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1.
老年脑梗死患者血清同型半胱氨酸水平及药物干预研究   总被引:16,自引:0,他引:16  
目的了解正常老年人、颈动脉硬化患者及脑梗死患者血清总同型半胱氨酸(serumtotalhomocysteine,tHcy)水平及给予叶酸和维生素B12治疗后血tHcy含量的变化.方法脑梗死组80例,男71例,女9例,年龄63~80岁,平均74岁,符合脑梗死的诊断标准,均在发病后2周内测定tHcy含量;颈动脉硬化组80例,男71例,女9例,年龄62~79岁,平均72岁.双侧颈动脉B超检查均存在颈动脉硬化及(或)粥样斑块.以上两组均除外甲状腺功能减退及肾功能减退.正常老年人组80名,男72名,女8名,年龄61~78岁,平均71岁,符合健康老年人的诊断标准.入选者在测定血清叶酸、维生素B12、肌酐、血糖、血脂水平及血压和体重指数后,各组均随机分成2组,即干预治疗组及非干预治疗组,每组40例.干预治疗组患者给予叶酸1.25mg,隔日1次,维生素B128μg,每日1次,口服10个月后复查上述各项指标.结果治疗前三组血tHcy水平各不相同,脑梗死组为(16.1±5.3)μmol/L,颈动脉硬化组为(14.2±4.7)μmol/L,正常老年人组为(12.5±3.0)μmol/L,三组比较差异有显著意义.血tHcy含量越高,叶酸水平越低.相关分析发现,血tHcy水平与叶酸、维生素B12呈负相关.干预治疗后,治疗组患者的血tHcy含量均有下降.结论不同程度的脑缺血性疾病与血tHcy水平有一定的关系,补充营养元素有助于降低血tHcy水平,以减少高tHcy对血管的毒性作用.  相似文献
2.
Hyperhomocysteinemia in dementia   总被引:13,自引:0,他引:13  
Summary. Hyperhomocysteinemia is a strong risk factor for atherosclerotic vascular disease, and elevated serum homocysteine is correlated with vitamin B deficiency. In this pilot study, significantly elevated homocysteine levels were found in patients with Alzheimer's disease as well as in patients with vascular dementia, probably indicating similar pathophysiological pathways. We found significant correlations between low folic acid concentrations as well as high homocysteine concentrations and cognitive decline. Supplementation with folic acid may be an inexpensive way to reduce elevated homocysteine levels in demented patients. Received March 20, 2000; accepted June 30, 2000  相似文献
3.
Summary: Exposure to antiepileptic drug (AED) treatment in utero occurs in 1 of every 250 newborns. The absolute risk of major malformations in these infants is about 7–10%, ˜3–5% higher than in the general population. Specific risk factors include high maternal daily dosage or serum concentrations of AED, low folate levels, polytherapy, and generalized seizures during pregnancy. Adverse pregnancy outcomes, including congenital heart malformations, facial clefts, spina bifida aperta, hypospadias, growth retardation, and psychomotor and mental retardation, are associated with, although not necessarily caused by, AED exposure. Specific cognitive defects, hypertelorism, and nail hypoplasia can be causally related to specific AED exposures. To prevent teratogenic side effects, the prospective mother should be treated with AEDs only when absolutely necessary. Monotherapy with the AED that is most effective in the lowest possible daily dose (divided into at least two or three administrations) should be prescribed. High-dose folate supplementation (4–5 mg/day) reduces the risk of a neural tube defect in a child whose sibling had such a defect, but its impact on the specific teratogenic risks of AEDs is unknown. A substantial proportion of fetal malformations may be secondarily prevented by prenatal diagnosis, consisting of a fetal structural ultrasound examination at weeks 18 and 20 of gestation and, with VPA or CBZ administration, an α1-fetoprotein analysis of amniotic fluid at week 16. Determination of a specific defect prevention strategy depends largely on parental attitudes toward prenatal diagnosis and termination of pregnancy, which should be discussed before conception. The availability of many new AEDs, many of which will be used in polytherapy, will make prospective evaluation of large numbers of pregnancy outcome on a population basis even more important in the future.  相似文献
4.
5.
抑郁症患者血清叶酸和维生素B12浓度研究   总被引:5,自引:1,他引:4  
目的:探讨抑郁症患者血清叶酸和维生素B12浓度改变。方法:收集门诊患者76例,均符合国际疾病分类第10版抑郁症诊断标准,病程至少半年;健康对照组67名。测定血清叶酸和维生素B12浓度。结果:两组之间叶酸平均浓度和叶酸缺乏的发生差异均无显著性(P〉0.05)。抑郁症组维生素B12平均浓度显著较低(P〈0.05),维生素B12缺乏的发生率显著较高(P〈0.01)。结论:抑郁症与维生素B12缺乏有关,与叶酸无关。  相似文献
6.
Risks of Pregnancy in Women with Epilepsy   总被引:4,自引:3,他引:1  
Mark S. Yerby 《Epilepsia》1992,33(S1):S23-S27
Summary: Pregnant women with epilepsy are at increased risk of seizures and complications. An increase in seizure frequency is seen in 25–30% of pregnant women with epilepsy; the offspring of mothers who experienced seizures during pregnancy are at a 2.5 times higher risk for seizures later in life. One of the main reasons for the increase in seizures during pregnancy is a decline in plasma concentrations of antiepileptic drug (AED) that occurs as pregnancy progresses, largely as a result of marked alterations in plasma protein binding. It is well known that epilepsy represents a risk for a variety of adverse pregnancy outcomes or malformations, especially in polytherapy. The adverse outcomes range from dysmorphic features to hemorrhagic disorders resulting from a deficiency of vitamin K-dependent clotting factors or to spina bifida. Folic acid supplements appear to reduce the risk of spina bifida. A strong genetic link seems to exist for many of the malformations that occur, and more research is required in this field. In the meantime, there are interventions that clinicians can already make to reduce the risk of adverse outcomes, such as seizure control without toxicity, monotherapy, and preconceptual use of vitamins with folate.  相似文献
7.
Martha J. Morrell 《Epilepsia》1996,37(S6):S34-S44
Summary: As new antiepileptic drugs (AEDs) become available, physicians will define their appropriate use in particular patient populations. For women, the issues in clude gender-specific efficacy and tolerability, including the impact of the AED on reproductive health. Women with epilepsy who are treated with established AEDs ap pear to be at risk for compromised bone health, for dis turbances in fertility, menstrual cyclicity, ovulatory func tion, and sexuality and, with some AEDs, for failure of hormonal contraception. Finally, pregnancy outcome may be adversely affected by the established AEDs, all of which are human teratogens. Felbamate (FBM), gabap-entin (GBP), lamotrigine (LTG), oxcarbazepine (OCBZ), tiagabine (TGB), topiramate (TPM), and vigabatrin (VGB) were reviewed. The preclinical development pro cess had not addressed all the issues of concern to women. Although gender-specific efficacy is routinely evaluated, impact on reproductive health is not. FBM, GBP, LTG, TGB, TPM, and VGB have similar efficacy in women and men. It is not known whether the new AEDs will affect bone health, fertility, the menstrual cycle, and sexuality. FBM, GBP, LTG, TGB, and probably VGB do not interfere with hormonal contraception. Whether these new AEDs are good choices for the pregnant woman with epilepsy awaits further experience in human pregnancy. However, animal reproductive toxicology studies appear promising. The limited number of human pregnancy ex posures do not, thus far, signal a significant number or particular type of adverse outcomes. However, only with improved postmarketing surveillance can essential infor mation about teratogenic effects be acquired in an accept ably short time.  相似文献
8.
Studies investigating the influence of antiepileptic drugs on thyroid hormones usually have compared patients chronically treated with antiepileptic drugs to controls. To date, this type of designs has produced divergent results both with regard to individual drugs and individual thyroid hormones. The present study comprised 31 patients with newly diagnosed epilepsy, commencing treatment with either carbamazepine or valproate. T3, T4, FT4, FT3, rT3, TSH, T3 resin uptake and blood folic acid, were determined before and during antiepileptic monotherapy, thus making the patient his own control. During treatment with carbamazepine, a significant decrease in T4, FT4, FT3, rT3 and TBG was observed. Valproate caused a decrease in T4, FT4 and T3. Neither of the drugs caused any changes in blood folic acid concentrations or persistent increases in the TSH values. None of the patients developed overt symptoms of hypothyreoidism. Conceivable mechanisms underlying these hormonal changes are reviewed.  相似文献
9.
Unilateral lesions were induced in the substantia innominata (SI) of rats by 3 methods: electrocoagulation, 2 nmol kainic acid (KA) injection or 50–200 nmol folic acid (FA) injection. Histological examination by cresyl violet and GABA-transaminase staining and biochemical evaluation by glutamic acid decarboxylase (GAD) and choline acetyltransferase (ChAT) measurement were undertaken of the SI and several remote areas. Injections of FA into the SI produced much less local but more severe distant neuronal damage than did injections of KA. Both produced sustained epileptiform activity. Electrolytic lesions, on the other hand, produced only local neuronal damage and no epileptiform activity. Biochemical measurements of GAD and histochemical staining for GABA transaminase indicated many of the neurons in the distant areas affected following FA injections were GABAergic, but cholinergic neurons were relatively spared. Damage to the cortical areas was heaviest in the superficial layers. Dose-related losses were seen in GAD in a number of regions, with the most severe distant damage being in the amygdala and pyriform cortex and significant but lesser extent in the frontal, entorhinal and temporal cortices, and in the thalamus. The striatum and hippocampus were spared. The distant damage, except in the thalamus, seemed to parallel the density of cholinergic innervation from the SI as revealed by relative drops in ChAT following KA injections into the SI. Reduction in both seizure-like activity and remote damage was brought about by pretreatment of the animals with valium (20 mg/kg) or scopolamine (50 mg/kg). The protective action of scopolamine is consistent with the possibility that cholinergic neurons may mediate much of the remote damage to GABA neurons, although they themselves are little affected. Distant effects of injections of FA into the striatum were comparable in kind but much less in magnitude to those after SI injection while amygdala injections of FA did not produce significant losses in GAD in any of the regions examined.  相似文献
10.
PURPOSE: Homocysteine is an experimental convulsant and an established risk factor in atherosclerosis. A nutritional deficiency of vitamin B6, vitamin B12, or folate leads to increased homocysteine plasma concentrations. During treatment with carbamazepine (CBZ), phenytoin, or phenobarbital, a deficiency in these vitamins is common. The objective of the study was to test the hypothesis that antiepileptic drug (AED) treatment is associated with increased homocysteine plasma concentrations. METHODS: A total of 51 consecutive outpatients of our epilepsy clinic receiving stable, individually adjusted AED treatment and 51 sex- and age-matched controls were enrolled in the study. Concentrations of total homocysteine and vitamin B6 were measured in plasma; vitamin B12 and folate were measured in the serum of fasted subjects. RESULTS: Patients and controls differed significantly in concentrations of folate ( 13.5+/-1.0 vs. 17.4+/-0.8 nM and vitamin B6 (39.7+/-3.4 vs. 66.2+/-7.5 nM), whereas serum concentrations of vitamin B12 were similar. The homocysteine plasma concentration was significantly increased to 14.7+/-3.0 microM in patients compared with controls (9.5+/-0.5 microM; p < 0.05, Wilcoxon rank-sum test). The number of patients with concentrations of >15 microM was significantly higher in the patient group than among controls. The same result was obtained if only patients with CBZ monotherapy were included. Patients with increased homocysteine plasma concentrations had lower folate concentrations. CONCLUSIONS: These data support the hypothesis that prolonged AED treatment may increase plasma concentrations of homocysteine, although the alternative explanation that increased homocysteine plasma concentrations are associated with the disease and not the treatment cannot be completely excluded at the moment.  相似文献
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