慢性精神分裂症住院患者血清叶酸、维生素B12 及铁蛋白水平的研究

目的 探讨精神分裂症患者的血清叶酸、维生素B12及铁蛋白水平分布特点.方法 对1042例精神分裂患者进行血液采样,采用电化学发光技术检测血清叶酸、维生素B12、铁蛋白水平,并比较不同性别、年龄患者的水平差异.结果 精神分裂症患者中,较低维生素B12、叶酸及铁蛋白水平的发生率普遍>5%,低叶酸水平发生率高达38.29%,低维生素B12的发生率为18.14%.精神分裂症患者的叶酸水平存在性别差异(t=-5.83,P<0.01),维生素B12水平存在年龄差异(t=2.08,P<0.05).结论 慢性精神分裂症患者低血清维生素B12、叶酸及铁蛋白水平的发生率高,需要予以积极关注.     

Serum folate, vitamin B12, and homocysteine in major depressive disorder, Part 2: predictors of relapse during the continuation phase of pharmacotherapy

OBJECTIVE: In the present study, we assessed the relationship between serum folate, vitamin B12, and homocysteine levels on the rate of relapse in outpatients with remitted major depressive disorder (MDD) during a 28-week continuation phase of treatment with fluoxetine. METHOD: Seventy-one outpatients (mean +/- SD age = 40.2 +/- 11.1 years; 56.3% women) with MDD (as assessed with the Structured Clinical Interview for DSM-III-R) who had remitted and who were enrolled in the continuation phase of treatment with fluoxetine had serum folate, vitamin B12, and homocysteine measurements completed at baseline (prior to acute-phase treatment). Patients were followed for 28 weeks of continued treatment with fluoxetine 40 mg/day to monitor for depressive relapse. Folate levels were classified as either low (< or = 2.5 ng/mL) or normal. Vitamin B12 levels were classified as either low (< or = 200 pg/mL) or normal. Homocysteine levels were classified as either elevated (> or = 13.2 micromol/L) or normal. With the use of separate logistic regressions, we then assessed the relationship between folate, vitamin B12, and homocysteine level status and relapse. The study was conducted from November 1992 to January 1999. RESULTS: The presence of low serum folate levels (p =.004), but not low B12 (p >.05) or elevated homocysteine levels (p >.05), was associated with relapse during continuation treatment with fluoxetine. The relapse rates for patients with (N = 7) and without (N = 64) low folate levels were 42.9% versus 3.2%, respectively. CONCLUSION: Low serum folate levels were found to place patients with remitted MDD at risk for depressive relapse during the continuation phase of treatment with fluoxetine.     

Vitamin B12 and folic acid serum levels in obsessive compulsive disorder

Vitamin B12 and folate serum levels were studied in 30 patients with obsessive compulsive disorder (OCD), and in two control groups comprised of 30 chronic schizophrenics and 30 normal healthy subjects. Six patients (20%) of the OCD group had abnormal low levels of vitamin B12. This prevalence was significantly higher than that of the control groups. No clinical neurological or haematological abnormalities accompanied the reduced vitamin B12 levels. Possible implication of this finding for the pathophysiology of OCD in a subgroup of patients and the possibility that the B12 deficiency could be the consequence rather than the cause of OCD are suggested.     

Hyperhomocysteinemia in children treated with sodium valproate and carbamazepine

OBJECTIVE: To evaluate plasma homocysteine (Hcy) concentrations in children receiving sodium valproate (VPA) and carbamazepine (CBZ), monotherapy, in comparison with healthy control subjects and to determine the possible relationship between Hcy levels and dosage and plasma concentrations of the antiepileptic drugs. METHODS: We measured levels of fasting and post-methionine Hcy, plasma pyridoxal 5'-phosphate (PLP, active vitamin B6), serum folate, erythrocyte folate and serum vitamin B12 in 60 epileptic patients (29 females, 31 males), aged from 14.2 to 17.9 years, subdivided into two groups according to their therapy. Sixty-three healthy sex- and age-matched children served as controls. These measurements have been performed before the beginning of therapy and after 1 year of therapy with VPA or CBZ. RESULTS: Before the beginning of therapy, there were no significant differences in fasting and post-methionine Hcy, plasma PLP, serum folate, erythrocyte folate and serum vitamin B12 values between the control group and the two groups of epileptic children. After 1 year of therapy, patients treated with VPA and CBZ showed a significant increase of the plasma concentrations of Hcy when compared to baseline data and controls values. Moreover, was observed a significant decrease of serum folate and plasma PLP. On the contrary, serum vitamin B12 and erythrocyte folate levels remained in the normal range. CONCLUSIONS: Our study demonstrates that prolonged treatment with VPA and CBZ increases plasma concentrations of Hcy.     

Serum folate, vitamin B12, and homocysteine in major depressive disorder, Part 1: predictors of clinical response in fluoxetine-resistant depression

OBJECTIVE: In the present study, we assessed the relationship between serum folate, vitamin B12, and homocysteine levels and clinical response in patients with major depressive disorder (MDD) who had previously failed to respond to open treatment with fluoxetine 20 mg/day and were enrolled in a 4-week, double-blind trial of either (1) fluoxetine dose increase, (2) lithium augmentation of fluoxetine, or (3) desipramine augmentation of fluoxetine. METHOD: Fifty-five outpatients (mean +/- SD age = 41.7 +/- 10.6 years; 50.9% women) with MDD as assessed with the Structured Clinical Interview for DSM-III-R who were enrolled in the double-blind trial had serum folate, vitamin B12, and homocysteine measurements completed at baseline (prior to fluoxetine treatment initiation). Folate levels were classified as either low (< or = 2.5 ng/mL) or normal. Vitamin B12 levels were classified as either low (< or = 200 pg/mL) or normal. Homocysteine levels were classified as either elevated (> or = 13.2 micromol/L) or normal. With the use of a logistic regression, we then assessed the relationship between (1) low or normal folate levels, (2) normal or low B12 levels, and (3) elevated or normal homocysteine levels and clinical response to double-blind treatment. The study was conducted from November 1992 to January 1999. RESULTS: Low serum folate levels (chi2=3.626, p =.04), but not elevated homocysteine (p >.05) or low vitamin B12 levels (p >.05), were associated with poorer response to treatment. The response rates for patients with (N = 14) and without (N = 38) low folate levels were 7.1% versus 44.7%, respectively. CONCLUSION: Low serum folate levels were found to be associated with further treatment resistance among patients with fluoxetine-resistant MDD.     

Correlations between cognitive, behavioural and psychological findings and levels of vitamin B12 and folate in patients with dementia

BACKGROUND: Associations between low levels of folate and vitamin B12 and cognitive impairment in patients with dementia have been reported. Some studies revealed correlations between low levels of vitamin B12 and behavioural and psychological signs and symptoms of dementia (BPSD) in Alzheimer's disease (AD) patients. Given the lack of studies in frontotemporal dementia (FTD) and on folate and given the methodological shortcomings of former publications, we set up a prospective study. METHODS: At inclusion, AD (n=152) and FTD (n=28) patients underwent a neuropsychological examination. Behaviour was assessed using a battery of behavioural assessment scales. Determination of serum vitamin B12 and red cell folate levels were performed within a time frame of two weeks of inclusion. RESULTS: In both patient groups, significantly negative correlations between levels of serum vitamin B12 and red cell folate and the degree of cognitive deterioration were found. No correlations with BPSD were found in the AD patient group. In FTD patients, levels of vitamin B12 were negatively correlated with both hallucinations (p=0.022) and diurnal rhythm disturbances (p=0.036). CONCLUSIONS: The observed negative correlations between levels of vitamin B12 and folate and cognitive impairment in both AD and FTD patients, raise the possibility of a non-specific etiological role. Although levels of vitamin B12 and folate did not correlate with BPSD in AD patients, negative correlations between serum vitamin B12 levels and BPSD in FTD patients were revealed. Decreased serum vitamin B12 levels may predispose FTD patients to develop hallucinations and diurnal rhythm disturbances.     

Effect of Prolonged Anticonvulsant Medication in Epileptic Patients: Serum Lipids, Vitamins B6, B12, and Folic Acid, Proteins, and Fine Structure of Liver

Twenty-seven epileptic patients, most from low socioeconomic groups and aged 15-54 years, were studied for effects of prolonged anticonvulsant medication. They had received the usual doses of phenobarbitone and diphenylhydantoin (PHT) regularly for 3-32 years, with control of seizures, and had not taken any B-vitamins in the year before investigation. Besides reduced serum and cerebrospinal fluid (CSF) folate levels, significantly increased levels of total vitamin B6 in CSF and serum and of vitamin B12 in serum were found in patients as compared with normal healthy subjects. The bone marrow was normoblastic, and significant elevation of serum triglycerides and/or cholesterol was observed in patients. The total protein level was only slightly reduced as compared with that of controls, but there was significant increase in beta-lipoprotein fraction on gel electrophoresis. Plasma proteins concerned with vitamins and lipid transport showed no remarkable change, and no abnormal protein was detected. Although there was no clinical hepatic involvement, liver biopsy performed in 9 of 27 patients revealed fine structural changes in hepatocytes suggestive of varying degrees of drug-induced changes. A ramifying network of short, smooth, endoplasmic cisternae with depleted rough endoplasmic reticulum (RER), distended sinusoids with Kupffer cells, dark shrunken hepatocytes with reduced mitochondria, and increased lipofuscin were observed. This suggested an adaptive response of the liver, a reversible change, possibly related to the increased serum lipids in the same patients.     

MTHFR基因多态性及同型半胱氨酸与青年脑血管病的关系

目的:研究Ns,N10-亚甲基四氢叶酸还原酶(MTHFR)基因多态性及血浆同型半胱氨酸(Hcy)水平与青年脑血管病的关系。方法:研究对比40例青年脑血管病患者(首次发病年龄≤50岁)及32例健康青年人的MTHFR基因多态性及血浆Hcy水平。结果:(1)对照组及病例组T/T纯合子率分别为37.5％和22.5％;T等位基因频率分别为60.9％和51.3％,差异均无显著统计意义(均P>0.05)。(2)病例组血浆Hcy几何均值(11.0±2.3μmol/L)显著高于对照组(8.0±1.4μmol/L,P<0.05)。(3)所有受试者中T/T组Hcy值高于C/C组(10.4μmol/L和7.6μmol/L),但差异无显著性(P>0.05)。结合叶酸考虑,进一步将所有受试者按叶酸中位数水平分组。叶酸中位数以下组中,T/T组Hcy值显著高于C/C组(P<0.05);而叶酸中位数以上组中,T/T组Hcy值与C/C组无显著差异。(4)血浆Hcy与叶酸、维生素B12呈显著负相关,与肌酐呈显著正相关。吸烟者血浆Hcy水平显著高于不吸烟者(P<0.05)。结论:(1)本组人群MTHFR基因C677T突变的纯合子在低叶酸状态下可引起血浆Hcy水平显著增高,但与青年脑血管病无显著关系。MTHFR基因677TT纯合突变可能为健康青年人脑血管的保护因素。(2)血浆Hcy水平与青年脑血管病的发生密切相关。(3)叶酸、维生素B12肌酐、吸烟是Hcy的非遗传影响因素。     

Serum vitamin B12, folate,and homocysteine levels and their association with clinical and electrophysiological parameters in multiple sclerosis

Patients with multiple sclerosis (MS) may have low serum vitamin B12 and folate levels and high levels of homocysteine. We aimed to evaluate serum vitamin B12, folate, homocysteine, mean corpuscular volume (MCV), hemoglobin (Hb), and hematocrit (Hct) levels in patients with MS. We examined the relationship between these parameters and age, sex, disease type, age at onset, disease duration, Expanded Disability Status Score, immunoglobulin G (IgG) index, oligoclonal band presence, visual evoked potentials (VEP) and posterior tibial somatosensory evoked potentials (SEP). These parameters were evaluated in 35 patients during an acute attack and compared to data collected from 30 healthy individuals (control subjects). Serum vitamin B12, folate, homocysteine, Hb, and Hct levels and MCV were low in a proportion of patients with MS (20%, 14.3%, 20%, 6.7%, 3.3% and 10% respectively), whereas only vitamin B12 and folate levels were low in only 3.3% of the control subjects. Homocysteine levels were high in 20% of patients with MS but were within normal limits in the control group. Elevated Hct levels were significantly correlated (p < 0.05) with prolonged posterior tibial SEP P1 and P2 latencies compared to the control subjects. Patients with MS who had prolonged VEP and posterior tibial SEP P1 and P2 latencies also had lower vitamin B12 levels compared to patients with normal latencies. Thus, we found a significant relationship between MS and vitamin B12 deficiency, and also demonstrated a relationship between vitamin B12 deficiency, VEP and posterior tibial SEP in MS.     

血清叶酸、维生素B12水平与脑梗死的关系

目的为探讨血清叶酸、维生素B12水平与脑梗死的关系.方法运用放射免疫分析法检测50例脑梗死患者和44例正常对照组的血清叶酸、维生素B12浓度.结果脑梗死组血清叶酸、维生素B12浓度分别为(5.97±1.96)μg/ml、(511.47±212.06)μg/ml;对照组分别为(8.08±2.25)μg/ml、(806.91±254.60)μg/ml.脑梗死组血清叶酸、维生素B12水平均明显低于对照组,两组有显著性差异(P＜0.01).结论提示血清叶酸、维生素B12水平下降与脑梗死的发生有关,可能是其中又一危险因素.