标题：尼莫地平辅助治疗2型糖尿病周围神经病变的疗效及对患者血清神经标志物及FGF21的影响

      作者：路玉洁，南飞宁，高翠贤，邹湘君    陕西省第四人民医院消化内分泌科，陕西 西安 710043

      卷次： 2023年34卷3期

      【摘要】 目的 观察尼莫地平辅助治疗2型糖尿病周围神经病变的疗效，并探讨其对患者血清神经标志物及成纤维细胞生长因子(FGF21)的影响。方法 选择2020年1月至2021年12月陕西省第四人民医院消化内分泌科收治的92例2型糖尿病周围神经病变患者为研究对象，按随机数表法分为观察组和对照组各46例。对照组患者在常规治疗基础上给予甲钴胺注射液治疗，观察组患者在对照组治疗的基础上联合尼莫地平辅助治疗，所有患者均持续接受4周治疗。比较两组患者治疗4周后的临床疗效，以及治疗前、治疗4周后的正中神经、腓总神经的感觉神经传导速度(SNCV)、运动神经传导速度(MNCV)和血清磷髓脂碱性蛋白(MBP)、脑源性神经营养因子(BDNF)、神经生长因子(NGF)、FGF21水平以及治疗期间的不良反应发生情况。结果 治疗后，观察组患者的临床疗效总有效率为89.13%，明显高于对照组的69.57%，差异有统计学意义(P<0.05)；治疗后，观察组患者的正中神经SNCV、腓总神经 SNCV、正中神经MNCV、腓总神经MNCV分别为(46.73±3.08) m/s、(45.12±3.36) m/s、(47.72±3.31) m/s、(44.21±3.83) m/s，明显快于对照组的(43.18±3.17) m/s、(42.08±3.45) m/s、(43.64±3.82) m/s、(40.18±3.19) m/s，差异均有统计学意义(P<0.05)；治疗后，观察组患者的血清MBP水平为(2.22±0.36) μg/L，明显低于对照组的(3.17±0.69) μg/L，BDNF、NGF水平分别为(4.36±0.47) ng/L、(4.73±0.85) ng/L，明显高于对照组的(3.21±0.39) ng/L、(3.60±0.56) ng/L，差异均有统计学意义(P<0.05)；治疗后，观察组患者的血清 FGF21水平为(521.23±67.11) μg/L，明显低于对照组的(602.45±83.28) μg/L，差异有统计学意义(P<0.05)；观察组和对照组患者的总不良反应发生率分别为 15.22%和10.87%，差异无统计学意义(P>0.05)。结论 尼莫地平辅助治疗2型糖尿病周围神经病变患者的疗效明显，其不仅可有效调节患者的血清神经标志物及FGF21水平，还可提高神经传导速度，且安全性好，值得临床推广应用。
      【关键词】 糖尿病周围神经病变；尼莫地平；神经标志物；纤维细胞生长因子；疗效；不良反应
      【中图分类号】 R587.1 【文献标识码】 A 【文章编号】 1003—6350（2023）03—0322—05

Efficacy of nimodipine in the adjuvant treatment of type 2 diabetic peripheral neuropathy and its effect on serumneural markers and FGF21.
LU Yu-jie, NAN Fei-ning, GAO Cui-xian, ZOU Xiang-jun. Department of Digestion andEndocrinology, Shaanxi Fourth People's Hospital, Xi'an 710043, Shaanxi, CHINA
【Abstract】 Objective To observe the efficacy of nimodipine in the adjuvant treatment of type 2 diabetic pe-ripheral neuropathy, and to explore its effect on serum neural markers and fibroblast growth factor (FGF21) in patients.Methods A total of 92 patients with type 2 diabetic peripheral neuropathy admitted to Department of Digestive Endo-crinology, Shaanxi Fourth People's Hospital from January 2020 to December 2021 were selected as the research objects.They were divided into an observation group and a control group by random number table method, with 46 cases in eachgroup. The control group was given mecobalamin injection in addition to conventional treatment, and the observationgroup was given adjuvant treatment with nimodipineon on the basis of the treatment in the control group, both for 4weeks. The clinical efficacy at 4 weeks after treatment was compared between the two groups, as well as the sensorynerve conduction velocity (SNCV), motor nerve conduction velocity (MNCV) of median nerve and common peronealnerve, and myelin basic protein (MBP), brain derived neurotrophic factor (BDNF), nerve growth factor (NGF), FGF21level at before and 4 weeks after treatment, and adverse reactions occurred during the study. Results After treatment,the total effective rate in the observation group was 89.13%, which was significantly higher than 69.57% in the controlgroup (P<0.05); after treatment, the median nerve SNCV, common peroneal nerve SNCV, median nerve MNCV, andcommon peroneal nerve MNCV in observation group were (46.73±3.08) m/s, (45.12±3.36) m/s, (47.72±3.31) m/s, (44.21±3.83) m/s, which were significantly faster than (43.18±3.17) m/s, (42.08±3.45) m/s, (43.64±3.82) m/s, (40.18±3.19) m/s inthe control group (P<0.05). After treatment, the serum MBP level in the observation group was (2.22±0.36) μg/L, whichwas significantly lower than (3.17±0.69) μg/L in the control group, and the BDNF and NGF levels were (4.36±0.47) ng/L,(4.73±0.85) ng/L, which were significantly higher than (3.21±0.39) ng/L, (3.60±0.56) ng/L in the control group, with sta-tistically significant difference (P<0.05). After treatment, the serum FGF21 levels in the observation group was (521.23±67.11) μg/L, which was significantly lower than (602.45±83.28) μg/L in the control group (P<0.05). The total incidenceof adverse reactions was 15.22% in the observation group and 10.87% in the control group, with no statistically signifi-cant difference (P>0.05). Conclusion Nimodipine is effective in the adjuvant treatment of patients with type 2 diabeticperipheral neuropathy, and it can not only effectively regulate the serum nerve markers and FGF21 levels, but also im-prove nerve conduction velocity, with good safety, which is worthy of clinical application.
      【Key words】 Diabetic peripheral neuropathy; Nimodipine; Neural markers; Fibrocyte growth factor; Curative ef-fect; Adverse reactions