维生素B_(12)联合叶酸对老年糖尿病肾病伴高同型半胱氨酸血症的影响研究

Effect of Vitamin B_(12) and Folic Acid on Elderly Diabetic Nephropathy with Hyperhomocysteinemia

目的探讨维生素B12联合叶酸对糖尿病肾病(DN)伴高同型半胱氨酸血症(HHcy)老年患者尿白蛋白/肌酐(UACR)的影响,为DN的治疗提供更多的可行方案。方法选取2018年10月—2019年10月在上海市浦东新区花木社区卫生服务中心糖尿病管理库中的DN伴HHcy老年患者102例为研究对象,采用随机数字表将其分为对照组和干预组,各51例,对照组采用常规DN治疗,干预组另服用叶酸0.8 mg/d和维生素B121 mg/d,共治疗24周,分别在治疗前、治疗第12周、治疗第24周检测同型半胱氨酸(Hcy)水平,治疗前、治疗第24周检测UACR及空腹血糖(FPG)水平。结果治疗前、治疗第12周,两组患者Hcy水平比较,差异无统计学意义(P>0.05);治疗第24周,干预组患者Hcy水平低于对照组(P<0.05)。治疗前,两组患者UACR比较,差异无统计学意义(P>0.05);治疗第24周,干预组患者UACR低于对照组(P<0.05)。治疗前、治疗24周,两组患者FPG水平比较,差异无统计学意义(P>0.05)。结论对于DN伴HHcy老年患者,在常规治疗的基础之上辅以维生素B12联合叶酸治疗,不仅可有效降低患者体内Hcy,还可进一步降低UACR,从而保护患者的肾功能,有利于控制DN的进展,并改善患者的预后。该疗法有望成为DN临床治疗的一种新的干预策略。

Objective To analyze the effect of vitamin B12 and folic acid on urine albumin creatine ratio(UACR)in elderly nephropathy(DN)and hyperhomocysteinemia(HHcy)patients,and to provide more feasible options for the treatment of DN.Methods 102 elderly patients with DN and HHcy were selected from the community diabetes management database in Shanghai Pudong New Area Huamu Community Health Service Center from October 2018 to October 2019 as the research objects.They were divided into a control group(51 cases)and an intervention group(51 cases)by a random number table.The control group took conventional treatment for DN,and the intervention group was additionally given folic acid 0.8 mg/d and vitamin B121 mg/d for a total of 24 weeks.The levels of homocysteine(Hcy)were detected before treatment,12 weeks and 24 weeks after treatment,the UACR and FPG were measured before and 24 weeks after treatment.Results There was no significant difference in Hcy level between the two groups before treatment and 12 weeks of treatment(P>0.05);at the 24th weeks of treatment,Hcy level in the intervention group was lower than that in the control group(P<0.05).There was no significant difference in UACR between the two groups before treatment(P>0.05);at the 24th weeks of treatment,UACR in the intervention group was lower than that in the control group(P<0.05).There was no significant difference in FPG level between the two groups before treatment and 24 weeks of treatment(P>0.05).Conclusion For patients with DN and HHcy,supplementation of vitamin B12 and folic acid on the basis of conventional treatment can not only effectively reduce the plasma Hcy level in patient’s body,but also further reduce the UACR level,thereby protecting the patient’s renal function.It showed that this therapy is beneficial to control the progression of DN and improve the prognosis of patients,so it is expected to become a new intervention strategy for the clinical treatment of DN.