Effects of Mudan granule combined with Mecobalamin on nerve conduction velocity and Nrf2/HO-1 signaling pathways in patients with diabetic peripheral neuropathy

YAN Xue; ZHANG Xiao; CHEN Liang; XU Yan

doi:10.3969/j.issn.1002-3429.2025.22.018

Abstract：Objective To investigate the effects of Mudan granule combined with Mecobalamin on nerve conduction velocity and nuclear factor-E2-related factor 2(Nrf2)/heme oxygenase-1(HO-1)signaling pathways in patients with diabetic peripheral neuropathy(DPN).Methods A total of 180 patients with DPN admitted from May 2023 to May 2024 were selected and divided into the Mecobalamin group(n=90)and the Mecobalamin+Mudan granule combination therapy group(n=90)by the random number table method.The Mecobalamin group was treated with Mecobalamin,while the Mudan granule combination therapy group was treated with Mudan granules combined with Mecobalamin.Both groups were treated continuously for 12 weeks,to observe and compare the clinical efficacy and the occurrence of adverse reactions of the two groups.The motor nerve conduction velocity(MNCV)and sensory nerve conduction velocity(SNCV)of bilateral tibial nerves,serum oxidative stress indicators,blood glucose indicators,blood lipid levels,Toronto clinical scoring system(TCSS),as well as the mRNA expression levels of Nrf2 and HO-1 were compared before and after treatment.Results The total effective rates of the Mecobalamin group was higher than that in the Mudan granule combination therapy group[90.00％(81/90)vs.97.78％(88/90)](P＜0.05).After treatment,the MNCV and SNCV of bilateral tibial nerves in the Mudan granule combination therapy group were both higher than those in the Mecobalamin group(P＜0.05).After treatment,the 8-hydroxydeoxyguanosine,total cholesterol,low-density lipoprotein cholesterol and TCSS score in the Mudan granule combination therapy group were lower than those in the Mecobalamin group,while the total antioxidant capacity and high-density lipoprotein cholesterol level were higher than those in the Mecobalamin group(P＜0.05).After treatment,there were no significant differences in glycated hemoglobin,fasting blood glucose,and 2-hour postprandial blood glucose between the Mecobalamin group and the Mudan granule combination therapy group(P＞0.05).After treatment,the expression levels of Nrf2 and HO-1 mRNA in the Mudan granule combination therapy group were both higher than those in the Mecobalamin group(P＜0.05).There was no significant difference in the total incidence of adverse reactions between the Mecobalamin group and the Mudan granule combination therapy group(P＞0.05).Conclusion Mudan granule combined with Mecobalamin can significantly accelerate nerve conduction velocity and relieve clinical symptoms in DPN patients.The mechanism may be related to up-regulating the mRNA expressions of Nrf2/HO-1 signaling pathways and relieving oxidative stress injury.