甲钴胺治疗糖尿病周围神经病变的疗效及其对患者血浆同型半胱氨酸水平的影响

目的：观察甲钴胺治疗糖尿病周围神经病变(DPN)的疗效，并探讨其对患者血浆同型半胱氨酸(Hcy)水平的影响。方法回顾性分析2014年5月至2015年10月期间我院内泌科收治的140例2型糖尿病(T2DM)患者的临床资料，比较合并DPN组与无DPN组患者血浆Hcy水平。对伴有高Hcy的DPN患者予甲钴胺治疗，观察治疗前后血浆Hcy、神经传导速度及症状总评分(TSS)的变化。结果 DPN组患者血浆Hcy水平为(21.3±7.3)μmol/L，明显高于无DPN组的(11.1±4.8)μmol/L，差异有统计学意义(P<0.05)；正常Hcy组血浆Hcy水平、TSS评分分别为(12.6±4.2)μmol/L、(3.4±1.2)分，明显低于高Hcy组患者治疗前的(26.9±7.2)μmol/L、(4.6±1.5)分，而胫神经、腓神经运动神经传导速度(MNCV)及感觉神经传导速度(SNCV)明显增快，差异均具有统计学意义(P<0.05)；与治疗前比较，高Hcy组患者治疗后血浆Hcy水平、TSS评分较治疗前明显较低，胫神经、腓神经的MNCV、SNCV明显增快，差异均具有统计学意义(P<0.05)。结论高Hcy血症是引起DPN重要因素，甲钴胺治疗DPN可以明显降低血浆Hcy水平，改善神经传导速度及临床症状。

Clinical efficacy of mecobalamin in the treatment of diabetic peripheral neuropathy and its effects on plasma homocysteine

Objective To investigate the clinical efficacy of mecobalamin in the treatment of diabetic peripher-al neuropathy (DPN) and its influence on plasma homocysteine (Hcy) levels. Methods We retrospectively analyzed the clinical data of 140 cases of patients with type 2 diabetes mellitus from May 2014 to October 2015 treated in Department of Endocrinology in our hospital, and Hcy levels of DPN group and non-DPN group were compared. The patients with high Hcy were treated by mecobalamin, and the changes of plasma Hcy, nerve conduction velocity and total symptom score (TSS) were compared before and after treatment. Results The plasma Hcy level in DPN group (21.3 ± 7.3) μmol/L] was signifi-cantly higher than non-DPN group (11.1±4.8) μmol/L] (P<0.05). The Hcy level and TSS score in normal Hcy group (12.6± 4.2) μmol/L, (3.4 ± 1.2) points, respectively] were significantly lower than those in high Hcy group (26.9 ± 7.2) μmol/L, (4.6±1.5) points, respectively] before treatment, and tibial nerve, motor nerve conduction velocity (MNCV) and sensory nerve conduction velocity (SNCV) of peroneal nerve were significantly increased. The differences were statistically sig-nificant (P<0.05). Compared with before treatment, the Hcy level and TSS score in high Hcy group after treatment were significantly lower, and tibial nerve, MNCV and SNCV of peroneal nerve were significantly increased. The differences were statistically significant (P<0.05). Conclusion The high plasma Hcy is an important factor for causing DPN, and mecobalamin can significantly reduce plasma Hcy levels, and improve nerve conduction velocity and clinical symptoms in patients with DPN.