探討二甲雙胍對糖尿病患者血清維生素B12及周圍神經(jīng)病變的影響
發(fā)布時間：2019-07-06 18:53
【摘要】：【目的】探討二甲雙胍對血清維生素B12水平及糖尿病周圍神經(jīng)(DPN)的影響,分析維生素B12相關(guān)因素及DPN危險因素,從而為臨床預(yù)防或診治由二甲雙胍引起維生素B12下降進而導(dǎo)致或加重DPN的發(fā)生發(fā)展提供一定的臨床依據(jù)�！痉椒ā繉ο筮x擇2013年7月至2014年11月延安大學(xué)附屬醫(yī)院內(nèi)分泌科門診及住院的2型糖尿病患者120例,其中男50例,女70例;年齡最小的27歲,最大的73歲,糖尿病病程最短1月,最長14年。糖尿病的診斷滿足下述3個診斷標(biāo)準(zhǔn)任意一個并需重復(fù)確認(rèn)一次。即①糖尿病癥狀+隨機血糖水平≥11.1mmol/L,或②空腹血糖(FBP)水平≥7.0 mmol/L,或③OGTT2小時血糖水平≥11.1mmol/L。根據(jù)二甲雙胍應(yīng)用情況分為2組:二甲雙胍組(近期二甲雙胍應(yīng)用史至少6個月)及非二甲雙胍組(近6個月未使用二甲雙胍),根據(jù)DPN診斷標(biāo)準(zhǔn)將二甲雙胍組分為DPN、NDPN,非二甲雙胍組分為DPN、NDPN。詳細(xì)詢問并記錄所有入選患者姓名、年齡、性別、糖尿病病史、二甲雙胍及其他藥物使用史,有無惡性貧血、腸道手術(shù)、頸椎、腰椎病變等其他疾病史;平時飲食習(xí)慣;是否伴有DPN癥狀,如肢端感覺異常、麻木、疼痛等,及記錄DPN病史。所有入選對象臨床資料的采集都在清晨空腹?fàn)顟B(tài)下準(zhǔn)確測量,并記錄身高、血壓、體重,計算體重指數(shù)BMI(體重(kg)/身高2(kg/m2),抽取患者靜脈血查貧血相關(guān)測定包括葉酸、維生素B12、鐵蛋白,血常規(guī)包括血紅蛋白(HGB)、平均紅細(xì)胞體積(MCV),腎功包括血尿素氮(Urea)、肌酐(Cre),血脂包括甘油三酯(TG)、高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-C)、總膽固醇(TC),以及同型半胱氨酸(Hcy)和糖化血紅蛋白(Hb AIc)。使用SPSS17.0統(tǒng)計分析軟件對試驗數(shù)據(jù)進行統(tǒng)計學(xué)處理,計量資料采用.x±s表示,兩樣本計量資料采用t檢驗,計數(shù)資料采用卡方檢驗(x2),對計量資料采用線性相關(guān)分析,分類變量采用Logistic回歸分析。P0.05,差異有統(tǒng)計學(xué)意義�！窘Y(jié)果】1、二甲雙胍組血清維生素B12及HGB水平均低于非二甲雙胍組,兩者比較差異有統(tǒng)計學(xué)意義。2、二甲雙胍組血清Hcy水平及DPN患病率均高于非二甲雙胍組,差異有統(tǒng)計學(xué)意義。3、各受試組在年齡、性別、血壓、體重指數(shù)等資料之間差異均無統(tǒng)計學(xué)意義。4、葉酸、鐵蛋白與維生素B12水平呈直線正相關(guān),糖尿病病程、Hcy與維生素B12呈直線負(fù)相關(guān)。5、糖尿病病程、Hb AIc、Hcy、維生素Bl2是DPN發(fā)生的危險因素�！窘Y(jié)論】1、長期服用二甲雙胍可能是糖尿病患者出現(xiàn)維生素Bl2水平下降或缺乏進而導(dǎo)致或加重DPN發(fā)生發(fā)展的一個藥物性原因。2、Hcy升高是維生素B12水平下降或缺乏的敏感指標(biāo),二者聯(lián)合檢測有助于發(fā)現(xiàn)早期維生素B12的缺乏。3、葉酸、鐵蛋白有助于評估維生素B12水平的高低。4、糖尿病患者病程越長、整體血糖控制不佳、維生素B12水平缺乏、Hcy水平升高均可促進DPN的發(fā)生。本研究提示我們對長期服用二甲雙胍這些高危人群的糖尿病患者,在血糖達標(biāo)的基礎(chǔ)上,建議定期監(jiān)測血清維生素B12水平,以及與之相關(guān)因素Hcy、葉酸等,并定期篩查DPN,并積極給與相應(yīng)干預(yù),從而可在一定程度上達到降低或延緩由二甲雙胍造成DPN的發(fā)生發(fā)展。
文內(nèi)圖片：
圖片說明：二甲雙胍組HGB為128.4±14.4g/L,非二甲雙胍組HGB為136.8±16.5g/L,
[Abstract]:[Objective] To study the effect of dimethoxy-2-2 on the level of serum vitamin B12 and diabetic peripheral nerve (DPN), and to analyze the related factors of vitamin B12 and the risk factors of DPN. [Methods] 120 patients with type 2 diabetes mellitus, including 50 males and 70 females, were selected from July 2013 to November 2014 in the Department of the Endocrinology Department of the affiliated hospital of Yanan University, including 50 males and 70 females, with a minimum age of 27, a maximum of 73 years, a minimum of 1 month in the course of diabetes, and a maximum of 14 years. The diagnosis of diabetes met either of the following three diagnostic criteria and was repeated to confirm one time. And homocysteine (Hcy) and glycosylated hemoglobin (Hb AIc). Statistical analysis of the test data was performed using the SPSS17.0 statistical analysis software. The measurement data was expressed by. x's. The two measurement data were tested with t-test and the count data was chi-square test (x2), and the linear correlation analysis was used for the measurement data. Logistic regression analysis was used for categorical variables. [Results] The levels of serum vitamin B12 and HGB in the first and second dicyandiamide group were lower than that of the non-disimethorphan group, and the difference of the two groups was statistically significant. [Conclusion] 1. It may be a drug-induced factor in the development of DPN in the patients with diabetes.2. The increase in Hcy is a sensitive indicator of the decrease or deficiency of vitamin B12. The combination of these two results can help to find the deficiency of vitamin B12. The longer the course of the diabetes, the longer the whole blood glucose control, the lack of vitamin B12 and the increase of Hcy level can promote the occurrence of DPN. This study suggests that we can regularly monitor the level of vitamin B12 in serum and the related factors, Hcy, folic acid and so on, and regularly screen DPN.
【學(xué)位授予單位】：延安大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R587.1
本文編號：2511254
文內(nèi)圖片：
圖片說明：二甲雙胍組HGB為128.4±14.4g/L,非二甲雙胍組HGB為136.8±16.5g/L,
[Abstract]:[Objective] To study the effect of dimethoxy-2-2 on the level of serum vitamin B12 and diabetic peripheral nerve (DPN), and to analyze the related factors of vitamin B12 and the risk factors of DPN. [Methods] 120 patients with type 2 diabetes mellitus, including 50 males and 70 females, were selected from July 2013 to November 2014 in the Department of the Endocrinology Department of the affiliated hospital of Yanan University, including 50 males and 70 females, with a minimum age of 27, a maximum of 73 years, a minimum of 1 month in the course of diabetes, and a maximum of 14 years. The diagnosis of diabetes met either of the following three diagnostic criteria and was repeated to confirm one time. And homocysteine (Hcy) and glycosylated hemoglobin (Hb AIc). Statistical analysis of the test data was performed using the SPSS17.0 statistical analysis software. The measurement data was expressed by. x's. The two measurement data were tested with t-test and the count data was chi-square test (x2), and the linear correlation analysis was used for the measurement data. Logistic regression analysis was used for categorical variables. [Results] The levels of serum vitamin B12 and HGB in the first and second dicyandiamide group were lower than that of the non-disimethorphan group, and the difference of the two groups was statistically significant. [Conclusion] 1. It may be a drug-induced factor in the development of DPN in the patients with diabetes.2. The increase in Hcy is a sensitive indicator of the decrease or deficiency of vitamin B12. The combination of these two results can help to find the deficiency of vitamin B12. The longer the course of the diabetes, the longer the whole blood glucose control, the lack of vitamin B12 and the increase of Hcy level can promote the occurrence of DPN. This study suggests that we can regularly monitor the level of vitamin B12 in serum and the related factors, Hcy, folic acid and so on, and regularly screen DPN.
【學(xué)位授予單位】：延安大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R587.1
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