甲钴胺序贯治疗2型糖尿病神经病变的疗效观察

目的观察甲钴胺序贯治疗2型糖尿病周围神经病变的临床疗效。方法 30例2型糖尿病周围神经病变患者,使用甲钴胺注射液1000μg静脉注射2周（1次/d）,改为甲钴胺片500μg口服10周（3次/d）,疗程共12周。治疗前和治疗后2周、6周、12周分别记录多伦多临床评分系统（TCSS）评分、神经病变主觉症状问卷（TSS）评分、阳性症状数字化的视觉量表（VAS）评分,进行足部10g尼龙丝压力觉、温度觉、振动感觉阈值、跟腱反射检查。结果治疗后2周、6周、12周TCSS、TSS评分较治疗前显著降低（P〈0.05）;疼痛、麻木、感觉减退VAS评分较治疗前显著降低（P〈0.05）;烧灼VAS评分治疗后2周较治疗前显著降低（P〈0.05）,但治疗后6周、12周烧灼VAS评分与治疗前比较差异无统计学意义（P〉0.05）;压力觉检查异常点数治疗后2周、12周较治疗前显著减少（P〈0.05）,振动感觉阈值治疗后6周、12周较治疗前显著降低（P〈0.05）;温度觉检查、跟腱反射检查结果治疗后2周、6周、12周与治疗前比较差异无统计学意义（P〉0.05）。结论甲钴胺序贯治疗2型糖尿病周围神经病变的临床疗效显著。

Clinical efficacy of methycobal sequential therapy on type 2 diabetic peripheral neuropathy

Objective To observe the efficacy of methycobal sequential therapy in treating type 2 diabetic peripheral neuropathy. Methods 30 inpatients with type 2 diabetic peripheral neuropathy were chosen to receive methycobal （1 000μg iv 1/d for 2 weeks and then 500 μg oral 3/d for 10 weeks） for 12 weeks. Before and after treatment for 2 weeks, 6 weeks and 12 weeks the TCSS score,TSS score, and positive symptom VAS score were recorded and the 10 g monofilament, temperature sensation, vibration perception threshold and tendon reflex were measured. Results After treatment both of the TCSS score and TSS score had significantly decreased（P0.05 or P0.01）,and the VAS score of pain, numbness and loss of sensati were much lower than those before therapy（P0.05 or P0.01）.The VAS score of burning was decreased significantly after treatment for 2 weeks when compared with that before treatment（P0.05）,while no significant difference between 6 weeks and 12 weeks after treatment（P0.05）. The monofilament abnormal feeling points reduced significantly after treatment for 2 weeks and 12 weeks compared with that before treatment （P0.05）. The vibration perception threshold decreased significantly after treatment for 6 and 12 weeks（P0.05,P0.01）,while temperature sensation and tendon reflex showed no significant difference （P0.05）. Conclusion The methycobal sequential therapy on type 2 diabetic peripheral neuropathy is effective.