骨化三醇对糖尿病周围神经病变疗效评价的研究

The effect of calcitriol on diabetic peripheral neuropathy

目的探讨骨化三醇治疗糖尿病周围神经病变(DPN)的疗效。方法选取DPN合并维生素D(Vit D)缺乏患者76例,随机分为常规治疗组(Con)和补充活性VitD组(VitD),各38例。采用多伦多临床评分系统进行临床评分,应用肌电图进行神经传导研究,比较12周后疗效。结果VitD组临床症状评分(84.2%vs 60.5%)、体征改善情况(86.8%vs 57.9%)有效率高于Con组(P<0.05)。VitD组治疗后正中及腓神经感觉神经波幅较治疗前升高[(35.93±3.02)vs(20.03±2.39)mv,(22.89±3.31)vs(11.83±3.09)mv,P<0.05];运动神经潜伏期较治疗前缩短[(2.99±0.79)vs(4.86±1.52)ms,(2.55±1.24)vs(4.96±1.77)ms,P<0.05],波幅较治疗前升高[(26.24±1.38)vs(12.16±1.49)mv,(9.96±1.57)vs(4.36±1.85)mv,P<0.05]。VitD组治疗后神经传导的潜伏期小于Con组,波幅高于Con组(P<0.05)。结论骨化三醇有助于改善DPN患者临床症状、体征、神经传导潜伏期及波幅。

Objective To investigate the clinical efficacy of calcitriol supplementation in patients with diabetic peripheral neuropathy(DPN).Methods A total of 76 patients with DPN and vitamin D deficiency were selected and randomly divided into routine treatment group(Con,n=38)and active Vit D group(Vit D,n=38).Toronto clinical scoring system(TCSS)was used for clinical scoring,electromyography was used for nerve conduction study(NCV),and the therapeutic effects were compared after 12 weeks’therapy.Results The effective rate of clinical symptom score(84.2%vs 60.5%)and improvement of physical signs(86.8%vs 57.9%)was significantly higher in Vit D group than in Con group(P<0.05).In Vit D group,wave amplitudes of sensory nerve in median nerve and peroneal nerve were significantly higher after treatment than baseline[(35.93±3.02)vs(20.03±2.39)mv,(22.89±3.31)vs(11.83±3.09)mv,P<0.05].The latencies of motor nerve were significantly shorter after treatment than baseline[(2.99±0.79)vs(4.86±1.52)ms,(2.55±1.24)vs(4.96±1.77)ms,P<0.05].The amplitudes of motor nerve were significantly higher after treatment than baseline[(26.24±1.38)vs(12.16±1.49)mv,(9.96±1.57)vs(4.36±1.85)mv,P<0.05].The latencies of nerve conduction were lower and the amplitudes were higher in Vit D group than in Con group after treatment(P<0.05).Conclusion Calcitriol supplementation could improve the symptoms and signs of the patients with DPN and Vitamin D deficiency,and it could improve the latency and amplitude of EMG.