照组，每组54例。对照组给予甲钴胺及维生素B1治疗，治疗组另加用黄芪桂枝五物汤，两组疗程均为3个月。评估两组临床疗效，比较两组治疗前后中医证候积分、感觉神经传导速度（Sensory nerve conduction velocity，SNCV）、运动神经传导速度（Motor nerve conduction velocity，MNCV）、多伦多临床评分系统（Toronto clinical scoring system，TCSS）评分、miR-146a、MyD88蛋白、IκBα蛋白、磷酸化-IκBα（Phosphorylated-IκBα，p-IκBα）蛋白水平及不良反应发生情况。

结果

治疗组总有效率为92.59%（50/54），明显优于对照组的77.78%（42/54）（P<0.05）。治疗后，两组各项中医证候积分较治疗前均有改善（P<0.05），且治疗组优于对照组（P<0.05）。治疗后，两组膝总SNCV、正中SNCV、膝总MNCV、正中MNCV、TCSS评分较治疗前均有改善（P<0.05），且治疗组优于对照组（P<0.05）。治疗后，治疗组miR-146a、MyD88蛋白、IκBα蛋白、p-IκBα蛋白较治疗前均有改善（P<0.05），且治疗组优于对照组（P<0.05）。两组不良反应发生率组间比较差异无统计学意义（P>0.05）。

结论

黄芪桂枝五物汤在DPN中有较好疗效，可有效减轻临床症状并改善神经传导速度，抑制miR-146a及MyD88/IκB信号通路表达，且安全性较高。

, authors=贾于儒, 刘镭, 丁跃玲, authorsList=贾于儒, 刘镭, 丁跃玲, authorCompany=null, correspAuthors=丁跃玲, authorNote=

贾于儒（1985-），男，安徽宿州人，主治医师，硕士，研究方向：《金匮要略》理论与实践。

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丁跃玲（1964-），女，河北定州人，教授，博士，研究方向：《金匮要略》理论。E-mail：。
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贾于儒（1985-），男，安徽宿州人，主治医师，硕士，研究方向：《金匮要略》理论与实践。

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贾于儒（1985-），男，安徽宿州人，主治医师，硕士，研究方向：《金匮要略》理论与实践。

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天然产物研究与开发，2020，32（11）：1844-1851，1865., articleTitle=基于网络药理学与分子对接技术探讨红花治疗视网膜静脉阻塞的作用机制研究, refAbstract=null)], funds=[Fund(id=1322927683566436903, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322927676704555509, awardId=2022079, language=CN, fundingSource=河北省中医药管理局指令性课题(2022079), fundOrder=null, country=null), Fund(id=1322927683633545768, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322927676704555509, awardId=201801, language=CN, fundingSource=河北省中医药管理局重大项目(201801), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1322927679728648705, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322927676704555509, xref=null, ext=[AuthorCompanyExt(id=1322927679737037314, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322927676704555509, companyId=1322927679728648705, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Hebei University of Traditional Chinese Medicine，Shijiazhuang 050200，Hebei，China), AuthorCompanyExt(id=1322927679749620227, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322927676704555509, companyId=1322927679728648705, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=河北中医药大学，河北 石家庄 050200)])], figs=[ArticleFig(id=1322927681146323485, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322927676704555509, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数显效有效无效总有效
治疗组5423（42.59）27（50.00）4（7.41）50（92.59）a
对照组5416（29.63）26（48.15）12（22.22）42（77.78）
), ArticleFig(id=1322927681226015262, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322927676704555509, language=CN, label=表1, caption=

两组糖尿病周围神经病变患者临床疗效比较

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组别例数显效有效无效总有效
治疗组5423（42.59）27（50.00）4（7.41）50（92.59）a
对照组5416（29.63）26（48.15）12（22.22）42（77.78）
), ArticleFig(id=1322927681314095647, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322927676704555509, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数时间手足麻木肢体刺痛气短懒言倦怠乏力肌肤甲错
治疗组54治疗前4.76±1.124.42±1.094.13±1.064.34±1.154.08±1.02
治疗后1.15±0.34ab1.04±0.31ab1.21±0.37ab1.16±0.33ab0.95±0.31ab
对照组54治疗前4.89±1.054.53±1.134.25±1.144.43±1.184.14±1.09
治疗后1.42±0.41b1.39±0.36b1.57±0.44b1.61±0.45b1.32±0.41b
), ArticleFig(id=1322927681406370336, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322927676704555509, language=CN, label=表2, caption=

两组糖尿病周围神经病变患者治疗前后中医证候积分比较（）

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组别例数时间手足麻木肢体刺痛气短懒言倦怠乏力肌肤甲错
治疗组54治疗前4.76±1.124.42±1.094.13±1.064.34±1.154.08±1.02
治疗后1.15±0.34ab1.04±0.31ab1.21±0.37ab1.16±0.33ab0.95±0.31ab
对照组54治疗前4.89±1.054.53±1.134.25±1.144.43±1.184.14±1.09
治疗后1.42±0.41b1.39±0.36b1.57±0.44b1.61±0.45b1.32±0.41b
), ArticleFig(id=1322927683050537505, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322927676704555509, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数时间膝总SNCV/（m/s）正中SNCV/（m/s）膝总MNCV/（m/s）正中MNCV/（m/s）TCSS/（分）
治疗组54治疗前34.53±2.9138.92±3.0640.03±4.2540.65±4.189.58±0.91
治疗后43.26±3.27ab48.06±2.53ab48.24±4.51ab48.17±3.95ab4.13±0.39ab
对照组54治疗前34.41±2.8238.73±3.1539.91±4.4240.46±3.839.68±0.95
治疗后40.81±3.52b42.11±2.87b42.67±5.03b45.05±3.52b7.52±0.63b
), ArticleFig(id=1322927683159589410, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322927676704555509, language=CN, label=表3, caption=

两组糖尿病周围神经病变患者治疗前后神经传导速度及TCSS评分比较（）

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组别例数时间膝总SNCV/（m/s）正中SNCV/（m/s）膝总MNCV/（m/s）正中MNCV/（m/s）TCSS/（分）
治疗组54治疗前34.53±2.9138.92±3.0640.03±4.2540.65±4.189.58±0.91
治疗后43.26±3.27ab48.06±2.53ab48.24±4.51ab48.17±3.95ab4.13±0.39ab
对照组54治疗前34.41±2.8238.73±3.1539.91±4.4240.46±3.839.68±0.95
治疗后40.81±3.52b42.11±2.87b42.67±5.03b45.05±3.52b7.52±0.63b
), ArticleFig(id=1322927683226698275, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322927676704555509, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数时间miR-146aMyD88蛋白/（μg/L）IκBα蛋白/（μg/L）p-IκBα蛋白/（μg/L）
治疗组54治疗前2.48±0.81　2.38±0.59　1.02±0.14　2.65±0.54
治疗后1.13±0.32ab0.96±0.18ab1.79±0.31ab0.96±0.13ab
对照组54治疗前2.54±0.832.43±0.620.98±0.152.73±0.52
治疗后2.35±0.752.31±0.541.04±0.212.64±0.48
), ArticleFig(id=1322927683298001444, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322927676704555509, language=CN, label=表4, caption=

两组糖尿病周围神经病变患者治疗前后miR-146及MyD88/IκB信号通路表达比较（）

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组别例数时间miR-146aMyD88蛋白/（μg/L）IκBα蛋白/（μg/L）p-IκBα蛋白/（μg/L）
治疗组54治疗前2.48±0.81　2.38±0.59　1.02±0.14　2.65±0.54
治疗后1.13±0.32ab0.96±0.18ab1.79±0.31ab0.96±0.13ab
对照组54治疗前2.54±0.832.43±0.620.98±0.152.73±0.52
治疗后2.35±0.752.31±0.541.04±0.212.64±0.48
), ArticleFig(id=1322927683373498917, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322927676704555509, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数食欲不振恶心腹泻皮疹总发生
治疗组543（5.56）2（3.70）2（3.70）0（0.00）7（12.96）
对照组542（3.70）1（1.85）1（1.85）1（1.85）5（9.26）
), ArticleFig(id=1322927683453190694, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322927676704555509, language=CN, label=表5, caption=

两组糖尿病周围神经病变不良反应情况

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组别例数食欲不振恶心腹泻皮疹总发生
治疗组543（5.56）2（3.70）2（3.70）0（0.00）7（12.96）
对照组542（3.70）1（1.85）1（1.85）1（1.85）5（9.26）
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黄芪桂枝五物汤对糖尿病周围神经病变患者miR-146a、MyD88/IκB信号通路的影响
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贾于儒 , 刘镭 , 丁跃玲
中华中医药学刊 | 省级项目平台 2025,43(8): 211-214
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中华中医药学刊 |省级项目平台 2025 , 43 (8) : 211 -214
黄芪桂枝五物汤对糖尿病周围神经病变患者miR-146a、MyD88/IκB信号通路的影响
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贾于儒, 刘镭, 丁跃玲
作者信息
  • 河北中医药大学，河北 石家庄 050200
通讯作者:
丁跃玲（1964-），女，河北定州人，教授，博士，研究方向：《金匮要略》理论。E-mail：。
作者简介:

贾于儒（1985-），男，安徽宿州人，主治医师，硕士，研究方向：《金匮要略》理论与实践。

Effect of Huangqi Guizhi Wuwu Decoction（黄芪桂枝五物汤）on MiR-146a and MyD88/IκB Signaling Pathway in Diabetic Peripheral Neuropathy Patients
Yuru JIA, Lei LIU, Yueling DING
Affiliations
  • Hebei University of Traditional Chinese Medicine，Shijiazhuang 050200，Hebei，China
出版时间: 2025-08-10 doi: 10.13193/j.issn.1673-7717.2025.08.041
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摘要
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目的

探讨黄芪桂枝五物汤对糖尿病周围神经病变（Diabetic peripheral neuropathy，DPN）患者微小RNA-146a（Microrna RNA-146a，miR-146a）、髓样分化因子88（Myeloid differentiation factor 88，MyD88）/核转录因子-κB抑制蛋白（Inhibitory subunit of NF kappa B，IκB）信号通路的影响。

方法

选取DPN患者108例，以随机数字表法分为治疗组与对照组，每组54例。对照组给予甲钴胺及维生素B1治疗，治疗组另加用黄芪桂枝五物汤，两组疗程均为3个月。评估两组临床疗效，比较两组治疗前后中医证候积分、感觉神经传导速度（Sensory nerve conduction velocity，SNCV）、运动神经传导速度（Motor nerve conduction velocity，MNCV）、多伦多临床评分系统（Toronto clinical scoring system，TCSS）评分、miR-146a、MyD88蛋白、IκBα蛋白、磷酸化-IκBα（Phosphorylated-IκBα，p-IκBα）蛋白水平及不良反应发生情况。

结果

治疗组总有效率为92.59%（50/54），明显优于对照组的77.78%（42/54）（P<0.05）。治疗后，两组各项中医证候积分较治疗前均有改善（P<0.05），且治疗组优于对照组（P<0.05）。治疗后，两组膝总SNCV、正中SNCV、膝总MNCV、正中MNCV、TCSS评分较治疗前均有改善（P<0.05），且治疗组优于对照组（P<0.05）。治疗后，治疗组miR-146a、MyD88蛋白、IκBα蛋白、p-IκBα蛋白较治疗前均有改善（P<0.05），且治疗组优于对照组（P<0.05）。两组不良反应发生率组间比较差异无统计学意义（P>0.05）。

结论

黄芪桂枝五物汤在DPN中有较好疗效，可有效减轻临床症状并改善神经传导速度，抑制miR-146a及MyD88/IκB信号通路表达，且安全性较高。

糖尿病周围神经病变  /  黄芪桂枝五物汤  /  髓样分化因子88  /  核转录因子-κB抑制蛋白
Objective

To investigate the effects of Huangqi Guizhi Wuwu Decoction（黄芪桂枝五物汤）on microRNA-146a（miR-146a），myeloid differentiation factor 88（MyD88）/inhibitor of nuclear factor-κB inhibitory protein（IκB）signaling pathway in diabetic peripheral neuropathy（DPN）patients.

Methods

A total of 108 DPN patients were selected and divided into treatment group and control group by random number table method，with 54 cases in each group.The control group was treated with mecobalamine and vitamin B1，and the treatment group was treated with Huangqi Guizhi Wuwu Decoction.The course of treatment in both groups was 3 months.The clinical efficacy of the two groups was evaluated.Traditional Chinese medicine（TCM）syndrome score，sensory nerve conduction velocity（SNCV），motor nerve conduction velocity（MNCV），Toronto Clinical Scoring System（TCSS）score，the levels of miR-146a，MyD88 protein，IκBαprotein and phosphorylated-IκBα（p-IκBα）protein before and after treatment and the occurrence of adverse reactions were compared between the two groups.

Results

The total effective rate of the treatment group was 92.59%（50/54），which was significantly better than 77.78%（42/54）of the control group（P<0.05）.After treatment，the scores of TCM syndrome in both groups were improved compared with those before treatment（P<0.05），and the treatment group was better than the control group（P<0.05）.After treatment，the total knee SNCV，median SNCV，total knee MNCV，median MNCV and TCSS scores of both groups were improved compared with those before treatment（P<0.05），and the treatment group was better than the control group（P<0.05）.After treatment，the levels of miR-146a，MyD88 protein，IκBαprotein and p-IκBαprotein in the treatment group were improved compared with those before treatment（P<0.05），and the treatment group was better than the control group（P<0.05）.There was no difference in the incidence of adverse reactions between the two groups（P>0.05）.

Conclusion

Huangqi Guizhi Wuwu Decoction has good efficacy in DPN.It can effectively reduce clinical symptoms，improve nerve conduction velocity，inhibit the expressions of miR-146a and MyD88/IκB signaling pathway，and has high safety.

diabetic peripheral neuropathy  /  Huangqi Guizhi Wuwu Decoction（黄芪桂枝五物汤）  /  myeloid differentiation factor 88  /  inhibitor of nuclear factor-κB
贾于儒, 刘镭, 丁跃玲. 黄芪桂枝五物汤对糖尿病周围神经病变患者miR-146a、MyD88/IκB信号通路的影响. 中华中医药学刊, 2025 , 43 (8) : 211 -214 . DOI: 10.13193/j.issn.1673-7717.2025.08.041
Yuru JIA, Lei LIU, Yueling DING. Effect of Huangqi Guizhi Wuwu Decoction（黄芪桂枝五物汤）on MiR-146a and MyD88/IκB Signaling Pathway in Diabetic Peripheral Neuropathy Patients[J]. Chinese Archives of Traditional Chinese Medicine, 2025 , 43 (8) : 211 -214 . DOI: 10.13193/j.issn.1673-7717.2025.08.041
正文
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糖尿病是一组以持续性高血糖为特征的代谢疾病群，在我国成年人群中患病率为11.2%，居世界首位[1]。长期高血糖会对多个系统或器官造成损害，导致各种并发症发生，如糖尿病周围神经病变（Diabetic peripheral neuropathy，DPN），DPN患者常见肢体麻木、疼痛等症状[2]。临床对此病的主要治疗包括改善代谢、针对神经病变发生机制及对症治疗，如神经修复药物甲钴胺的使用[3-4]。但西医药物治疗易发生不良反应，可能导致患者生活质量及依从性下降。中医在多种疾病中均有确切疗效，且不良反应较少。此病在中医中通常以活血化瘀、益气通络类中药汤剂治疗[5]。黄芪桂枝五物汤为温里剂，有益气温经、和血通痹等效，临床常用于治疗关节炎、末梢神经炎等症见肢体麻木疼痛者[6-7]。髓样分化因子88（Myeloid differentiation factor 88，MyD88）/核转录因子-κB抑制蛋白（Inhibitory subunit of NF kappa B，IκB）信号通路是炎症反应中的重要途径，其与炎症发生具有密切关系[8]。而研究报道，DPN患者体内炎症水平高于正常水平[9-10]。本次研究对DPN患者应用黄芪桂枝五物汤治疗，观察其对微小RNA-146a（Microrna RNA-146a，miR-146a）及MyD88/IκB信号通路的影响，为临床治疗提供帮助。
1　临床资料
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1.1　一般资料
选取2021年6月—2023年6月我院收治的DPN患者108例，以随机数字表法分为治疗组与对照组，每组54例。治疗组男33例，女22例；年龄36～64岁，平均（50.07±8.14）岁；病程1～8年，平均（4.47±1.32）年。对照组男35例，女19例；年龄35～65岁，平均（50.18±8.23）岁；病程1～8年，平均（4.52±1.35）年。两组一般资料比较差异无统计学意义（P>0.05）。研究开始前经医院医学伦理委员会批准。
1.2　诊断标准
①西医标准：参照文献[11-12]确诊DPN。②中医标准：参照《糖尿病周围神经病变中医临床诊疗指南（2016年版）》[13]，主症：手足麻木、肢体刺痛，次症：气短懒言、倦怠乏力、肌肤甲错等，舌脉：舌质黯有瘀斑，苔薄或花剥，脉细数。
1.3　纳入标准
①符合以上诊断标准；②年龄≥18岁；③患者对研究知情且同意。
1.4　排除标准
①合并恶性肿瘤；②合并感染、炎症；③合并精神疾病；④心、肝等器官功能不全；⑤其他原因所致周围神经病变；⑥对研究中药物严重过敏。
1.5　治疗方法
对照组给予甲钴胺片［卫材（中国）药业有限公司，国药准字H20143107，规格0.5 mg］0.5 mg/次+维生素B1片（海南赛立克药业有限公司，国药准字H46020448，规格10 mg）10 mg/次，3次/d。在此基础上，治疗组给予黄芪桂枝五物汤，方组：黄芪40 g，桂枝15 g，鸡血藤15 g，白芍15 g，红花10 g，牛膝10 g，乳香10 g，生姜10 g，甘草6 g，大枣3枚。取1200 mL水煎制药汁400 mL，分3次温服。两组均治疗3个月。
1.6　观察指标
①中医证候积分[14]：治疗前后，将手足麻木、肢体刺痛、气短懒言、倦怠乏力、肌肤甲错按无、轻度、中度、重度分别赋予0、2、4、6分，记录各项中医证候积分。②神经传导速度及多伦多临床评分系统（Toronto clinical scoring system，TCSS）评分[15]：治疗前后，使用肌电诱发电位仪（日本光电工业株式会社，型号MEB-2306C）检测膝总神经及正中神经感觉神经传导速度（Sensory nerve conduction velocity，SNCV）、运动神经传导速度（Motor nerve conduction velocity，MNCV）。③miR-146a及MyD88/IκB信号通路表达：治疗前后，以实时荧光定量法检测miR-146a，相对表达以2-△△CT表示；以双抗体夹心法检测MyD88蛋白、IκBα蛋白、磷酸化-IκBα（Phosphorylated-IκBα，p-IκBα）蛋白水平。④记录两组治疗期间不良反应发生情况。
1.7　疗效标准[16]
显效：症状显著减轻，神经传导速度提快≥5 m/s；有效：症状有一定减轻，神经传导速度提快<5 m/s；无效：症状及神经传导速度无变化。总有效＝（显效+有效）/总例数×100%。
1.8　统计学方法
采用SPSS 22.0统计软件进行数据分析，计量资料以表示，组间比较采用t检验，组内比较采用配对t检验；计数资料以［例（%）］表示，采用χ2检验；P<0.05为差异有统计学意义。
2　结果
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2.1　临床疗效比较
治疗组总有效率为92.59%，明显优于对照组的77.78%（χ2＝4.696，P<0.05）。见表1。
2.2　中医证候积分比较
治疗前，两组间各项中医证候积分比较差异无统计学意义（P>0.05）；治疗后，两组各项中医证候积分较治疗前均有改善（P<0.05），且治疗组优于对照组（P<0.05）。见表2。
2.3　神经传导速度及TCSS评分比较
治疗前，两组间膝总SNCV、正中SNCV、膝总MNCV、正中MNCV、TCSS评分比较差异无统计学意义（P>0.05）；治疗后，两组膝总SNCV、正中SNCV、膝总MNCV、正中MNCV、TCSS评分较治疗前均有改善（P<0.05），且治疗组优于对照组（P<0.05）。见表3。
2.4　miR-146a及MyD88/IκB信号通路表达比较
治疗前，两组间miR-146a、MyD88蛋白、IκBα蛋白、p-IκBα蛋白比较差异无统计学意义（P>0.05）；治疗后，治疗组miR-146a、MyD88蛋白、IκBα蛋白、p-IκBα蛋白较治疗前均有改善（P<0.05），且治疗组优于对照组（P<0.05）。见表4。
2.5　不良反应情况
治疗组不良反应发生率为12.96%，对照组不良反应发生率为9.26%，组间比较差异无统计学意义（χ2＝0.375，P>0.05）。见表5。
3　讨论
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DPN的发病机制复杂，是多种因素共同作用的结果，目前研究显示其可能与代谢紊乱、微血管病变、氧化应激、神经炎症等有关[17-18]。临床根据其发病机制进行治疗，如抗氧化应激、改善微循环、改善代谢紊乱等治疗方法。在中医理论中，糖尿病属“消渴”范畴，而DPN虽无确切记载的病名，但根据其临床表现可归入“痹证”“麻木”等范畴，认为其属本虚标实之证，因消渴病日久损及肝肾，耗伤气阴，气血亏虚，久病入络，血行瘀滞致脉络痹阻，不通则肌肤失荣，而出现肢体麻木、疼痛等症状[19-20]。
本次研究结果显示，治疗组总有效率明显优于对照组，治疗后，治疗组各项中医证候积分改善程度优于对照组，提示黄芪桂枝五物汤在DPN中有较好疗效，可显著减轻患者症状。黄芪桂枝五物汤中含有多种中药材，其中黄芪归脾、肺经，有补气升阳、益卫固表、生津养血等功效[21]；桂枝有发汗解肌、温经通脉、助阳化气等功效，与黄芪配伍，益气温阳，和血通经；鸡血藤活血补血、调经止痛、舒筋活络，可缓解肢体麻木等症状[22]；白芍养血调经、平肝止痛；红花活血通经、散瘀止痛；牛膝可逐瘀通经、引血下行[23]；乳香入心、肝、脾经，能活血止痛、通经；生姜味辛，有温中止痛、疏散风邪之效；大枣甘温，养血益气、补益脾胃。方中多味药材共奏益气温经、活血通络等效，可有效减轻DPN肢体麻木、疼痛等症状[24]。
另外，本次研究结果显示，治疗后，治疗组神经传导速度及TCSS评分改善程度显著优于对照组，治疗组miR-146a、MyD88蛋白、p-IκBα蛋白水平高于对照组，IκBα蛋白水平低于对照组，提示黄芪桂枝五物汤可有效改善神经功能、抑制炎症表达。长期高血糖状态会导致机体氧化应激及炎症水平处于较高水平，并对血管造成损伤，导致血液循环受阻，此外，糖基化终末产物在神经内膜滋养血管中的长期沉积，使得血管管腔狭窄甚至闭塞，导致神经血供不足，发生病变，因此，DPN患者凝血功能存在异常[25-26]。现代药理学研究显示，黄芪能够抑制血小板聚集、降低全血黏度、改善血流动力学[27]。桂枝中的桂皮油、桂皮醛等有效成分能促进血管扩张，改善血液循环。鸡血藤中的有效成分具有抗血小板聚集、调节血脂、抗炎、抗氧化等药理活性[28]。白芍中的白芍总苷有免疫调节、抗炎、神经保护等作用[29]；梅寒颖等[30]的动物实验显示，白芍总苷可能通过调节Toll样受体4/MyD88/NF-κB信号通路活性，从而减少炎症因子，发挥抗炎作用。裴超等[31]研究报道，红花中有效成分可作用于核转录因子-κB等信号通路发挥炎症抑制作用。方中药材通过改善血液循环、减轻氧化应激、抗炎等药理作用，使周围神经血供恢复正常，改善神经功能，抑制炎症。最后，结果显示两组不良反应相当，提示黄芪桂枝五物汤具有较高安全性。
综上所述，黄芪桂枝五物汤在DPN中有较好疗效，可有效减轻临床症状并改善神经功能，抑制miR-146a及MyD88/IκB信号通路表达，且安全性较高。
基金
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  • 河北省中医药管理局指令性课题(2022079)
  • 河北省中医药管理局重大项目(201801)
文献
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2025年第43卷第8期
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doi: 10.13193/j.issn.1673-7717.2025.08.041
  • 首发时间：2026-10-30
  • 出版时间：2025-08-10
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基金
河北省中医药管理局指令性课题(2022079)
河北省中医药管理局重大项目(201801)
作者信息
    河北中医药大学，河北 石家庄 050200

通讯作者:

丁跃玲（1964-），女，河北定州人，教授，博士，研究方向：《金匮要略》理论。E-mail：。
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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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