二甲双胍降低T2DM血清维生素B12的研究进展

Progress of metformin in reducing serum vitamin B12 in T2DM

二甲双胍主要通过排斥回肠细胞表面钙离子、促进小肠分泌胰高血糖素样肽-1(GLP-1)、增加抑酸药使用提升胃内pH值、降低维生素B12-内因子复合物吸收、导致肠道微生物失调、抑制维生素B12吸收相关酶、增加血清维生素B12在肝、肾部位的沉积等机制,降低2型糖尿病(T2DM)患者血清维生素B12。这可能导致这部分患者出现巨幼红细胞血症、认知障碍、周围神经病变、糖尿病视网膜病变。因此,在长期大剂量服用二甲双胍的糖尿病患者中,有必要进行血清维生素B12状态评估。在不停用二甲双胍的基础上,注射或口服羟钴胺、维生素B12及钙剂都能取得很好的治疗效果。这印证了二甲双胍在T2DM治疗中基石地位并未改变。

Metformin can reduce serum vitamin B12 in patients with type 2 diabetes mellitus through promoting the secretion of glucagon-like peptide-1(GLP-1)in small intestine by rejecting calcium ions on the surface of ileal cells,increasing the use of acid suppressants and gastric pH,reducing the absorption of vitamin B12-internal factor complex,leading to intestinal microorganisms,inhibiting vitamin B12 absorption related enzymes,increasing serum vitamin B12 deposition in liver and kidney regions,etc.This may lead to megaloblastic hemorrhage,cognitive impairment,peripheral neuropathy and diabetic retinopathy in these patients.It is necessary to evaluate the status of vitamin B12 in diabetic patients with long-term high-dose metformin.It is concluded that on the basis of continuing to use metformin,injection or oral administration of hydroxycobal amine,vitamin B12 and calcium can achieve good therapeutic effects.This confirms that the cornerstone status of metformin in the treatment of T2DM has not changed.