JCEM：长期应用二甲双胍与维生素B12缺乏相关（DPPOS研究）？

2016-03-06 MedSci MedSci原创

来自纽约阿尔伯特 ·爱因斯坦医学院的Crandall JP博士和同事对糖尿病预防计划(DPP)和糖尿病预防计划结果研究(Diabetes Prevention Program Research Group，DPPOS)中1073 名接受二甲双胍治疗和1082名接受安慰剂的参与者3.2 年的随访数据进行分析，以确定长期应用二甲双胍对维生素B12的影响。随后，参与者再次接受9年的非盲二甲双胍

来自纽约阿尔伯特 ·爱因斯坦医学院的Crandall JP博士和同事对糖尿病预防计划(DPP)和糖尿病预防计划结果研究(Diabetes Prevention Program Research Group，DPPOS)中1073 名接受二甲双胍治疗和1082名接受安慰剂的参与者3.2 年的随访数据进行分析，以确定长期应用二甲双胍对维生素B12的影响。

随后，参与者再次接受9年的非盲二甲双胍治疗。研究人员分别在第5年和(n = 857，安慰剂;n = 858，二甲双胍)第13年时(n = 756，安慰剂;n = 764，二甲双胍)对参与者B12水平进行评估。

与安慰剂组相比，二甲双胍组在第5年时维生素B12平均水平低10% (P =0 .02)。维生素的B12缺乏在二甲双胍组更普遍且整个研究中人数在增加。第5年时维生素B12缺乏的参与者在第13年时仍然缺乏情况：安慰剂组比例为38%，二甲双胍组比例为45%。

维生素B12缺乏的风险增加与二甲双胍使用时间的增加相关(B12缺乏/二甲双胍使用年限的OR= 1.13;95% CI，1.06-1.2)。二甲双胍组贫血发生率更高。在二甲双胍组中，与B12水平正常的参与者相比， B12水平较低的参与者神经病变的发生率更高(P = 0.03)。

研究人员写道：“考虑到二甲双胍是治疗2型糖尿病的一线药物，而且因为其他适应症(包括高风险的糖尿病、妊娠糖尿病、多囊卵巢综合征)而接受二甲双胍治疗的个体越来越多。因此了解长期接受二甲双胍治疗带来的潜在不利后果至关重要。DPP/DPPOS的长期随访数据支持二甲双胍与维生素B12缺乏相关。因此接受二甲双胍治疗的个体应考虑常规测定维生素B12 。”

此前荷兰学者发现，2型糖尿病患者长期使用二甲双胍会增加维生素B12缺乏的危险，导致同型半胱氨酸（Hcy）浓度升高。由于维生素B12缺乏是可以预防的，因此，患者长期使用二甲双胍时应定期检测维生素B12的浓度。相关论文发表于《英国医学杂志》（BMJ 2010，340：c2198）。

2012一项研究也得出相似结果，详细见：久服二甲双胍的T2DM患者维生素B12缺乏与神经病变高发相关

原始出处：

Aroda VR, Edelstein SL, Goldberg RB, Knowler WC, Marcovina SM, Orchard TJ, Bray GA, Schade DS, Temprosa MG, White NH, Crandall JP; Diabetes Prevention Program Research Group. Long-term Metformin Use and Vitamin B12 Deficiency in the Diabetes Prevention Program Outcomes Study. J Clin Endocrinol Metab. 2016 Feb 22:jc20153754.

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2016-10-26 smallant2015

#JCEM#

31 0
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2016-06-30 achengzhao

#JCE#

0 0
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2016-10-16 12498adam40暂无昵称

#维生素B12缺乏#

42 0
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2016-03-08 bnjfx@127.com

#维生素B12#

38 0
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2016-03-08 马龙

#维生素B#

36 0
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2016-03-06 layyjiangli

口服二甲双胍后是否需要常规补充维生素B12呢

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JCEM：长期应用二甲双胍与维生素B12缺乏相关（DPPOS研究）？

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