摘要目的 探究甲钴胺联合叶酸治疗2型糖尿病肾病(DN)伴高血清同型半胱氨酸(Hcy)血症患者的临床疗效及安全性.方法 回顾性分析2015年8月至2016年7月期间本院收治的70例2型DN伴高Hcy血症患者分为两组,各35例.对照组采用常规西药综合治疗(短效注射胰岛素、盐酸贝那普利片、缬沙坦分散片),观察组在此基础上辅以甲钴胺联合叶酸治疗,两组均连续治疗52周,对比两组临床疗效及两组治疗前后24 h尿蛋白定量(24 h Pro)、血Hcy水平,并记录两组治疗安全性.结果 观察组总有效率为88.6％(31/35),高于对照组的77.1％(27/35)(P<0.05).观察组治疗后12、20、36、52周的24 h Pro均低于同期对照组(P<0.05).观察组治疗后12、20、36、52周的血Hcy均分别低于同期对照组(P<0.05).两组均未发生严重药物不良反应.结论 对DN伴高Hcy血症患者加用甲钴胺、叶酸治疗的临床疗效确切,有助于降低血Hcy水平,以减少尿蛋白排泄,且治疗安全可靠.

abstractsObjective To investigate the clinical efficacy and safety of mecobalamin combined with folic acid in the treatment of type 2 diabetic nephropathy(DN) with high serum homocysteine. Methods From August 2015 to July 2016, a retrospective analysis of 70 patients with type 2 DN with high Hcy levels in our hospital were divided into two groups, 35 cases in each group. Control group underwent conventional western medicine comprehensive treatment ( short-acting insulin injections, hydrochloric acid that captopril and valsartan tablets) for 52 weeks, the observation group received combined therapy with folic acid, cobalt amine on the basis of control group for 52 weeks. Clinical cur-ative effect, the 24 h urine protein quantitative (24 h Pro) before and after treatment, blood levels of Hcy and security in two groups were compared. Results The total effective rate in the observation group was ,higher than that in the control group (88. 6％ vs. 77. 1％,P<0. 05). In the observation group, 24 h Pro at 12, 20, 36 and 52 weeks after treatment was (1135. 76 ± 175. 69) mg/24 h, (831. 02 ± 165. 71) mg/24 h, (423. 14 ± 102. 93) mg/24 h, (165. 05 ± 73. 36) mg/24 h, respec-tively. They were all lower than the control group ( 1524. 83 ± 183. 24 ) mg/24 h, ( 1057. 69 ± 143. 35) mg/24 h, (785. 68 ± 114. 39) mg/24 h, (423. 17 ± 109. 27) mg/24 h (P<0. 05). Blood Hcy of the observation group at 12, 20, 36 and 52 weeks after treatment was (18. 25 ± 1. 13) μmol/L, (14. 32 ± 1. 22) μmol/L, (10. 53 ± 1. 09) μmol/L, (6. 15 ± 1. 15) μmol/L, (19. 58 ± 1. 31)μmol/L,(16.31±1.18) μmol/L,(12.67±1.09) μmol/L(P<0.05),respectively. Noserious adverse drug reactions occurred in either group. Conclusions The treatment of DN with high Hcy with addition of mecobalamin and folic acid has a definite clinical effect, which is helpful to reduce the level of blood Hcy in order to reduce the excretion of urinary protein, and the treatment is safe and reliable.