·糖尿病临床研究·

　　【摘要】　目的 探讨T2DM患者应用二甲双胍对血清VitB12水平及同型半胱氨酸(Hcy)的影响。研究甲钴胺治疗口服二甲双胍的T2DM患者引起VitB12缺乏及Hcy升高的临床意义。 方法 采用前瞻性病例对照研究，将T2DM患者随机分为二甲双胍降糖(A)组和为其他降糖药物(B)组。6个月后测定两组VitB12、Hcy及HbA1c等水平，并给予A组辅助口服甲钴胺3个月后，再次测定上述实验指标，进行对照分析。结果　 A组血清VitB12[(347.21±21.18)vs(392.52±18.34)ng/L及Hcy[( 14.13±2.46) vs (11.02±1.96)μmol/L]与B组比较，差异有统计学意义(P<0.05)。A组口服二甲双胍+口服甲钴胺较单纯口服二甲双胍时VitB12升高，Hcy下降(P<0.05)。VitB12与Hcy呈负相关(r =-0.281，P<0.05)。结论　二甲双胍可能是糖尿病患者出现VitB12水平降低，同型半胱氨酸升高的原因之一，应定期监测VitB12、Hcy水平,适时补充甲钴胺。

　　【关键词】　糖尿病，2型;甲钴胺;同型半胱氨酸;维生素B12;二甲双胍

The clinical significance of mecobalamin treatment on type 2 diabetic patients with oral metformin LUO Wei，YAO Yong-li，FAN Pei-yun. Qinghai People's Hospital，Xining，810007,China

　　【Abstract】Objective To investigate clinical significance of mecobalamin on type 2 diabetic patients with oral metformin, and the effects of metformin on serum vitamin B12 and homocysteine (Hcy) in the type 2 diabetic patients. Methods 80 T2DM patients were divided into group A (taking metformin) and group B (taking other hypoglycaemic agents) in a prospective, case-controlled study. The levels of VitaminB12, Hcy and glycated hemoglobin of two groups were determined 6 month later and then patients in group A were given mecobalamin as accessory treatment for three months before above indicators were determined again and compared with those of control. Results In comparison difference in Vitamin B12 [(347.21±21.18) vs (392.52±18.34)ng/L] and in Hcy levels [(14.13±2.46 ) vs (11.02±1.96)μmol/L (all P<0.05)], group A had vitamin B12 level was decreased and Hcy was significantly increased after 3 months’ treatment. vitamin B12 was negatively correlated with Hcy (r =﹣0.281，P<0.05). Conclusion Metformin might play a role in increasing the level of Hcy and decreasing the level of vitamin B12. The levels of Vitamin B12 and Hcy should be periodically monitored so as to give in time mecobalamin treatment.

　　【Key Words】　Diabetes mullitus，type2;Mecobalamin;Homocysteine(Hcy) ;Vitamin B12;Metformin