摘要
目的 探究司美格鲁肽联合二甲双胍治疗2型糖尿病合并周围神经病变(DPN)的疗效及对体重的影响.方法 将2023年1月至2024年2月在黑龙江省医院接受治疗的80例DPN患者纳入本次前瞻性研究,按照随机数字表法将其分为观察组(n=40)和对照组(n=40).观察组患者接受二甲双胍+甲钴素+司美格鲁肽治疗,对照组患者接受二甲双胍+甲钴素治疗,治疗时间为6周.比较两组的临床疗效,治疗前及治疗6周后的血糖相关指标[空腹血糖和餐后2 h血糖(2 hPG)、糖化血红蛋白(HbA1c)、胰岛素抵抗指数(HOMA-IR)]、体重指数(BMI)、多伦多临床评分系统(TCSS)评分、双侧正中神经及腓总神经的电流感觉阈值(CPT)、双侧腓肠神经传导速度(CV).结果 观察组的总有效率为95.00％,显著高于对照组(80.00％),差异有统计学意义(P＜0.05).观察组治疗6周后的血糖相关指标(空腹血糖、2 hPG、HbA1c和HOMA-IR)均显著低于对照组,差异均有统计学意义(P＜0.05).观察组治疗6周后的BMI和TCSS 评分分别为(24.68±1.19)kg/m2、(7.72±1.23)分,均较对照组[(25.60±1.22)kg/m2、(9.34±1.17)分]显著降低,差异均有统计学意义(P＜0.05).观察组治疗6周后的2 000、250、5 Hz的左侧正中神经、右侧正中神经、左侧腓总神经、右侧腓总神经CPT均显著低于对照组,差异均有统计学意义(P＜0.05).观察组治疗6周后的左侧腓肠神经和右侧腓肠 NCV 分别为(45.62±4.51)、(43.79±4.17)m/s,均较对照组[(39.06±4.05)、(40.36±4.01)m/s]显著升高,差异均有统计学意义(P＜0.05).结论 司美格鲁肽联合二甲双胍治疗DPN的疗效良好,可有效控制血糖和体重,显著改善临床症状和胰岛素抵抗,提高神经传导速度,减少感觉神经亚群损伤.
Abstract
Objective To investigate the efficacy of semaglutide combination with metformin in the treatment of diabetic peripheral neu-ropathy(DPN)and its impact on body weight.Methods Eighty patients with DPN admitted to Heilongjiang Province Hospital from January 2023 to February 2024 were included in this prospective study and were divided into the observation group(n=40)and the control group(n=40)according to the random number table method.The observation group received metformin+cobamamide+bevacizumab treatment,while the control group received metformin+cobamamide treatment.The treatment duration was 6 weeks.The clinical efficacy,changes in blood glucose related in-dexes[including fasting blood glucose and 2 h postprandial blood glucose(2 hPG),glycosylated hemoglobin(HbA1c),insulin resistance index(HOMA-IR)],body mass index(BMI),Toronto clinical scoring system(TCSS),current perception threshold(CPT)of bilateral median nerve and common peroneal nerve,conduction velocity(CV)of bilateral sural nerve before treatment and after 6 weeks of treatment were compared.Results The total effective rate of the observation group was 95.00％,obvously higher than the control group(80.00％),and the difference was statistically significant(P＜0.05).The blood glucose related indicators(including FPG,2 hPG,HbA1c,and HOMA-IR)in the observation group after 6 weeks of treatment were lower than those in the control group,the differences were statistically significant(P＜0.05).The BMI and TCSS scores of the observation group after treatment were(24.68±1.19)kg/m2 and(7.72±1.23)points,respectively,which were lower than those of the control group[(25.60±1.22)kg/m2 and(9.34±1.17)points],the differences were statistically significant(P＜0.05).The left median nerve,right median nerve,left common peroneal nerve,and right common peroneal nerve CPT of 2 000,250,5 Hz in the observation group after treatment were lower than those in the control group,the differences were statistically significant(P＜0.05).The CV of the left and right sural nerves in the observation group after 6 weeks of treatment were(45.62±4.51)and(43.79±4.17)m/s,respectively,which were higher than those in the control group[(39.06±4.05)and(40.36±4.01)m/s],the differences were statistically significant(P＜0.05).Conclusion Semaglutide combination with metformin has good clinical efficacy in treating DPN.It effectively controls blood glucose and body weight,significantly improves clinical symptoms and insulin resistance,and improves nerve conduction velocity and sensory nerve damage.
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