Objective To assess the efficacy of mecobalamine and calcium carbonate in treatment of metformin-related vitamin B12 deficiency.Methods Ninety type 2 diabetic patients,who received metformin for more than six months and with serum vitamin B12＜200pg/ml,were randomly divided into mecobalamine group (n=27),calcium carbonate group (n=29) and mecobalamine+calcium carbonate group(n=26).Serum vitamin B12,folic acid and anemia related indicators were measured,and nerve conduction velocity was determined at baseline and 3,6 and 12 months after treatment.Results The serum vitamin B12,folic acid and Hb levels were increased,and the conduction velocity of the tibial nerve,total peroneal nerve,sural nerve,the superficial peroneal nerve were also increased.MCV and MCH were significantly decreased in mecobalamine group and combination group after treatment,compared with those before treatment(all P＜0.05),and those in calcium carbonate group after treatment (P＜0.05).The above parameters in the combination group were improved more markedly than those in mecobalamine group 12 months after treatment (all P＜0.05).There were no significant differences in above parameters of calcium carbonate group before and after treatment (P ＞0.05).Conclusion Mecobalamine combined with oral calcium can effectively increase serum levels of vitamin B12 and folic acid,improve the anemia and nerve conduction velocity in diabetic patients with metformin-associated vitamin B12 deficiency.%目的 观察甲钴胺或碳酸钙或两者合用对二甲双胍相关性维生素B12缺乏患者的治疗效果.方法 将90例连续服用二甲双胍片6个月以上,血清维生素B12＜200pg/ml的2型糖尿病患者,采用随机数字法分为3组,分别采用甲钴胺(27例)、碳酸钙(29例)、甲钴胺和碳酸钙联合(26例)治疗,所有患者均在初治时和治疗3、6、12个月时测定血清维生素B12、叶酸、贫血相关指标及神经传导速度,并进行治疗前后及组间比较.结果 甲钴胺组及甲钴胺和碳酸钙联合组治疗后血清维生素B12、叶酸、Hb水平及胫神经、腓总神经、腓肠神经、腓浅神经传导速度明显高(快)于治疗前(均P＜0.05),平均红细胞体积(MCV)、平均红细胞血红蛋白含量(MCH)明显低于治疗前(均P＜0.05),且均优于碳酸钙组(均P＜0.05),碳酸钙组治疗前后血清维生素B12及叶酸水平、贫血相关指标、神经传导速度均无统计学差异(均P ＞0.05),治疗12个月后甲钴胺和碳酸钙联合组维生素B12、叶酸、Hb、MCV、MCH及胫神经、腓总神经、腓肠神经、腓浅神经传导速度均优于甲钴胺组(均P＜0.05).结论 甲钴胺联合口服碳酸钙能有效提高血清维生素B12和叶酸水平,改善二甲双胍相关性维生素B12缺乏情况,防止贫血发生,改善神经传导速度,较单独应用碳酸钙或甲钴胺效果好.
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