【摘要】：目的:探討依帕司他聯(lián)合甲鈷胺治療老年2型糖尿病周圍神經(jīng)病變(DPN)的療效。方法:選取2015年4月至2016年4月在新疆醫(yī)科大學(xué)第二附屬醫(yī)院住院及門診就診的老年2型糖尿病伴DPN患者158例為研究對象,采用隨機數(shù)字法將其分為聯(lián)合治療組(80例)和甲鈷胺組(78例)。治療前兩組患者均有效控制血糖、血壓等,其中甲鈷胺組單獨給予甲鈷胺治療,每次0.5mg,每日3次,飯前口服,聯(lián)合治療組在甲鈷胺組基礎(chǔ)上聯(lián)合依帕司他治療,每次50mg,每日3次,飯前口服,兩組患者均治療3個月。比較兩組患者治療前后神經(jīng)病變主覺癥狀問卷評分(T SS)、右側(cè)正中神經(jīng)、腓總神經(jīng)感覺神經(jīng)傳導(dǎo)速度及運動神經(jīng)傳導(dǎo)速度、血清同型半胱氨酸(Hcy)的水平,比較兩組患者的不良反應(yīng)發(fā)生情況。結(jié)果:治療后兩組患者的TSS均降低,差異有統(tǒng)學(xué)意義(P0.05),且聯(lián)合治療組的TSS較甲鈷胺組更低[(0.9±0.3)分比(1.4±0.5)分](P0.05);治療后,兩組患者的腓總神經(jīng)及正中神經(jīng)(運動支及感覺支)的傳導(dǎo)速度明顯增快,與治療前相比差異有統(tǒng)計學(xué)意義(P0.05),且聯(lián)合治療組患者腓總神經(jīng)及正中神經(jīng)(運動支及感覺支)的傳導(dǎo)速度較甲鈷胺組更快[腓總神經(jīng)(47.2±0.9)m/s比(39.9±1.2)m/s,(44.2±1.5)m/s比(34.8±0.9)m/s;正中神經(jīng)(51.3±1.0)m/s比(45.0±0.9)m/s,(45.0±1.9)m/s比(39.5±1.0)m/s](P0.05);治療后聯(lián)合治療組患者的Hcy水平降低,與治療前相比差異有統(tǒng)計學(xué)意義(P0.05),且聯(lián)合治療組患者Hcy水平較甲鈷胺組更低[(20.9±8.6)μmol/l比(28.0±11.6)μmol/l](P0.05)。治療過程中聯(lián)合治療組患者有2例發(fā)生惡心、嘔吐,未停藥,2天后上述癥狀緩解;甲鈷胺組未發(fā)生不良反應(yīng)。結(jié)論:依帕司他聯(lián)合甲鈷胺治療老年2型DPN有助于改善患者周圍神經(jīng)癥狀、體征及神經(jīng)傳導(dǎo)速度,提高機體抗氧化應(yīng)激能力,降低血漿Hcy水平,且無明顯不良反應(yīng)。
[Abstract]:Objective: to evaluate the efficacy of epalrestat combined with mecobalamin in the treatment of senile type 2 diabetic peripheral neuropathy (DPN). Methods: from April 2015 to April 2016, 158 elderly patients with type 2 diabetes mellitus (T2DM) with DPN were selected from the second affiliated Hospital of Xinjiang Medical University. They were randomly divided into two groups: the combined treatment group (n = 80) and mecobalamin group (n = 78). Before treatment, the two groups were all effective in controlling blood glucose and blood pressure. Mecobalamin group was given megalobalamin alone, 0.5 mg per day, 3 times a day, orally before meals. The combined treatment group combined with epalcitrate on the basis of mecobalamin group, 50 mg per time. The patients in both groups were treated for 3 months. The (T SS), right median nerve, common peroneal nerve sensory nerve conduction velocity, motor nerve conduction velocity and serum homocysteine (Hcy) were compared between the two groups before and after treatment. Adverse reactions were compared between the two groups. Results: the TSS of the two groups decreased after treatment (P0.05), and the TSS of the combined treatment group was lower than that of the mecobalamin group [(0.9 鹵0.3) score vs (1.4 鹵0.5) score] (P0.05). After treatment, the conduction velocity of the common peroneal nerve and the median nerve (motor branch and sensory branch) of the two groups increased obviously, and the difference was statistically significant compared with that before treatment (P0.05). The conduction velocity of common peroneal nerve and median nerve (motor branch and sensory branch) in combined treatment group was faster than that in mecobalamin group [common peroneal nerve (47.2 鹵0.9) m / s vs (39.9 鹵1.2) m / s]. The ratio of (44.2 鹵1.5) m / s to (34.8 鹵0.9) m / s; Median nerve (51.3 鹵1.0) m / s vs (45.0 鹵0.9) m / s, (45.0 鹵1.9) m / s ratio (39.5 鹵1.0) m / s] (P0.05); After treatment, the level of Hcy in the combined treatment group was significantly lower than that before treatment (P0.05). The level of Hcy in the combined treatment group was lower than that in the mecobalamin group [(20.9 鹵8.6) 渭 mol/l vs (28.0 鹵11.6) 渭 mol/l] (P0.05). During the course of treatment, two patients in the combined treatment group developed nausea, vomiting and no withdrawal of the drug, and the symptoms were relieved 2 days later, while no adverse reactions occurred in the mecobalamin group. Conclusion: the treatment of elderly type 2 DPN with epalrestat and megalobalamin can improve the peripheral nerve symptoms, signs and nerve conduction velocity, increase the ability of antioxidant stress and decrease the level of plasma Hcy without obvious adverse reactions.
【學(xué)位授予單位】：新疆醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R587.2

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