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目的观察甲钴胺或碳酸钙或两者合用对二甲双胍相关性维生素B_(12)缺乏患者的治疗效果。方法将90例连续服用二甲双胍片6个月以上,血清维生素B_(12)<200pg/ml的2型糖尿病患者,采用随机数字法分为3组,分别采用甲钴胺(27例)、碳酸钙(29例)、甲钴胺和碳酸钙联合(26例)治疗,所有患者均在初治时和治疗3、6、12个月时测定血清维生素B_(12)、叶酸、贫血相关指标及神经传导速度,并进行治疗前后及组间比较。结果甲钴胺组及甲钴胺和碳酸钙联合组治疗后血清维生素B_(12)、叶酸、Hb水平及胫神经、腓总神经、腓肠神经、腓浅神经传导速度明显高(快)于治疗前(均P<0.05),平均红细胞体积(MCV)、平均红细胞血红蛋白含量(MCH)明显低于治疗前(均P<0.05),且均优于碳酸钙组(均P<0.05),碳酸钙组治疗前后血清维生素B_(12)及叶酸水平、贫血相关指标、神经传导速度均无统计学差异(均P>0.05),治疗12个月后甲钴胺和碳酸钙联合组维生素B_(12)、叶酸、Hb、MCV、MCH及胫神经、腓总神经、腓肠神经、腓浅神经传导速度均优于甲钴胺组(均P<0.05)。结论甲钴胺联合口服碳酸钙能有效提高血清维生素B_(12)和叶酸水平,改善二甲双胍相关性维生素B_(12)缺乏情况,防止贫血发生,改善神经传导速度,较单独应用碳酸钙或甲钴胺效果好。
Objective To observe the therapeutic effect of mecobalamin or calcium carbonate or both in patients with metformin-related vitamin B 12 deficiency. Methods Ninety patients with type 2 diabetes mellitus who were treated with metformin for more than 6 months and serum vitamin B 12 (200pg / ml) were randomly divided into three groups. Mecobalamin (27 cases), calcium carbonate (N = 29), mecobalamin combined with calcium carbonate (n = 26). All patients were measured on serum creatinine B 12, folic acid, anemia and nerves at the time of initial treatment and 3, 6 and 12 months of treatment Conduction velocity, and before and after treatment and comparison between groups. Results The serum vitamin B 12, folic acid and Hb levels and the tibial nerve, common peroneal nerve, sural nerve and peroneal nerve were significantly higher (faster) in the mecobalamin and mecobalamin combined with calcium carbonate treatment group The average volume of erythrocytes (MCV) and the average hemoglobin content (MCH) were significantly lower than those before treatment (all P <0.05), and were superior to those of calcium carbonate group (all P <0.05) Calcium group before and after treatment, serum vitamin B 12 and folic acid levels, anemia related indicators, nerve conduction velocity were no significant difference (all P> 0.05), 12 months after treatment of mecobalamin and calcium carbonate group B 12 ), Folic acid, Hb, MCV, MCH and tibial nerve, common peroneal nerve, sural nerve and peroneal nerve were all better than mecobalamin group (all P <0.05). Conclusion Mecobalamin combined with oral calcium carbonate can effectively increase the levels of serum vitamin B 12 and folic acid, improve the metformin-related vitamin B 12 deficiency, prevent the occurrence of anemia and improve the nerve conduction velocity. Compared with calcium carbonate or cobalt Good amine effect.