Effects Of Combined Treatment With Mecobalamine And Pancreatic Kininogenase In VPT In Diabetic Peripheral Neuropathy

Diabetic peripheral neuropathy is the most common chronic complication of diabetes, and one of the major causes of disability, which impacts seriously on the quality of patients'lives. Strict blood glucose control is the basic measure of preventing diabetic peripheral neuropathy. On this basis, the application of mecobalamine treatment for diabetic peripheral neuropathy is found to be in favor of the nerve injury repair. Mecobalamine can effectively alleviate diabetic peripheral neuropathy symptoms, and increase peripheral nerve conduction velocity and reduce side effects, which is an effective and practical treatment of diabetic peripheral neuropathy. Mecobalamine is the promising drug of diabetic peripheral neuropathy treatment. Mecobalamine combined with pancreatic kininogenase when used for the treatment of diabetic peripheral neuropathy can expand microvasculature more effectively, reduce blood viscosity, improve ischemia and hypoxia, increase nerve conduction velocity and improve the clinical symptoms. Since they have good effect on improving symptom and sign with no obvious side effects, they are better than mecobalamine alone. Mecobalamine combined with pancreatic kininogenase is a safe, convenient and effective way in treating diabetic peripheral neuropathy with fewer side effects. It has better compliance in outpatient and hospitalized patients.Objective : To study the effects of combined treatment with mecobalamine and pancreatic kininogenase in vibration perception threshold in patients with diabetic peripheral neuropathy. Method:60 patients were selected from January 2010 to January 2011 diagnosed as DPN according to 1999 WHO diabetes mellitus diagnostic criteria. We randomly divided into mecobalamine combined with pancreatic kininogenase treatment group of 30 cases, 13 males and 17 females; and mecobalamine alone group of 30 cases, 16 males and 14 females, aged 50 to 70years, medical history of 5 to 20 years. They had various degrees of numbness, pain, paresthesia and other symptoms before admission. The exclusion criteria were patients having surgery, trauma, drugs, genetic factors and other metabolic factors induced neuropathy. The two groups were statistically significantly different in age, gender, disease duration (P>0.05). Cases were confirmed according to the 1999 WHO diagnostic criteria for diabetes and with any point of the following: (1) Symmetrical and significant sensory impairments of the lower extremities, such as numbness, needle-like, burning, flashing pain, a knife like pain, coldness or accompanied by weakness.(2)Neurologic examination with different degrees of pain, temperature sense, altered or slow, weak or abnormal sensitivity, significantly decreased sensation of feeling, tuning fork vibration sense weakened and reduced or lost limbs tendon reflexes; (3) nerve velocity conduction suggestive of significant barriers to exercise, nerve conduction velocity(MNCV)and sensory nerve conduction velocity(SNCV)were significantly slowed down. All patients with diabetes were managed through education, appropriate exercise, with diabetic diet, regular insulin or oral hypo glycemic agents for glycemic control. On this basis, the treatment group were given 0.9% sodium chloride solution 20ml, mecobalamine (trade name: mecobalamine, the Japanese company Eisai) 500μg, 1 time/day, intravenous injection; while giving the pancreatic kininogenase Enzyme (trade name: Yee On, Benny Biochemical Pharmaceutical Co., Ltd. Changzhou production) 40u, 1 time/day, intramuscular injection for 4 weeks. The control group was given 20ml of 0.9% sodium chloride solution, mecobalamine (trade name: mecobalamine, the Japanese company Eisai) 500μg, 1 time/day, intravenous injection for 4 weeks. Vibration perception threshold inspection: Using the United States production of digital vibration perception threshold inspection apparatus Sensitometer A, under constant temperature(22±10)℃, the vibration perception threshold was detected in supine position. All the patients in case as well as control group were examined for vibration perception threshold. The data were expressed as ( x±s) and the mean between the two groups were compared using t test. The vibration perception threshold between the two groups was compared by x2 test, P<0.05 was considered statistically significant.Result : After treatment with mecobalamine, vibration perception threshold was lower, but after treatment with mecobalamine combined with pancreatic kininogenase it was significantly lower(P<0.01), and there was significantly different (P<0.01) between the two groups. The total effective rate of combined treatment group was significantly better than single treatment group (P<0.05).Conclusion:Mecobalamine combined with pancreatic kininogenase significantly reduced the vibration perception threshold in patients with diabetic peripheral neuropathy, and had important role in the treatment of diabetic peripheral neuropathy.