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目的探讨鼠神经生长因子联合维生素D及甲钴胺治疗糖尿病周围神经病变的疗效。方法 124例糖尿病周围神经病变患者,随机分为甲钴胺组41例,观察1组41例,观察2组42例。甲钴胺组口服甲钴胺胶囊;观察1组口服甲钴胺胶嚢+碳酸钙D_3片+骨化三醇软胶囊;观察2组在观察1组治疗基础上肌内注射鼠神经生长因子30μg+生理盐水2 mL,1次/d。3组分别于治疗前及治疗4周后进行多伦多临床评分系统(Toronto clinical scoring system,TCSS)评分;行肌电图检査记录肢体正中神经、排总神经运动神经传导速度(motor nerve conduction velocity,MNCV)以及正中神经、腓总神经感觉神经传导速度(sensory nerve conduction velocity,SNCV);比较3组临床疗效。结果治疗4周后甲钴胺组、观察1组、观察2组TCSS评分[(7.85±1.01)、(5.86±0.83)、(3.56±0.72)分]均较治疗前[(9.92±1.33)、(9.35±1.26)、(9.57±1.24)分]降低(P<0.05);观察2组治疗后TCSS评分低于甲钴胺组和观察1组,观察1组低于甲钴胺组(P<0.05);治疗4周后甲钴胺组、观察1组、观察2组正中神经MNCV[(42.34±6.88)、(43.62±5.75)、(48.19±4.73)m/s]、腓总神经MNCV[(38.67±6.09)、(39.66±5.89)、(43.95±5.95)m/s]、正中神经SNCV[(39.52±8.62)、(40.25±9.18)、(46.17±6.97)m/s]、腓总神经SNCV[(36.49±6.35)、(37.71±6.12)、(42.47±6.75)m/s]均较治疗前[正中神经MNCV:(40.82±5.64)、(41.27±5.12)、(42.13±4.36)m/s;腓总神经MNCV:(37.11±4.35)、(38.03±4.88)、(37.21±4.31)m/s;正中神经SNCV:(37.57±6.16)、(38.15±6.49)、(38.02±4.05)m/s;腓总神经SNCV:(35.06±5.16)、(36.05±4.65)、(37.08±5.18)m/s]增快(P<0.05),观察2组改善较甲钴胺组和观察1组明显(P<0.05),甲钴胺组与观察1组比较差异无统计学意义(P>0.05);观察2组总有效率(95.24%)明显高于观察1组(75.61%)和甲钴胺组(53.66%)(P<0.05)。结论糖尿病周围神经病变患者应用鼠神经生长因子联合维生素D及甲钴胺治疗可有效降低TCSS评分,提高神经传播速度及治疗效果。
Objective To investigate the therapeutic effect of nerve growth factor combined with vitamin D and mecobalamin on diabetic peripheral neuropathy. Methods A total of 124 patients with diabetic peripheral neuropathy were randomly divided into mecobalamin group (n = 41), observation group (n = 41) and observation group (n = 42). Mecobalamin group oral mecobalamin capsules; observed a group of oral mecobalamin capsule + calcium carbonate D_3 tablets + calcitriol soft capsule; observed two groups in the observation group 1 treatment based on intramuscular injection of rat nerve growth factor 30μg + Saline 2 mL, 1 time / d. The scores of Toronto clinical scoring system (TCSS) were evaluated before treatment and after 4 weeks of treatment. The electromyography was performed to record the median nerve and motor nerve conduction velocity MNCV) and median nerve, sensory nerve conduction velocity (SNCV). The clinical efficacy of the three groups were compared. Results After 4 weeks of treatment, the TCSS scores in the two groups were significantly higher than those before treatment [(9.92 ± 1.33), (9.35 ± 5.71), (5.86 ± 0.83), (3.56 ± 0.72) ± 1.26), (9.57 ± 1.24) points (P <0.05). The TCSS score of the two groups was lower than that of the mecobalamin group and the observation group 1 after treatment (P0.05) ; After 4 weeks of treatment, the patients in the mecobalamin group were observed for 1 group. MNCV [(42.34 ± 6.88), (43.62 ± 5.75), (48.19 ± 4.73) m / s] (39.66 ± 5.89) and (43.95 ± 5.95) m / s, respectively. The median SNCV [(39.52 ± 8.62), (40.25 ± 9.18) and (46.17 ± 6.97) m / 36.46 ± 6.35), (37.71 ± 6.12) and (42.47 ± 6.75) m / s, respectively, compared with that before treatment [median nerve MNCV: (40.82 ± 5.64), (41.27 ± 5.12) and (42.13 ± 4.36) m / The MNCV of the common peroneal nerve was (37.11 ± 4.35), (38.03 ± 4.88) and (37.21 ± 4.31) m / s respectively. The SNCV of median nerve was (37.57 ± 6.16), (38.15 ± 6.49) and (38.02 ± 4.05) m / ; The peroneal nerve SNCV: (35.06 ± 5.16), (36.05 ± 4.65), (37.08 ± 5.18) m / s] increased significantly (P <0.05) P <0.05), mecobalamin group and observation group 1 comparison There was no significant different (P> 0.05); The total effective rate was observed 2 (95.24%) was significantly higher than that observed 1 group (75.61%) and methyl cobalamin group (53.66%) (P <0.05). Conclusion The application of NGF in combination with vitamin D and mecobalamin in diabetic peripheral neuropathy patients can effectively reduce the TCSS score and improve the nerve transmission rate and therapeutic effect.