依帕司他联合甲钴胺治疗老年2型糖尿病周围神经病变的随机对照研究

发布时间：2018-11-24 11:34

【摘要】：目的:探讨依帕司他联合甲钴胺治疗老年2型糖尿病周围神经病变(DPN)的疗效。方法:选取2015年4月至2016年4月在新疆医科大学第二附属医院住院及门诊就诊的老年2型糖尿病伴DPN患者158例为研究对象,采用随机数字法将其分为联合治疗组(80例)和甲钴胺组(78例)。治疗前两组患者均有效控制血糖、血压等,其中甲钴胺组单独给予甲钴胺治疗,每次0.5mg,每日3次,饭前口服,联合治疗组在甲钴胺组基础上联合依帕司他治疗,每次50mg,每日3次,饭前口服,两组患者均治疗3个月。比较两组患者治疗前后神经病变主觉症状问卷评分(T SS)、右侧正中神经、腓总神经感觉神经传导速度及运动神经传导速度、血清同型半胱氨酸(Hcy)的水平,比较两组患者的不良反应发生情况。结果:治疗后两组患者的TSS均降低,差异有统学意义(P0.05),且联合治疗组的TSS较甲钴胺组更低[(0.9±0.3)分比(1.4±0.5)分](P0.05);治疗后,两组患者的腓总神经及正中神经(运动支及感觉支)的传导速度明显增快,与治疗前相比差异有统计学意义(P0.05),且联合治疗组患者腓总神经及正中神经(运动支及感觉支)的传导速度较甲钴胺组更快[腓总神经(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;正中神经(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);治疗后联合治疗组患者的Hcy水平降低,与治疗前相比差异有统计学意义(P0.05),且联合治疗组患者Hcy水平较甲钴胺组更低[(20.9±8.6)μmol/l比(28.0±11.6)μmol/l](P0.05)。治疗过程中联合治疗组患者有2例发生恶心、呕吐,未停药,2天后上述症状缓解;甲钴胺组未发生不良反应。结论:依帕司他联合甲钴胺治疗老年2型DPN有助于改善患者周围神经症状、体征及神经传导速度,提高机体抗氧化应激能力,降低血浆Hcy水平,且无明显不良反应。
[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 卤0.3) score vs (1.4 卤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 卤0.9) m / s vs (39.9 卤1.2) m / s]. The ratio of (44.2 卤1.5) m / s to (34.8 卤0.9) m / s; Median nerve (51.3 卤1.0) m / s vs (45.0 卤0.9) m / s, (45.0 卤1.9) m / s ratio (39.5 卤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 卤8.6) 渭 mol/l vs (28.0 卤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.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R587.2

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