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[摘要]
目的 探讨二甲双胍对2型糖尿病患者维生素B12(Vit B12)、甲基丙二酸(MMA)水平和神经病变的影响。方法 纳入2型糖尿病患者60例,按治疗方法分为观察组30例,对照组30例。两组均按入组前的剂量继续使用胰岛素治疗,此外,观察组给予二甲双胍治疗,对照组给予安慰剂治疗。两组疗程均为3年,通过定期门诊对患者进行随访,比较两组治疗前后空腹血糖(FPG)、餐后2 h血糖(PPPG)、糖化血红蛋白(HbA1c)、Vit B12、MMA和神经病变评分的变化。结果 两组治疗后FPG、PPPG、HbA1c均显著下降,同组治疗前后比较差异有统计学意义(P<0.05),且观察组显著低于对照组,组间差异有统计学意义(P<0.05)。两组治疗后肾小球滤过率(eGFR)均下降,同组治疗前后比较差异有统计学意义(P<0.05);但组间无显著差异。治疗后,两组MMA均显著上升,同组治疗前后比较差异有统计学意义(P<0.05);且观察组更明显,组间差异有统计学意义(P<0.05);VitB12均显著下降,且观察组更明显(P<0.05);两组神经病变评分有所上升,但组间无显著差异。结论 二甲双胍不仅会降低血浆VitB12水平,还导致血浆MMA显著增加,血浆MMA增加与神经病变评分相关,提示临床应用二甲双胍时应监测Vit B12。
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[Abstract]
Objective To investigate the effects of metformin on Vit B12, MMA and neuropathy in type 2 diabetic patients.Methods A total of 60 insulin-treated patients with type 2 diabetes were enrolled. They were randomly divided into the observation group and the control group, then they were treated with metformin or placebo for 52 months. We compared the level of FPG、PPPG、HbA1c、Vit B12、MMA and Neuropathy Scores before and after treatment between the two groups.Results After treatment with metformin for 3 years, FPG, PPPG and HbA1c in the observation group were decreasing significantly(P<0.05), and those in the observation group were significantly lower in the control group. The scores ofneuropathy and MMA in the two groups were increasing significantly, the observation group was significantly higher than the control group (P<0.05). Meanwhile, Vit B12 were decreasing significantly, the observation group was significantly lower than the control group (P<0.05).Conclusions Metformin not only reduces serum levels of B12, but also increases serum MMA progressively. The increase of MMA was associated with the NPS significantly. These results suggested that monitoring of B12 in users of metformin should be considered
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