探讨二甲双胍对糖尿病患者血清维生素B12及周围神经病变的影响
发布时间：2019-07-06 18:53
【摘要】：【目的】探讨二甲双胍对血清维生素B12水平及糖尿病周围神经(DPN)的影响,分析维生素B12相关因素及DPN危险因素,从而为临床预防或诊治由二甲双胍引起维生素B12下降进而导致或加重DPN的发生发展提供一定的临床依据。【方法】对象选择2013年7月至2014年11月延安大学附属医院内分泌科门诊及住院的2型糖尿病患者120例,其中男50例,女70例;年龄最小的27岁,最大的73岁,糖尿病病程最短1月,最长14年。糖尿病的诊断满足下述3个诊断标准任意一个并需重复确认一次。即①糖尿病症状+随机血糖水平≥11.1mmol/L,或②空腹血糖(FBP)水平≥7.0 mmol/L,或③OGTT2小时血糖水平≥11.1mmol/L。根据二甲双胍应用情况分为2组:二甲双胍组(近期二甲双胍应用史至少6个月)及非二甲双胍组(近6个月未使用二甲双胍),根据DPN诊断标准将二甲双胍组分为DPN、NDPN,非二甲双胍组分为DPN、NDPN。详细询问并记录所有入选患者姓名、年龄、性别、糖尿病病史、二甲双胍及其他药物使用史,有无恶性贫血、肠道手术、颈椎、腰椎病变等其他疾病史;平时饮食习惯;是否伴有DPN症状,如肢端感觉异常、麻木、疼痛等,及记录DPN病史。所有入选对象临床资料的采集都在清晨空腹状态下准确测量,并记录身高、血压、体重,计算体重指数BMI(体重(kg)/身高2(kg/m2),抽取患者静脉血查贫血相关测定包括叶酸、维生素B12、铁蛋白,血常规包括血红蛋白(HGB)、平均红细胞体积(MCV),肾功包括血尿素氮(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)、总胆固醇(TC),以及同型半胱氨酸(Hcy)和糖化血红蛋白(Hb AIc)。使用SPSS17.0统计分析软件对试验数据进行统计学处理,计量资料采用.x±s表示,两样本计量资料采用t检验,计数资料采用卡方检验(x2),对计量资料采用线性相关分析,分类变量采用Logistic回归分析。P0.05,差异有统计学意义。【结果】1、二甲双胍组血清维生素B12及HGB水平均低于非二甲双胍组,两者比较差异有统计学意义。2、二甲双胍组血清Hcy水平及DPN患病率均高于非二甲双胍组,差异有统计学意义。3、各受试组在年龄、性别、血压、体重指数等资料之间差异均无统计学意义。4、叶酸、铁蛋白与维生素B12水平呈直线正相关,糖尿病病程、Hcy与维生素B12呈直线负相关。5、糖尿病病程、Hb AIc、Hcy、维生素Bl2是DPN发生的危险因素。【结论】1、长期服用二甲双胍可能是糖尿病患者出现维生素Bl2水平下降或缺乏进而导致或加重DPN发生发展的一个药物性原因。2、Hcy升高是维生素B12水平下降或缺乏的敏感指标,二者联合检测有助于发现早期维生素B12的缺乏。3、叶酸、铁蛋白有助于评估维生素B12水平的高低。4、糖尿病患者病程越长、整体血糖控制不佳、维生素B12水平缺乏、Hcy水平升高均可促进DPN的发生。本研究提示我们对长期服用二甲双胍这些高危人群的糖尿病患者,在血糖达标的基础上,建议定期监测血清维生素B12水平,以及与之相关因素Hcy、叶酸等,并定期筛查DPN,并积极给与相应干预,从而可在一定程度上达到降低或延缓由二甲双胍造成DPN的发生发展。
文内图片：
图片说明：二甲双胍组HGB为128.4±14.4g/L,非二甲双胍组HGB为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.
【学位授予单位】：延安大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R587.1
本文编号：2511254
文内图片：
图片说明：二甲双胍组HGB为128.4±14.4g/L,非二甲双胍组HGB为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.
【学位授予单位】：延安大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R587.1
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相关期刊论文 前3条
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