甲钴胺联合叶酸治疗糖尿病周围神经病变合并高同型半胱氨酸血症的临床观察  

Clinical Observation of Mecobalamin Combined with Folic Acid in the Treatment of Diabetic Peripheral Neuropathy with Hyperhomocysteinemia

作　　者：闫洪领[1] 张爱华[2] 李慧琼[2] 陈雄兵[2] 朱圣群[2] 陈接强[2] 孙莉萍[2] 

机构地区：[1]青岛市市立医院内分泌科,山东青岛266000 [2]三峡大学第三临床医学院/葛洲坝中心医院内分泌科,湖北宜昌443001

出　　处：《中国药房》2015年第36期5087-5089,共3页China Pharmacy

摘　　要：目的:观察甲钴胺联合叶酸治疗糖尿病周围神经病变(DPN)合并高同型半胱氨酸(Hcy)血症的疗效和安全性。方法:回顾性分析40例DPN合并高Hcy血症患者资料,并作为高Hcy组,同期选择30例DPN但Hcy正常者为正常Hcy组。正常Hcy组患者给予控制饮食、降糖药或胰岛素控制血糖等常规治疗,使空腹血糖<7.0 mmol/L,餐后2 h血糖<11.0 mmol/L;在此基础上,高Hcy组患者给予甲钴胺注射液500μg,肌内注射,每日1次+叶酸片5 mg,口服,每日1次。两组患者均以14 d为1个疗程,连续治疗2个疗程。观察高Hcy组患者的临床疗效,治疗前后Hcy水平、胫神经、腓神经的运动神经传导速度(MNCV)和自主神经传导速度(SNCV)、症状总评分(TSS),并与正常Hcy组进行比较,记录高Hcy组患者不良反应发生情况。结果:治疗后,高Hcy组患者总有效率为75.0%;高Hcy组患者Hcy、TSS评分均显著低于同组治疗前,但高于正常Hcy组,胫神经、腓神经的MNCV和SNCV均显著高于同组治疗前,但低于正常Hcy组,差异均有统计学意义(P<0.05);高Hcy组患者不良反应发生率为5.0%。结论:在常规治疗的基础上,甲钴胺联合叶酸治疗DPN合并高Hcy血症的疗效较好,可明显降低Hcy水平,改善神经传导速度,且安全性较好。OBJECTIVE：To observe the efficacy and safety of mecobalamin combined with folic acid in the treatment of dia-betic peripheral neuropathy（DPN）with hyperhomocysteinemia. METHODS：Data of 40 DPN patients with high hyperhomocystein-emia were enrolled into high Hcy group and 30 DPN patients with normal Hcy were enrolled into normal Hcy group. Normal Hcy group was given diet control,hypoglycemic drugs or insulin for controlling glucose and other conventional treatment to make the fasting plasma glucose was lower than 7.0 mmol/L and 2 h postprandial glucose lower than 11.0 mmol/L;based on it,high Hcy group was given Mecobalamin injection 500 μg by intramuscular injection,once a day＋Folic acid tablet 5 mg,once a day. 14 d was a treatment course and it lasted 2 courses. Clinical efficacy,Hcy level,the motor nerve conduction velocity（MNCV）and sen-sory nerve conduction velocity （SNCV） of tibial and peroneal nerve and total symptom scale （TSS） score before and after treat-ment in high Hcy group were observed and compared with normal Hcy group,and the incidence of adverse reactions in high Hcy group was recorded. RESULTS：After treatment,the total effective rate in high Hcy group was 75.0%;Hcy and TSS score in high Hcy group were significantly lower than before and higher than normal Hcy group,MNCV and SNCV of tibial and peroneal nerve were significantly higher than before and lower than normal Hcy group,the differences were statistically significant（P〈0.05）. Th incidence of adverse reactions of high Hcy group was 5.0%. CONCLUSIONS：Based on the conventional treatment,Mecobalamin combined with folic acid has good efficacy in the treatmen of DPN with hyperhomocysteinemia,it can significantly reduce plasma Hcy levels and improve nerve conduction velocity in patients with DPN,with good safety.

关 键 词：甲钴胺 叶酸 糖尿病周围神经病变 同型半胱氨酸 疗效 安全性 

分 类 号：R587[医药卫生—内分泌]