银杏黄酮甙和甲基B_(12)联合治疗糖尿病周围神经病变的疗效观察

目的　探讨银杏黄酮甙和甲基B12 对糖尿病周围病变的治疗效果。方法　将 14 9例糖尿病周围神经病变患者随机分为 4组 ,分别为常规治疗组 (对照组 )、银杏黄酮甙组 (第 1组 )、甲基B12 组 (第 2组 )、银杏黄酮甙与甲基B12 联合组(第 3组 )。疗程为 8周。观察治疗前后自觉症状、腱反射和神经传导速度。结果　第 3组总有效率为 95 % ,显著高于对照组 (17% ) (P <0 .0 0 5 )。第 1组和第 2组 ,总有效率分别为 6 9%和 72 % ,与对照组比较均有显著差异 (P <0 .0 1)。第 3组神经传导速度治疗后较冶疗前显著改善 (P <0 .0 1) ,而且显著优于对照组 (P <0 .0 1)、第 1组 (P <0 .0 5 )和第 2组 (P <0 .0 5 )。结论　银杏黄酮甙和甲基B12 联合治疗糖尿病周围神经病变较单独应用更为有效。     

甲钴胺对大鼠受损背根节A-类神经元自发放电的抑制作用

目的:研究甲钴胺(methylcobalamin,Methyl B12)对损伤背根节(dorsal root ganglion,DRG)A-类神经元的不同模式自发放电的作用。方法:在大鼠L5椎间孔植入不锈钢柱制备大鼠DRG慢性压迫模型(chronic com-pression of DRG,CCD)上,利用在体单纤维细胞外记录方法研究Methyl B12对受损DRG神经元自发放电的影响。结果:(1)CCD模型大鼠出现明显的双侧机械刺激引起缩足反应阈值降低(P<0.001);(2)Methyl B12(300μmol/L)对受损A-类DRG神经元自发放电具有显著的抑制作用(n=13,P<0.05);(3)Methyl B12(300μmol/L)对受损A-类DRG神经元非周期和周期放电模式自发放电均有抑制作用,且两者之间没有明显差异。结论:Methyl B12(300μmol/L)对受损DRG A-类神经元产生的异位自发放电具有抑制作用,且对于非周期和周期放电模式的抑制作用没有差异。     

弥可保和维生素B12治疗眼肌麻痹性斜视

目的对照观察弥可保和普通维生素B12治疗眼肌麻痹性斜视的临床效果,评估弥可保的治疗有效性和优越性.方法 96例眼肌麻痹患者,随机分为弥可保治疗组52例和普通维生素B12治疗组44例.弥可保和普通维生素B12均以相同剂量500 μg联合维生素B1 100 mg 1次·d-1肌肉注射,连续3周,之后改口服剂量500 μg联合维生素B1 10 mg 3次·d-1,分别在用药后每隔2周随诊复查患者的主观症状、眼位偏斜和眼肌运动状况,以及复视相情况.结果弥可保组治疗后痊愈39例,治疗后好转8例,总有效率90.39%;普通维生素B12治疗组中痊愈31例,治疗后好转6例,总有效率84.09%;弥可保组的治愈率及总有效率均高于普通维生素B12治疗组,但2组差异无显著性(P>0.05).而弥可保组39例治愈者的疗程时间平均(6.77±3.48)周,较普通维生素B12组的(8.71±4.54)周明显缩短,2组的治疗时间差异有显著性(P<0.05)).2组间在治疗各种不同原因所引起的眼肌麻痹的疗效上无明显差别.2组的疗效均与致病原因、病损程度和病变范围等因素有关.结论弥可保治疗眼肌麻痹性斜视的临床疗效是肯定的.它治疗的总有效率高于普通维生素B12,且治疗时间缩短.     

舒血宁联合甲钻胺治疗面神经炎合并糖尿病的临床观察

目的观察舒血宁注射液联合甲钻胺注射液（弥可保）治疗急性面神经炎合并糖尿病的临床疗效。方法将60例急性面神经炎合并糖尿病的患者随机分为对照组（30例）和治疗组（30例）。对照组采用常规内科治疗,治疗组在常规治疗的基础上静滴舒血宁注射液联合甲钴胺注射液。结果治疗组总有效率为93.3%,对照组为73.3%。治疗组与对照组比较,其治愈率及有效率显著提高,有统计学意义（P〈0.05）。结论舒血宁注射液联合甲钴胺注射液对面神经炎合并糖尿病疗效确切,值得临床推广。     

Efficacy of methylcobalamin on lowering total homocysteine plasma concentrations in haemodialysis patients receiving high-dose folic acid supplementation.

BACKGROUND: Hyperhomocysteinaemia, which is considered to be induced by impairment of the remethylation pathway in patients with chronic renal failure (CRF), cannot be cured solely by folic acid therapy. In the present study, we investigated the additional benefit of administration of methylcobalamin, which is a co-enzyme in the remethylation pathway, on lowering total homocysteine (tHcy) plasma concentrations in haemodialysis (HD) patients receiving high-dose folic acid supplementation. METHODS: In order to assess the efficacy on lowering plasma tHcy levels (fasting concentration), 21 HD patients, were randomly assigned and provided folic acid supplementation: 15 mg/day orally (group I, n=7); methylcobalamin 500 mg intravenously after each HD, in addition to folic acid (group II, n=7); or vitamin B(6) (B(6)), 60 mg/day orally, in addition to folic acid and methylcobalamin (group III, n=7). All patients were treated for 3 weeks. A methionine-loading test was conducted before and after supplementation. The following measurements were also made before and after supplementation for each group: serum folic acid, B(6), and vitamin B(12) (B(12)) concentrations (including measurement of proportion of methylcobalamin fraction). Twelve HD patients receiving methylcobalamin alone served as the HD control group and seven healthy volunteers served as the normal control group for this study. RESULTS: In our randomized HD patients the proportions of methylcobalamin fraction (48.3+/-7.5%) and plasma vitamin B(6) concentration (2.9+/-1.1 ng/ml) were significantly lower than in the normal controls (methylcobalamin 58.7+/-2.2%, P<0.01; B(6) 20.1+/-10.8 ng/ml, P<0.01), while folic acid and vitamin B(12) were not significantly different from the normal controls. Mean percentage reduction in fasting tHcy was 17.3+/-8.4% in group I, 57.4+/-13.3% in group II, 59.9+/-5.6% in group III, and 18.7+/-7.5% in HD controls. The power of the test to detect a reduction of tHcy level was 99.6% in group II and 99.9% in group III when type I error level was set at 0.05. Groups II and III had normal results for the methionine-loading test after treatment. Treatment resulted in normalization of fasting tHcy levels (<12 ng/ml) in all 14 patients treated by the combined administration of methylcobalamin and supplementation of folic acid regardless of whether there was supplementation of vitamin B(6). CONCLUSION: The benefit of methylcobalamin administration on lowering plasma tHcy levels in HD patients was remarkable. Our study suggested that both supplementations of high-dose folic acid and methylcobalamin are required for the remethylation pathway to regain its normal activity. This method could be a therapeutic strategy to combat the risk associated with atherosclerosis and cardiovascular disease in patients with chronic renal failure.     

脉络宁联合弥可保治疗糖尿病周围神经病变疗效观察

目的探讨脉络宁注射液联合甲钴胺（弥可保）治疗糖尿病周围神经病变的疗效。方法将115例入院患者随机分为2组,在常规治疗基础上,治疗组予脉络宁注射液联合甲钴胺肌肉注射治疗,对照组单用甲钴胺肌肉注射治疗,疗程均为1个月,观察治疗后症状改善情况,测定胫神经、腓总神经运动神经传导速度,肥肠神经、腓浅神经感觉神经传导速度。结果治疗组临床症状、神经功能评分、神经传导速度的改善情况均明显优于对照组（P均〈0.05）。结论脉络宁注射液联合甲钴胺治疗糖尿病周围神经病变安全有效,优于单独应用甲钴胺。     

益气活血通痹法治疗糖尿病周围神经病变40例

目的观察糖痹汤与甲钴胺联合治疗糖尿病周围神经病变（diabetic peripheral neuropathy,DPN）的临床疗效。方法选择80例DPN患者,按排列表法随机分为两组,每组40例,对照组在基础治疗上予以甲钴胺1.5 mg加入100 ml氯化钠注射液中静脉滴注,每日1次,2周后改为口服,每次0.5 mg,每日3次,2周后再改为静脉滴注。治疗组在对照组基础上加用糖痹汤,口服,2周为1个疗程,停5 d继续下一个疗程;两组均治疗3个月。结果治疗组和对照组总有效率分别为92.5%和77.5%,两组总有效率比较,差异具有统计学意义（P〈0.05）。治疗后两组正中神经、腓总神经、胫神经传导速度均较治疗前显著改善（P〈0.01）,且治疗组3种运动神经的传导速度显著高于对照组（P〈0.05）。结论糖痹汤联合甲钴胺治疗DPN可以提高临床疗效,改善运动神经的传导速度。     

腕关节外固定支具联合复方倍他米松、甲钴胺治疗腕管综合征的临床疗效

目的:分析腕关节外固定支具联合复方倍他米松、甲钴胺治疗对腕管综合征(CTS)临床疗效、Boston 腕管问卷调查评分(BTCQ)及生活质量的影响。方法:回顾性收集2019年1月—2020年1月在我院收治的201例CTS患者的临床资料。所有患者均佩戴腕关节外固定支具,其中A组联合复方倍他米松注射液1 mL(52例)、B组予甲钴胺注射液0.5 mg(68例),C组予复方倍他米松1 mL联合甲钴胺0.5mg(81例)。对比三组治疗后3周的临床疗效、电生理指标改变情况、疼痛情况、症状缓解时间、BTCQ、生活质量以及不良反应。结果:C组总有效率为97.53%,明显高于A组(76.92%)、B组(72.06%),差异有统计学意义(P<0.05)。A、B组治疗后疼痛及麻木缓解时间、电生理指标及VAS评分比较,均无明显差异(P＞0.05),治疗后三组患者感觉神经传导速度(SCV)、运动神经传导速度(MCV)、肌肉动作电位(CMAP)值均升高,正中神经末端运动潜伏期(DML)值均降低,C组SCV、MCV、CMAP值均高于A、B组,DML值低于A、B组(P<0.05);三组治疗后视觉模拟疼痛评分(VAS)评分出现降低,C组VAS评分明显低于A、B组(P<0.05);C组疼痛及麻木缓解时间明显短于A、B组(P<0.05);治疗后,C组BTCQ明显低于A、B组,PCS、MCS评分则高于A、B组(P<0.05),A、B组治疗后BTCQ、PCS、MCS评分比较均无差异(P＞0.05);三组均未出现严重不良反应,A组不良反应总发生率为1.92%、B组为2.94%、C组为4.93%,三组比较差异无统计学意义(P＞0.05)。结论:腕关节外固定支具联合复方倍他米松、甲钴胺治疗CTS可提高患者治疗效果,改善腕功能,提高患者生活质量。