甲钴胺与维生素B_(12)治疗早期脊髓亚急性联合变性临床研究
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摘要
目的:探讨甲钴胺与维生素B_(12)治疗早期脊髓亚急性联合变性(SCD)的疗效差异。方法:将确诊为SCD的64例患者均分为两组,维B组在常规治疗基础上注射维生素B_(12)和维生素B_1,钴胺组则肌注甲钴胺实施治疗。对比两组治疗前后红细胞数目、血红蛋白及血清维生素B_(12)变化;从步态、感觉障碍及锥体束受累3个维度评估两组患者神经系统损伤程度;统计两组治疗效果及不良反应情况。结果:治疗后,两组红细胞数目、血红蛋白及血清维生素B_(12)水平均明显升高(P<0.05),步态、感觉障碍及锥体束受累3个维度的神经系统损伤评分明显下降(P<0.05),且钴胺组红细胞数目、血红蛋白水平均明显高于维B组(P<0.05),3个维度神经系统损伤评分明显低于维B组(P<0.05),但两组治疗后在血清B_(12)水平间差异无统计学意义(P>0.05)。钴胺组总有效率为93.75%,明显高于维B组(75.00%)(P>0.05),但两组不良反应发生情况间差异无统计学意义(P>0.05)。结论:甲钴胺是治疗早期SCD的有效药物,可有效改善患者贫血症状,促进神经系统损伤恢复,改善患者生活质量,且安全性高。
Objective To investigate the effect of mecobalamin and vitamin B_(12) in the treatment of early subacute combined degeneration(SCD)of the spinal cord.Methods The 64 patients who were diagnosed as SCD in the outpatient department of neurology department of Shaanxi Provincial Friendship Hospital from January 2015 to February 2018 were divided into two groups.In group B,vitamin B_(12) and vitamin B_1 were injected on the basis of conventional treatment,cobalamin group was treated with intramuscular mecobalamin.The changes in the number of red blood cells,hemoglobin,and serum vitamin B_(12) before and after treatment were compared in both groups.The degree of nervous system damage was evaluated in three dimensions of gait,sensory disturbance and pyramidal tract involvement.The treatment effects and adverse reactions of the two groups were recorded.Results After treatment,the number of red blood cells,hemoglobin,and serum vitamin B_(12) levels increased significantly in both groups(P<0.05),three-dimensional neurological impairment scores for gait,sensory impairment,and pyramidal tract involvement decreased significantly(P<0.05),and the number of red blood cells and hemoglobin were significantly higher in the Cobalamin group than those in Group B(P<0.05),three-dimensional neurological impairment scores of neurological injury were significantly lower than those in group B(P<0.05).However,there was no significant difference in serum B_(12) levels between the two groups after treatment(P>0.05).The total effective rate of the cobalamin group was 93.75%,which was significantly higher than that in group B(75.00%)(P<0.05).However,there was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion:Methylcobalamin is an effective drug for the treatment of early SCD,which can effectively improve the symptoms of anemia in patients,promote the recovery of nervous system damage,improve the quality of life of patients,and have high safety.
Objective To investigate the effect of mecobalamin and vitamin B_(12) in the treatment of early subacute combined degeneration(SCD)of the spinal cord.Methods The 64 patients who were diagnosed as SCD in the outpatient department of neurology department of Shaanxi Provincial Friendship Hospital from January 2015 to February 2018 were divided into two groups.In group B,vitamin B_(12) and vitamin B_1 were injected on the basis of conventional treatment,cobalamin group was treated with intramuscular mecobalamin.The changes in the number of red blood cells,hemoglobin,and serum vitamin B_(12) before and after treatment were compared in both groups.The degree of nervous system damage was evaluated in three dimensions of gait,sensory disturbance and pyramidal tract involvement.The treatment effects and adverse reactions of the two groups were recorded.Results After treatment,the number of red blood cells,hemoglobin,and serum vitamin B_(12) levels increased significantly in both groups(P<0.05),three-dimensional neurological impairment scores for gait,sensory impairment,and pyramidal tract involvement decreased significantly(P<0.05),and the number of red blood cells and hemoglobin were significantly higher in the Cobalamin group than those in Group B(P<0.05),three-dimensional neurological impairment scores of neurological injury were significantly lower than those in group B(P<0.05).However,there was no significant difference in serum B_(12) levels between the two groups after treatment(P>0.05).The total effective rate of the cobalamin group was 93.75%,which was significantly higher than that in group B(75.00%)(P<0.05).However,there was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion:Methylcobalamin is an effective drug for the treatment of early SCD,which can effectively improve the symptoms of anemia in patients,promote the recovery of nervous system damage,improve the quality of life of patients,and have high safety.
引文
[1]马亚玲,刘彦西,张斌,等.脊髓亚急性联合变性38例临床与神经电生理特点分析[J].陕西医学杂志,2011,40(8):1083-1084.
[2]文钦生,杨劲松,张玉松.八珍汤治疗脊髓亚急性联合变性的疗效观察[J].中西医结合心脑血管病杂志,2017,15(19):2485-2487.
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[4]吴琳,陈雯,李鹏程,等.甲钴胺与维生素B1联合维生素B12治疗视神经炎的疗效比较[J].中国实用医药,2016,11(14):5-7.
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[9]Ghazala S,Alhazmi A,Almalki A.Skin Hyperpigmentation as the Presenting Symptom of Subacute Combined Degeneration of the Spinal Cord:[J].Case Reports in Neurological Medicine,2017,22(5):1-3.
[10]翟跃芬,王虎清,杜赟,等.脊髓亚急性联合变性患者血清维生素B12水平与临床表现的分析[J].中国临床神经科学,2017,25(1):31-39.
[11]曹西军,吴虎平.维生素B12配合地塞米松面神经根部注射治疗周围性面神经麻痹28例[J].陕西医学杂志,2011,40(2):253-253.
[12]Chin J,Forzani B,Chowdhury N,et al.Rehabilitation essential in the recovery of muhifactorial subacute combined degeneration[J].Ann Phys Rehabil Med,2015,58(3):190-192.
[13]赵斌,李鹏鹏,赵轶波,等.颈椎椎板成形术结合维生素B12治疗合并脊髓亚急性联合变性的脊髓型颈椎病[J].中华骨科杂志,2017,37(5):305-310.
[14]肖洋,何晶.疏血通联合甲钴胺穴位注射治疗糖尿病周围神经病变50例[J].陕西中医,2014,35(9):1178-1179.
[15]侯静雯,侯志梅,王娜,等.依帕司他联合甲钴胺治疗老年2型糖尿病周围神经病变的疗效[J].医学综述,2017,23(5):1013-1017.
[16]刘瑗.甲钴胺和地塞米松治疗腰-硬联合麻醉后神经根损伤早期疗效评价[J].中国医药导刊,2012,14(7):1218-1219.
[2]文钦生,杨劲松,张玉松.八珍汤治疗脊髓亚急性联合变性的疗效观察[J].中西医结合心脑血管病杂志,2017,15(19):2485-2487.
[3]尹建峰.骶管注射维生素B12治疗脊髓亚急性联合变性15例分析[J].中国误诊学杂志,2008,8(15):3748-3748.
[4]吴琳,陈雯,李鹏程,等.甲钴胺与维生素B1联合维生素B12治疗视神经炎的疗效比较[J].中国实用医药,2016,11(14):5-7.
[5]靳梅,谢炳玓.亚急性脊髓联合变性的临床表现与血清学检查的相关分析[J].实用医学杂志,2010,26(7):1170-1172.
[6]孙秀娟.17例慢性酒精中毒并脊髓亚急性联合变性的临床分析[J].中国医学工程,2013,21(7):182-182.
[7]朱海兵,欧阳桂兰,余海.老年人脊髓亚急性联合变性的临床分析[J].中华老年心脑血管病杂志,2016,18(2):175-178.
[8]王静,冯国栋,吴中亮,等.原发性干燥综合征并脊髓病变误诊为脊髓亚急性联合变性[J].临床误诊误治,2013,26(4):61-63.
[9]Ghazala S,Alhazmi A,Almalki A.Skin Hyperpigmentation as the Presenting Symptom of Subacute Combined Degeneration of the Spinal Cord:[J].Case Reports in Neurological Medicine,2017,22(5):1-3.
[10]翟跃芬,王虎清,杜赟,等.脊髓亚急性联合变性患者血清维生素B12水平与临床表现的分析[J].中国临床神经科学,2017,25(1):31-39.
[11]曹西军,吴虎平.维生素B12配合地塞米松面神经根部注射治疗周围性面神经麻痹28例[J].陕西医学杂志,2011,40(2):253-253.
[12]Chin J,Forzani B,Chowdhury N,et al.Rehabilitation essential in the recovery of muhifactorial subacute combined degeneration[J].Ann Phys Rehabil Med,2015,58(3):190-192.
[13]赵斌,李鹏鹏,赵轶波,等.颈椎椎板成形术结合维生素B12治疗合并脊髓亚急性联合变性的脊髓型颈椎病[J].中华骨科杂志,2017,37(5):305-310.
[14]肖洋,何晶.疏血通联合甲钴胺穴位注射治疗糖尿病周围神经病变50例[J].陕西中医,2014,35(9):1178-1179.
[15]侯静雯,侯志梅,王娜,等.依帕司他联合甲钴胺治疗老年2型糖尿病周围神经病变的疗效[J].医学综述,2017,23(5):1013-1017.
[16]刘瑗.甲钴胺和地塞米松治疗腰-硬联合麻醉后神经根损伤早期疗效评价[J].中国医药导刊,2012,14(7):1218-1219.