温阳活血法治疗二甲双胍所致Vit B_(12)缺乏性糖尿病周围神经病变临床研究

Clinical study on therapy of warming yang and promoting blood circulation in the treatment of metformin-induced diabetic peripheral neuropathy due to Vit B_(12) deficiency

目的探讨温阳活血法治疗二甲双胍所致Vit B_(12)缺乏性糖尿病周围神经病变(DPN)的疗效。方法将178例DPN患者随机分为两组,各89例;对照组予以甲钴胺治疗,观察组在对照组基础上结合温阳活血法治疗,疗程4周。观察两组临床疗效及治疗前后血清Vit B_(12)、MMA、holoTC、Hcy、贫血相关指标水平、神经传导速度变化。结果 (1)对照组临床总有效率为78.65%,观察组为91.01%;观察组临床疗效明显优于对照组(P<0.05)。(2)治疗后,两组患者血清Vit B_(12)、holoTC水平较治疗前升高(P<0.05),MMA、Hcy水平较治疗前降低(P<0.05);且观察组患者血清Vit B_(12)、holoTC水平较对照组升高(P<0.05),MMA、Hcy水平较对照组降低(P<0.05)。(3)治疗后,两组患者血清Hb、铁蛋白水平较治疗前升高(P<0.05),MCV水平较治疗前降低(P<0.05);且观察组患者血清Hb、铁蛋白水平高于对照组(P<0.05),MCV水平低于对照组(P<0.05)。(4)治疗后,两组患者正中神经和胫神经SCV、MCV增加(P<0.05),观察组患者SCV、MCV快于对照组(P<0.05)。结论温阳活血法能够通过改善二甲双胍治疗糖尿病过程中的Vit B_(12)缺乏而治疗DPN。

Objective To discuss the efficacy of therapy of warming yang and promoting blood circulation in the treatment of metformin-induced diabetic peripheral neuropathy（ DPN） due to Vit B（12） deficiency. Methods 178 DPN patients were randomly divided into the control group and observation group,89 cases in each group. The control group was treated with methylcobalamin,and the observation group was treated with the therapy of warming yang and promoting blood circulation based on the treatment for the control group,with a course of 4 weeks. The clinical efficacy was observed in both groups,and the changes on the serum levels of Vit B（12）,methyl malonic acid（ MMA）,holotranscobalamin（ holo TC）,homocysteine（ Hcy）,anemia related indicators and nerve conduction velocity were compared before and after treatment. Results（1） The clinical total effective rates were 78. 65% in the control group and 91. 01% in the observation group. The clinical efficacy of the observation group was obviously better than that of the control group（ P〈0. 05）.（2） After treatment,the serum levels of Vit B（12） and holo TC were increased（ P〈0. 05） and the serum levels of MMA and Hcy were decreased（ P〈0. 05） in both groups compared with treatment before,and the serum levels of Vit B（12） and holo TC in the observation group were higher than those in the control group（ P〈0. 05）,the serum levels of MMA and Hcy in the observation group were lower than those in the control group（ P〈0. 05）.（3）After treatment,the serum levels of hemoglobin（ Hb） and ferritin were increased（ P〈0. 05） and the serum level of mean corpuscular volume（ MCV） was decreased（ P〈0. 05） in both groups compared with treatment before,and the serum levels of Hb and ferritin in the observation group were higher than those in the control group（ P〈0. 05）,the serum level of MCV in the observation group was lower than that in the control group（ P〈0. 05）.（4）After treatment,the sensory conduction velocity（ SCV） and motor conduction velocity（ MCV） in median nerve and tibial nerve were increased in both groups（ P〈0. 05）,and the SCV and MCV of patients in the observation group were faster than those in the control group（ P〈0. 05）. Conclusion The therapy of warming yang and promoting blood circulation can improve the metformin-induced Vit B（12） deficiency in the treatment of diabetic peripheral neuropathy.