补充叶酸、甲钴胺对血液透析患者血浆同型半胱氨酸的影响

目的 探讨补充叶酸、甲钴胺对血液透析(血透)患者血浆同型半胱氨酸(Hcy)的影响.方法 将60例门诊血透患者随机分成五组,每组12例.Ⅰ组:口服叶酸5 mg 1次/d;Ⅱ组:口服叶酸5 mg 3次/d;Ⅲ组:口服甲钴胺0.5 mg 3次/d;Ⅳ组:每次血透后静脉注射甲钴胺0.5 mg 3次/周;Ⅴ组:口服叶酸5 mg 1次/d联合静脉注射甲钴胺0.5 mg 3次/周.观察每组患者用药前、用药2个月后和停药2个月后血浆Hcy、叶酸和维生素B12浓度,另选择32例健康体检者作为对照组.结果 与对照组比较,各组治疗前血浆Hcy浓度明显升高,维生素B12和叶酸浓度差异无统计学意义.治疗2个月后除Ⅲ组外各组血浆Hcy浓度较治疗前明显下降,其中Ⅴ组血浆Hcy下降效果最好,但均未达正常水平.停药2个月后各组血浆Hcy浓度又恢复到用药前水平.结论 血透患者普遍存在高Hcy血症,补充叶酸和/或甲钴胺可以降低血浆Hcy浓度,但不能使其正常,5 mg/d叶酸和15 mg/d叶酸所取得的效果相似,甲钴胺只有静脉应用才有降低血浆Hcy的作用.     

补充叶酸、甲钴胺对血液透析患者血浆同型半胱氨酸的影响

目的探讨补充叶酸、甲钴胺对血液透析（血透）患者血浆同型半胱氨酸（Hcy）的影响。方法将60例门诊血透患者随机分成五组,每组12例。Ⅰ组：口服叶酸5mg1次/d;Ⅱ组：口服叶酸5mg3次/d;Ⅲ组：口服甲钴胺0.5mg3次/d;Ⅳ组：每次血透后静脉注射甲钴胺0.5mg3次/周;Ⅴ组：口服叶酸5mg1次/d联合静脉注射甲钴胺0.5mg3次/周。观察每组患者用药前、用药2个月后和停药2个月后血浆Hcy、叶酸和维生素B12浓度,另选择32例健康体检者作为对照组。结果与对照组比较,各组治疗前血浆Hcy浓度明显升高,维生素B12和叶酸浓度差异无统计学意义。治疗2个月后除Ⅲ组外各组血浆Hcy浓度较治疗前明显下降,其中Ⅴ组血浆Hcy下降效果最好,但均未达正常水平。停药2个月后各组血浆Hcy浓度又恢复到用药前水平。结论血透患者普遍存在高Hcy血症,补充叶酸和/或甲钴胺可以降低血浆Hcy浓度,但不能使其正常,5mg/d叶酸和15mg/d叶酸所取得的效果相似,甲钴胺只有静脉应用才有降低血浆Hcy的作用。     

叶酸联合左旋氨氯地平对血压及HCY的影响

目的探讨不同剂量叶酸联合左旋氨氯地平对H型高血压患者血压水平及同型半胱氨酸(HCY)的影响。方法选取130例原发性高血压病患者,将其分为对照组40例,观察A组、观察B组、观察C组各30例。对照组予口服左旋氨氯地平5 mg/d;观察A组予口服左旋氨氯地平5 mg/d+叶酸0.4 mg/d,观察B组予口服左旋氨氯地平5mg/d+叶酸0.8mg/d,观察C组予口服左旋氨氯地平5 mg/d+叶酸1.25 mg/d。分别在治疗1个月及3个月后检测所有患者HCY及血压水平。结果治疗1个月及3个月后,观察A组、B组、C组血压降低幅度与对照组比较差异均无统计学意义(P0.05);治疗1个月后3个观察组降低HCY水平差异无统计学意义(P0.05),3个月后观察C组HCY水平降低幅度高于观察A、B组,差异均有统计学意义(P0.05)。结论高剂量组(1.25 mg/d)叶酸能更有效地降低H型高血压HCY水平。     

幽门螺杆菌感染对2型糖尿病血管病变影响的研究

目的探讨幽门螺杆菌（Hp）感染对2型糖尿病（T2DM）患者血管病变的影响。方法对94例T2DM（45例HP感染者、49例无HP感染者）和43例正常对照血浆同型半胱氨酸（HCY）,血清血管性血友病因子（vWF）、叶酸、维生素B12（VitB12）及血小板膜表面GMP-140（GMP-140）进行了测定。结果2组T2DM患者HCY、vWF、GMP-140均显著高于正常对照组（P〈0.01）,且HP感染组明显高于无HP感染组（P〈0.01）;叶酸、VitB12均明显低于正常对照组（P〈0.05和P〈0.01）,且HP感染组明显低于无HP感染组（P〈0.01）;T2DM患者HCY与vWF、GMP-140呈正相关（P〈0.01）,与叶酸、VitB12呈负相关（P〈0.01）,进一步多元回归Hp感染与T2DM血管病变直接相关。结论HP感染直接或间接地参与了T2DM血管病变的发生、发展过程。     

妊娠期高血压疾病患者血浆总同型半胱氨酸水平监测及其干预治疗的研究

目的:研究血浆总同型半胱氨酸(tHcy)水平和血清叶酸、维生素B12(VitB12)水平与妊娠期高血压疾病的关系并进行干预治疗研究。方法:测定350例妊娠期高血压疾病患者(A组)和350例正常晚期妊娠妇女(B组)血浆tHcy水平和血清叶酸、VitB12水平,并对妊娠期高血压疾病伴高同型半胱氨酸(Hcy)血症患者应用叶酸联合甲钴胺进行干预治疗(给予叶酸5mg,每日3次,甲钴胺500μg,每日1次,疗程4周),测定治疗前后患者血浆tHcy水平和血清叶酸、VitB12水平。结果:血浆tHcy水平A组显著高于B组(P<0.01),血清叶酸、VitB12水平A组显著低于B组(P<0.01);A组中83例伴高Hcy血症患者经叶酸联合甲钴胺干预治疗4周后,血浆tHcy水平显著下降(P<0.01),血清叶酸、VitB12水平显著上升(P<0.01)。结论:妊娠期高血压疾病患者血浆tHcy水平显著上升,血清叶酸、VitB12水平显著下降,叶酸联合甲钴胺干预治疗能使妊娠期高血压疾病伴高Hcy血症患者血浆tHcy水平显著下降。     

VitB12、叶酸、同型半胱氨酸和血管内皮生长因子水平与胎儿生长受限的相关性

目的 探讨妊娠晚期孕妇空腹静脉血及脐带静脉血中维生素B12(VitB12)、叶酸、同型半胱氨酸(HCY)及血管内皮生长因子(VEGF)的水平与胎儿生长受限(FGR)的关系。方法 选取2019年1月1日至2021年12月31日在郑州市妇幼保健院住院分娩的138例妊娠合并FGR孕妇为FGR组,同期住院分娩的无妊娠并发症且新生儿体重正常的138例孕妇为对照组,比较两组间孕妇空腹静脉血及脐带静脉血中VitB12、叶酸、HCY和VEGF水平,采用Pearson相关分析以上指标与FGR新生儿出生体重之间的关系。结果 FGR组孕妇年龄、妊娠合并子痫前期的比例高于对照组,孕期增重低于对照组,差异均有统计学意义(t/χ²值分别为2.027、43.371、-4.513,P<0.05);FGR组孕妇空腹静脉血及脐带静脉血中VitB12、叶酸及VEGF的水平低于对照组,而孕HCY的水平高于对照组,差异均有统计学意义(t值介于-4.757～6.968之间,P<0.05);FGR组孕妇空腹静脉血及脐带静脉血VitB12、叶酸及VEGF水平与新生儿出生体重正相关(r值介于0.540...     

孕妇血浆叶酸、维生素B12和同型半胱氨酸水平测定及临床意义

目的:通过测定孕妇血浆叶酸、VitB12和同型半胱氨酸水平,了解其与发生妊娠期并发症的关系。方法:对2004年3月～2005年6月在产科门诊及住院妊娠中、晚期孕妇以及健康育龄妇女,测定血浆叶酸、VitB12400例,同时测血浆Hcy165例,采用酶免疫检测法检测同型半胱氨酸浓度;叶酸及VitB12测量采用放射免疫法。结果:①正常非孕妇女、孕12～27 6周、28～36 6周、37～42周及产后的孕妇血浆FA、VitB12及Hcy含量比较,差异无统计学意义(P>0.05);②孕妇并发妊高征、贫血、心肌缺血或损害及胎儿异常者与正常晚孕组及正常非孕组血FA、VitB12及Hcy异常水平比较差异有统计学意义(P<0.05,0.01)。结论:孕妇妊娠期缺乏叶酸及VitB12,将可能发生高同型半胱氨酸血症,从而对母儿造成危害。     

急性脑梗死患者血浆同型半胱氨酸水平及其干预治疗探讨

目的:分析急性脑梗死患者的同型半胱氨酸、叶酸、维生素B12水平,并对患者接受维生素B12制剂和叶酸治疗之后的各项指标变化情况做出准确判断。方法:随机抽取我院收治的90例急性脑梗死患者作为研究对象,检测患者的血浆同型半胱氨酸、叶酸、维生素B12水平,另外选择我院50例健康体检者作为健康对照组,同样检测患者的血浆同型半胱氨酸、叶酸、维生素B12水平。比较两组之间存在的差异;初步检测完成后将90例急性脑梗死患者随机分为两组:观察组45例接受在常规治疗的基础上接受维生素B12制剂与叶酸联合治疗,对照组45例患者接受常规治疗。治疗1个月后比较两组患者的血浆同型半胱氨酸、叶酸、维生素B12水平,比较患者的神经功能缺损情况。结果:急性脑梗死患者的血浆同型半胱氨酸、叶酸、维生素B12水平与健康者比较存在明显差异(P0.05);治疗后,观察组患者的各项指标以及神经功能状况均发生了显著的好转,与对照组相比存在着显著的优越性(P0.05)。结论:急性脑梗死患者的血浆同型半胱氨酸水平升高情况异常,使用维生素B12制剂和叶酸为其进行治疗可有效改善指标异常情况,保护患者的生命安全。     

缺血性脑卒中的发生与血清叶酸、血小板聚集率、同型半胱氨酸和维生素B12的关系研究

目的:探讨缺血性脑卒中患者血清叶酸(Folic Acid,FA)、血小板聚集率(Platelet Aggregation Rate,PAR)、同型半胱氨酸(Homocysteine,Hcy)和维生素B12(vitamin B12,VitB12)变化的原因及其关系。方法:选择缺血性脑卒中患者和健康对照组各60例,利用免疫法测其FA、PAR、Hcy和vitamin B12水平。结果:缺血性脑卒中患者体内FA水平偏低,PAR、VitB12和Hcy水平偏高,P<0.05;与缺血性脑卒中关系依次为FA>VitB12>PAR>Hcy,FA与PAR的相关关系r=0.006,P<0.01;HCY与PAR的相关关系r=0.03,P<0.05,FA与HCY的相关关系r=0.07。结论:缺血性脑卒中患者FA水平偏低,补充叶酸能降低PAR、改善HCY的氧化和VitB12的吸收,降低缺血性脑卒中的发生。     

MTHFR基因C677T位点多态性与胎儿生长受限的相关性

目的:探讨亚甲基四氢叶酸还原酶(MTHFR)基因C677T位点多态性与胎儿生长受限(FGR)的关系。方法:FGR患者62例,正常妊娠妇女65例。聚合酶链反应—限制性内切酶片段长度多肽性(PCR-RFLP)法检测MTHFR C677T基因多态性;荧光偏振免疫法测定血浆总同型半胱氨酸水平;微粒子酶免分析法测定血浆叶酸、VitB12浓度。结果:①FGR组MTHFR C677TC/T基因型频率显著高于正常对照组,C/C基因型频率显著低于对照组,总的突变T等位基因频率显著高于对照组(P<0.05)。②FGR组MTHFRT/T基因型Hcy水平较C/C、C/T基因型患者显著增高,而血清叶酸水平则明显降低(P<0.05)。血清VitB12水平在FGR3种基因型之间差异无显著性(P>0.05)。对照组MTHFR C677T3种基因型之间血清Hcy、叶酸、VitB12,水平差异无显著性(P>0.05)。结论:MTHFR基因C677T位点多态性与FGR有关,高同型半胱氨酸血症是FGR发病的危险因素。     

老年冠心病与血浆同型半胱氨酸及其代谢相关因子

目的观察老年冠心病及糖尿病与血浆同型半胱氨酸及其代谢相关因子之间的关系。方法选择老年冠心病患者68例,其中伴发Ⅱ型糖尿病的16例为A组;无伴发Ⅱ型糖尿病52例为B组;选择22例健康老年人作为对照组C组。对受试者进行血浆同型半胱氨酸、叶酸和维生素B12定量测定。结果患病组老年血浆同型半胱氨酸值明显高于健康老年组,血浆Vit B12、叶酸值明显低于健康对照组,两组间比较有统计学意义(P<0.05),Ⅱ型糖尿病组(A组)血浆同型半胱氨酸值明显高于无糖尿病组(B组)(P<0.05),且A组VitB12和叶酸值明显低于B组(P<0.01),B组血浆同型半胱氨酸值高于C组,Vit B12明显低于C组(P<0.01),而叶酸两组间差别无统计学意义。患病组的同型半胱氨酸值和叶酸、VitB12呈明显的负相关,相关系数分别为-0.61和-0.49,P均<0.01。结论老年冠心病患者高同型半胱氨酸血症与动脉硬化、冠心病的发病及糖尿病胰岛素相对或绝对缺乏有密切关系,探讨老年人同型半胱氨酸的代谢规律对预防老年心脑血管疾病有重要意义。     

老年人巨幼细胞性贫血临床分析

目的探讨老年人巨幼细胞性贫血（巨幼贫）的特点。方法对１９９５～１９９８年住院的１７例患者进行临床分析。结果全部患者均呈典型的巨幼贫骨髓象,血清叶酸或维生素Ｂ１２下降。病因方面７例有消化道疾患,其他方面为高血压,糖尿病,冠心病等。有１２例患者全血细胞下降。与非老年巨幼细胞贫血骨髓增生程度比较,呈增生下降,有明显差异。２例呈双相性贫血,即同时合并缺铁性贫血。结论当老年人以头昏、眼花、纳差等主诉就诊,而血常规呈大细胞、高色素贫血,要考虑巨幼贫的诊断,而一旦巨幼贫确诊,用叶酸、维生素Ｂ１２治疗效果非常显著。     

高同型半胱氨酸血症与颈动脉粥样硬化对老年急性脑梗死影响的研究

目的：探讨老年急性脑梗死患者血清同型半胱氨酸（Hcy）水平与颈动脉硬化（CAA）程度之间的关系。方法：对80例老年急性脑梗死患者进行空腹血浆Hcy、空腹血糖、胆固醇、甘油三酯、叶酸、维生素B12（VitB12）水平的测定,并且进行彩超检查颈动脉内膜-中层厚度（IMT）、斑块大小、狭窄程度及血流速度的检测,按照颈动脉狭窄程度及IMT值分为A、B、C、D四组;对Hcy水平与叶酸、VitB12及其他相关因素进行分析。结果：（1）随着CAA程度的加重,Hcy水平升高,A、B、C组和D组之间比较差异均有统计学意义（P〈0.05）;（2）叶酸与VitB12的水平随着CAA程度的加重而降低,仅在A组和D组之间比较差异有统计学意义（P〈0.05）;（3）统计学分析表明血清Hcy水平与血叶酸和VitB12水平负相关（r=-0.328、-0.442,P〈0.05）。结论：高Hcy血症与颈动脉粥样硬化程度密切相关,是脑梗死发生的独立危险因素。     

B族维生素及同型半胱氨酸与复发性流产的关系

目的测定血清叶酸、维生素B。同型半胱氨酸及红细胞叶酸水平,探讨其与早期原因不明复发性流产的关系。方法分别采用磁微粒酶免疫分析方法、ELISA方法及电化学发光法测定流产组与对照组外周血中血清叶酸、维生素B12、同型半胱氨酸及红细胞叶酸水平。结果76例早期原因不明复发性流产患者（流产组）与40例正常同期育龄期妇女（对照组）比较,血清叶酸（t=-3．631,P〈0．005）、维生素B12（t=-4．790,P〈0．005）、同型半胱氨酸（t=3．019,P〈0．005）及红细胞叶酸（t=-3．640,P〈0．005）,均有显著性差异。流产组A组（补充0．4mg／d叶酸片）与B组（补充5mg／d叶酸片及复合维生素B）,2组补充叶酸后1个月与首诊比较,血清叶酸（t=2．131,P〈0．005）及同型半胱氨酸（t=2．685,P〈0．05）,均有显著性差异。结论体内叶酸水平低下可能是早期原因不明复发性流产发生、发展的-个重要因素,它的检测对于早期原因不明复发性流产患者的预防及治疗具有一定的临床意义。     

The folic acid metabolite L-5-methyltetrahydrofolate effectively reduces total serum homocysteine level in orthotopic liver transplant recipients: a double-blind placebo-controlled study

OBJECTIVE: Hyperhomocysteinemia is a described risk factor of cardiovascular diseases. The aim of this study was the treatment of hyperhomocysteinemia in liver transplant recipients with L-5-methyltetrahydrofolate (L-5-MTHF; 1 mg) vs folic acid (1 mg) vs placebo in a double-blind placebo-controlled study and to compare the relative responsiveness of these patients to L-5-MTHF and folic acid. SUBJECTS/METHODS: Patients were recruited from Hepatology-Transplantation-Unit at Johann Wolfgang Goethe-University, Frankfurt. Sixty patients were included in this study and 12 patients dropped out for different reasons. The patients were treated over 8 weeks with supplemental L-5-MTHF or folic acid or placebo. Serum homocysteine (HCY) was analyzed with high-performance liquid chromatography (HPLC) beside routine lab tests. RESULTS: We observed only a significant decrease of total serum HCY in the L-5-MTHF group during the study period (at week 0: 15+/-7.7 microM; after 8 weeks treatment: 9.41+/-2.6 microM, P<0.001). There was no significant decrease of total serum HCY neither in the folic acid group nor in the placebo group. CONCLUSION: The effects of L-5-MTHF are significantly more potent than folic acid itself. Therefore, lowering serum HCY in liver transplant recipients is effective with L-5-MTHF.     

Frequency of hyperhomocysteinemia in hemodialysis patients with folic acid supplementation

BACKGROUND: It is known that hyperhomocystinemia is an independent risk factor for development of atherosclerosis. In end stage renal disease the frequency of hyperhomocystinemia is much greater than in normal populations. AIM: In this study homocystein (Hcy), folic acid and vitamin B12 concentrations were determined in 125 chronic renal failure patients being on folic acid supplementation (3 mg/day). In 107 patients the frequency of C667T polymorphism of methylene tetrahyrofolate reductase (MTHFR) was also determined. The relationships between these parameters were also studied. RESULTS: It was found that in these patients who are under continuous folic acid supplementation the mean level of homocysteine was 16.8 +/- 7.2 mumol/L, a value considerably lower than the homocysteine concentration reported for non-supplemented patients. The elevation of homocysteine concentrations was independent of gender, time spent in renal replacement therapy, and the type of renal replacement therapy (hemodialysis: 17.6 +/- 12.6; hemodiafiltration: 16.6 +/- 12.9 mumol/L). Data showed an inverse relation between plasma homocysteine concentrations and the concentrations of folic acid and vitamin B12. Moderately severe hyperhomocystinemia (Hcy > 20 mumol/L) was found in about 30% of patients. In those the frequency of patients for homozygous T677 allele of MTHFR was about 25-30%. However, in all ESRD patients the frequency of the homozygotes was the same then in the normal population. Homocysteine plasma levels correlated with MTHFR polymorphism: in the wild type group Hcy was 14 +/- 7 mumol/L, in the heterozygous group was 17.2 +/- 6.2 mumol/L, and in the homozygous group was 21 +/- 19 mumol/L. CONCLUSIONS: Long-term folic acid supplementation decreased the homocysteine level in end stage renal disease patients. However, in folic acid resistant group, who were in 30% homozygotes for C667T of MTHFR (suggesting that homocysteine-methionine remethylation cycle is disturbed), instead of the administration of folic acid, methylene tetrahydrofolate supplementation might be considered.     

肝病患者血清叶酸与维生素B12含量的临床意义

目的 探讨肝病患者血清叶酸(FA)与维生素B12(VitB12)含量的变化及其临床意义.方法 应用微粒子化学发光免疫分析技术(CLIA)检测315例肝病患者及84例健康对照者的血清FA和VitB12含量,并对检测数据进行统计学分析.结果 急性肝炎组血清FA含量与对照组比较,差异无统计学意义(P>0.05),但其VitB12含量明显高于对照组(P<0.05).慢性肝炎轻度组血清FA、VitB12含量与对照组相比,差异无统计学意义(P>0.05).慢性肝炎中度组血清FA、VitB12含量与对照组相比,差异有统计学意义(P<0.05).慢性肝炎重度组、肝炎后肝硬化组、原发性肝癌组的FA含量均低于对照组(P<0.01),VitB12含量均高于对照组(P<0.01).结论 血清FA、VitB12含量变化与肝细胞病损程度密切相关,其检测结果对肝脏疾病的诊断、治疗及预后判断具有重要的临床价值.     

Folic acid therapy reduces plasma homocysteine levels and improves plasma antioxidant capacity in hemodialysis patients

OBJECTIVE: We evaluated the effects of folic acid on homocysteine levels and oxidative stress in 46 stable patients on hemodialysis. METHODS: This double-blind, placebo-controlled, randomized trial assessed the effects of 6 mo of 10 mg of folic acid (26 patients) or placebo (20 patients) given three times weekly after each dialysis under nurse supervision on homocysteine levels, total plasma antioxidant capacity, and hydroperoxide plasma levels. RESULTS: Folic acid treatment normalized plasma homocysteine levels in most patients, significantly increased total plasma antioxidant capacity levels, but had no significant effect on hydroperoxide levels. Placebo treatment had no statistically significant effect on the three parameters. CONCLUSION: The folic acid therapy protocol effectively lowered plasma homocysteine levels and improved the total plasma antioxidant capacity in hemodialysis patients. Further studies are required to assess the usefulness of folic acid for decreasing cardiovascular mortality in patients with chronic kidney disease.     

Folic acid and vitamin B12 are more effective than vitamin B6 in lowering fasting plasma homocysteine concentration in patients with coronary artery disease

OBJECTIVE: To investigate whether vitamin B(6) supplementation had a beneficial effect on lowering fasting plasma homocysteine concentrations in coronary artery disease (CAD) patients. DESIGN: A single-blind intervention study. SETTING: The study was performed at the Taichung Veterans General Hospital, the central part of Taiwan. SUBJECTS: A total of 50 subjects were identified by cardiac catheterization to have at least 70% stenosis of one major coronary artery. In all, 42 patients successfully completed this study. INTERVENTIONS: Patients were randomly assigned to one of five groups and treated with a daily dose of placebo (n=8), 5 mg vitamin B(6) (n=8), 10 mg vitamin B(6) (n=8), 50 mg vitamin B(6) (n=9), or 5 mg folic acid combined with 0.25 mg vitamin B(12) (n=9) for 12 weeks. MAIN OUTCOME MEASURES: Nutrient intakes were recorded by using 24-h diet recalls when patients returned to the cardiology clinic before the intervention (week 0) and at week 12. Vitamin B(6) status was assessed by direct measures (plasma pyridoxal 5'-phosphate) and indirect measures (erythrocyte alanine and aspartate aminotransaminase activity coefficient). Fasting plasma homocysteine, serum folic acid, and vitamin B(12) were measured. RESULTS: Fasting plasma homocysteine concentration did not respond to high or low doses of vitamin B(6) when compared with a placebo treatment after 12 weeks of supplementation. The mean fasting plasma homocysteine concentration, however, decreased significantly after 12 weeks of folic acid combined with vitamin B(12) supplementation (P=0.047). Further, within group, mean fasting plasma homocysteine concentration was nonsignificantly increased by 25.5, 16.2, and 18.3% in placebo, 10 mg/day and 50 mg/day vitamin B(6) supplemented groups, respectively; whereas folic acid combined with vitamin B(12) supplementation significantly reduced fasting plasma homocysteine concentration by 32% (P<0.001). CONCLUSIONS: Our results indicate that vitamin B(6) supplementation alone is less effective than folic acid combined with vitamin B(12) in lowering plasma homocysteine concentrations in CAD patients. SPONSORSHIP: This study was supported by the National Science Council, Taiwan, Republic of China (NSC-91-2320-B-040-023).