依帕司他对糖尿病周围神经病变患者同型半胱氨酸和多伦多临床评分的影响

Effect of epalrestat on serum homocysteine and score of Toronto clinical scoring system in patients with diabetic peripheral neuropathy

目的探讨依帕司他对糖尿病周围神经病变(DPN)患者血清同型半胱氨酸(Hcy)及多伦多临床评分系统(TCSS)评分的影响。方法入选2016年4月至2017年4月怀化市第一人民医院内分泌代谢科2型糖尿病患者97例,随机数表法分为依帕司他组(n=33)、依帕司他联合甲钴胺组(n=30)和甲钴胺组(n=34)。甲钴胺片0.5mg/次,依帕司他片50mg/次,2种药物均口服,3次/d。治疗周期3个月。比较3组患者治疗前后空腹血糖(FBG)、餐后2小时血糖(2hPBG)、糖化血红蛋白(HbA1c)、Hcy和TCSS水平。应用SPSS21.0统计软件对数据进行分析。依据数据类型组间比较采用方差分析或χ^2检验。LSD法进行两两比较。结果3组患者治疗后FBG、2hPBG、HbA1c水平相比治疗前均下降,但差异无统计学意义(P>0.05)。3组患者治疗前Hcy和TCSS水平差异无统计学意义(P>0.05)。3组患者治疗后相比治疗前Hcy水平[(11.39±1.39)vs(13.40±2.26)μmol/L;(11.27±2.46)vs(13.51±2.32)μmol/L;(10.13±1.84)vs(14.91±6.78)μmol/L]下降,依帕司他组和依帕司他联合甲钴胺组治疗后相比治疗前TCSS评分[(7.64±1.87)vs(8.30±2.59);(5.83±1.88)vs(9.13±2.91)]下降,差异均有统计学意义(P<0.05)。依帕司他联合甲钴胺组治疗后相比依帕司他组和甲钴胺组Hcy[(10.13±1.84)vs(11.39±1.39),(11.27±2.46)μmol/L]和TCSS评分[(5.83±1.88)vs(7.64±1.87),(8.59±2.22)]水平低,差异均有统计学意义(P<0.05)。结论依帕司他联合甲钴胺缓解糖尿病患者DPN效果明显,可推广应用。

Objective To investigate the effect of epalrestat on serum level of homocysteine (Hcy) and score of Toronto clinical scoring system (TCSS) in patients with diabetic peripheral neuropathy (DPN). Methods A total of 97 patients with type 2 diabetes mellitus admitted in our Department of Endocrinology and Metabolism from April 2016 to April 2017 were enrolled prospectively,and then randomly divided into epalrestat group ( n =33), epalrestat combined with mecobalamin group ( n =30) and mecobalamin group ( n =34 ). Mecobalamin tablet (0.5 mg/time) and epalrestat tablet (50 mg/time) were given to the corresponding patients orally,3 times per day,for 3 months. The levels of fasting blood glucose (FBG),2 h postprandial blood glucose (2hPBG),glycosylated hemoglobin A1c (HbA1c) and Hcy,and TCSS score were compared before and after treatment in the 3 groups. SPSS statistics 21.0 was used for data analysis. Analysis of variance or Chi-square test was employed for intergroup comparison based on different data types among the 3 groups,and LSD test was applied for comparison between groups. Results The levels of FBG,2hPBG and HbA1c were decreased in all the 3 groups after treatment,but without significant differences ( P >0.05). There was no statistical difference in the Hcy level and TCSS score in the 3 groups before treatment ( P >0.05),but the Hcy level [(11.39±1.39) vs (13.40±2.26)μmol/L,(11.27±2.46) vs (13.51±2.32)μmol/L,(10.13±1.84) vs (14.91±6.78)μmol/L] was decreased in all of them after treatment. The score of TCSS [(7.64±1.87) vs (8.30±2.59);(5.83±1.88) vs (9.13±2.91)] was decreased in the epalrestat and epalrestat combined with mecobalamin group after treatment when compared with before treatment. The treatment of epalrestat combined with mecobalamin resulted in the lowest Hcy level [(10.13±1.84) vs (11.39±1.39) or ( 11.27±2.46 )μmol/L] and TCSS score [( 5.83±1.88 ) vs (7.64±1.87) or (8.59±2.22)] when compared with the treatment of epalrestat or mecobalamin ( P <0.05). Conclusion Epalrestat combined with mecobalamin shows obvious effect on DPN patients,and it is worthy of promotion in clinical practice.