探讨补阳还五汤对糖尿病周围神经病变（DPN）大鼠的止痛作用及机制。【方法】将60只大鼠分为正常组，模型 组（MNCV）和感觉神经传导速度（SNCV），中药低、中、高剂量组，中药高剂量+H-89[蛋白激酶A（PKA）抑制剂]组，每组 10只。除正常组，其他各组大鼠采用高脂高糖饲料饲喂结合腹腔注射链脲佐菌素（STZ）法构建DPN模型。给药结束后，检测 大鼠足热痛阈值，测定大鼠运动神经传导速度（MNCV）和感觉神经传导速度（SNCV），免疫组织化学法观察表皮内神经纤维 密度（IENF），酶联免疫吸附分析（ELISA）检测血清空腹胰岛素（FINS）、总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白胆 固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）、胰岛素抵抗指数（HOMA-IR），白细胞介素（IL）-1β、IL-6、肿瘤坏死因子 α（TNF-α），血管内皮生长因子（VEGF）、血管生成素1（Ang-1）、CD34水平，坐骨神经组织中环磷酸腺苷（cAMP）浓度， Western Blot法检测坐骨神经组织中PKA和反应元件结合蛋白（CREB）表达水平。【结果】与正常组比较，模型组足热痛阈 值，TC、TG、LDL-C、HOMA-IR，IL-1β、IL-6 和TNF-α 水平均显著增加（P＜0.05），HDL-C、FINS，VEGF、Ang-1、 CD34，IENF，MNCV和SNCV值，cAMP浓度水平，PKA和CREB磷酸化水平均显著降低（P＜0.05）；与模型组比较，中药 低、中、高剂量组上述指标均得到显著改善（P＜0.05），且呈剂量依赖性；与中药高剂量+H-89组比较，中药高剂量组各指 标水平均被逆转。【结论】补阳还五汤可改善DPN大鼠胰岛素抵抗、血脂代谢，减轻肢体疼痛，改善局部微循环障碍，保护 神经功能，体现了“活血通络止痛”的治疗特点；补阳还五汤的止痛作用可能与改善局部微循环障碍、抑制炎症因子释放 及调节cAMP/PKA/CREB信号通路蛋白表达有关。

To investigate the analgesic effect and mechanism of Buyang Huanwu Decoction on diabetic peripheral neuropathy（DPN）rats. Methods Sixty rats were divided into normal group， model group， low-， medium- and high- dose groups of Chinese medicine，and high-dose + H-89 [protein kinase A（PKA）inhibitor] group，with 10 rats in each group. Except for the normal group，rats in all other groups were fed with high-fat and high-sugar chow combined with intraperitoneal injection of streptozotocin（STZ）method to construct DPN model. At the end of drug administration，the foot thermal pain threshold of rats was detected，the motor nerve conduction velocity（MNCV）and sensory nerve conduction velocity（SNCV）of rats was measured，the intraepidermal nerve fiber（IENF）in the epidermis was observed by immunohistochemistry，and serum fasting insulin（FINS）， total cholesterol（TC），triglyceride（TG），low-density lipoprotein cholesterol（LDL-C），high-density lipoprotein cholesterol（HDL-C）， insulin resistance index（HOMA-IR）， and the interleukin（IL）-1β， IL-6， tumor necrosis factor α（TNF- α）， vascular endothelial growth factor（VEGF）， angiopoietin 1（Ang- 1）， CD34 levels， cyclic adenosine monophosphate（cAMP） concentration in the sciatic nerve tissues were detected by enzyme-linked immunosorbent assay（ELISA），and Western Blot assay to detect the PKA and the carbohydrate responsive element binding（CREB）in the sciatic nerve tissues. Results Compared with the normal group，foot thermal pain threshold， TC， TG， LDL-C， HOMA-IR， IL-1β， IL-6 and TNF-α levels were significantly increased in the model group（P＜0.05），HDL-C，FINS，VEGF，Ang-1，CD34，IENF，MNCV and SNCV values， cAMP concentration levels， PKA and CREB phosphorylation levels were significantly reduced（P＜ 0.05）. Compared with the model group，the above indexes were significantly improved in the low-，medium- and high- dose groups of Chinese medicine（P＜0.05）in a dose- dependent manner. Compared with the Chinese medicine high-dose + H-89 group， all the indexes were reversed in the Chinese medicine high-dose group. Conclusion Buyang Huanwu Decoction can improve insulin resistance and lipid metabolism，reduce limb pain， improve local microcirculation disorder，and protect nerve function in DPN rats，which reflects the therapeutic characteristics of "activating blood circulation and relieving pain". The pain-relieving effect of Buyang Huanwu Decoction may be related to the improvement of local microcirculation，inhibition of inflammatory factor release and regulation of cAMP/PKA/CREB signaling pathway protein expression

R285.5

武汉市卫生和计划生育委员会资助项目（编号：WZ18D08）