丙戊酸钠对癫痫患者血同型半胱氨酸、叶酸、维生素B_(12)水平的影响

目的探讨丙戊酸钠(VPA)对血同型半胱氨酸(Hcy)、叶酸(Fol)、维生素B12(VitB12)浓度的影响。方法分别检测VPA单药治疗癫痫患者的血Hcy、Fol、VitB12浓度,并与未服用抗癫痫药的癫痫患者组及健康对照组比较。结果 VPA组患者血Hcy浓度明显高于癫痫对照组和正常对照组(P<0.01),Fol浓度低于癫痫对照组和正常对照组(P<0.05),VitB12浓度在VPA组有升高趋势。结论 VPA可引起癫痫患者血Hcy水平升高和Fol水平降低,长期服用VPA的癫痫患者应监测血Hcy、Fol、VitB12浓度,及时补充B族维生素、Fol有利于减少血栓事件的发生。     

叶酸、Vit B_(12)干预对高Hcy的急性脑梗死近期预后的影响

目的观察叶酸、维生素B12干预治疗是否能降低高同型半胱氨酸血症的急性脑梗死患者的Hcy水平以及对患者近期预后的影响。方法根据血浆Hcy水平将急性脑梗死患者分为正常组(92例),干预组(39例)及对照组(37例),干预组除常规治疗外给予叶酸5mg.d-1和维生素B12500ug.d-1,其他两组仅予常规治疗。随访患者1年,观察血浆Hcy水平以及患者预后(NIHSS以及不良预后事件)。结果干预组Hcy水平显著降低(P=0.008),但是NIHSS评分较对照组无显著改善,不良预后事件发生率无差异。结论叶酸及维生素B12治疗能显著降低患者血浆Hcy水平,但是不能改善患者预后,考虑可能与维生素治疗不能改善炎症反应有关。维生素治疗能否降低心脑血管病的发生及复发需要进一步研究。     

不同药物对帕金森病患者血浆同型半胱氨酸的影响

目的探讨不同药物治疗方法对帕金森病患者血浆同型半胱氨酸(Hcy)、叶酸、维生素B12的影响,以及PD患者病情程度与血浆Hcy的关系。方法 79例PD患者按服药不同分为4组,比较各组血浆Hcy水平;观察Hoehn-Yahr(H-Y)分期与血浆Hcy水平的关系;观察血浆Hcy水平与病程的关系;观察不同治疗组患者叶酸、维生素B_(12)含量。结果服多巴胺制剂组血浆Hcy水平明显高于未服药组(P0.05);Hcy水平较高者H-Y分期较高(P0.05);病程较长的患者血浆Hcy水平升高(P0.05);服多巴胺制剂组患者叶酸、维生素B12水平均较未服药组明显降低(P0.05)。结论多巴胺制剂可引起血浆Hcy水平升高,使叶酸、维生素B12水平降低,有可能促进PD进展;血浆Hcy水平高者运动障碍分期较高,病程较长,即病情相对较重。     

帕金森病患者左旋多巴治疗对血浆同型半胱氨酸的影响

目的 探讨左旋多巴对帕金森病(Parkinson disease,PD)患者血浆同型半胱氨酸(Hcy)和维生素B12等的影响.方法 分为PD组28例和健康对照组30名,测定被检者血浆中Hcy和维生素B12浓度等,PD组患者分别在左旋多巴治疗前、后测两次.结果 PD组左旋多巴治疗后血Hcy浓度[(19.19±8.01)μmol/L]明显高于治疗前[(12.50±3.78)μmol/L]和健康对照组[(12.60±3.94)μmol/L],差异有统计学意义(P＜0.01);经相关回归分析显示PD组左旋多巴治疗后血Hcy水平与维生素B12呈负相关(r=-0.386).结论 左旋多巴治疗可导致血浆中Hcy升高,有必要对服用左旋多巴的PD患者群进行Hcy、维生素和叶酸的检测,补充维生素B12、叶酸可能会降低Hcy和危险因素.     

轻度认知障碍患者血浆同型半胱氨酸和血清维生素B12及叶酸水平变化研究

目的 探讨轻度认知障碍(MCI)患者血浆同型半胱氨酸(Hcy)、血清维生素B12及叶酸水平的变化及相互关系.方法 MCI组80例,正常对照组80例,检测所有观察对象的血浆同型半胱氨酸、血清VitB12及叶酸水平并分析相互关系.结果 MCI组血浆Hey水平较正常组显著增高为(18.9±8.8)μmol/L vs(14.35±5.7)μmol/L,而血清叶酸和VitB12水平在正常组和MCI组之间并没有显著差异;相对于血浆Hey正常组,MCI比值比(0R)在轻、中度高同型半胱氨酸血症组中增高(OR=1.85,95%CI=1.56～2.95;OR=3.32,95%CI=1.61～6.48;P=0.001);无论在MCI组还是在正常组中,血浆Hey与血清叶酸及Vit B12的水平均呈负相关.结论 血浆Hey水平升高与MCI相关,叶酸和VitB122缺乏可能导致血浆Hcy水平升高.     

B族维生素干预高同型半胱氨酸血症在缺血性卒中二级预防中的效果评价

目的评价B族维生素干预Hhcy在IS二级预防中的效果,为IS的二级预防提供更多的临床证据。方法 141例符合试验条件的汉族男性IS患者,随机纳入安慰剂对照组（在常规治疗的基础上添加安慰剂）或维生素干预组（在常规治疗的基础之上添加叶酸5mg/d＋维生素B620mg/d＋甲钴胺1.0mg/d）,检测入组后4周和6月时的血浆Hcy水平,同时追踪观察2组患者2a内IS再发及IS相关性死亡事件发生的情况。结果在入组后4周和6月时,维生素干预组的血浆Hcy水平明显低于安慰剂对照组（P〈0.01）;至2a随访期末,安慰剂对照组与维生素干预组IS的再发率分别为25.00%和8.82%（P〈0.05）,其中TIA的再发率分别为8.33%和2.94%（P〉0.05）,脑梗死的再发率分别为16.67%和5.88%（P〉0.05）;安慰剂对照组与维生素干预组IS相关性死亡事件的发生率分别为3.33%和1.47%（P〉0.05）。Logistic回归分析显示B族维生素干预Hhcy是IS再发的独立保护因素（OR=0.258,P〈0.05）。结论 B族维生素干预能有效降低合并Hhcy的汉族老年男性IS患者的血浆Hcy水平及IS的再发风险。     

老年脑梗死患者血清同型半胱氨酸水平及药物干预研究

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.     

血浆同型半胱氨酸与脑梗死的相关性研究

目的探讨血浆同型半胱氨酸水平对脑梗死的影响。方法采用高效液相色谱仪HPLC-FD法检测40例急性脑梗死患者的血浆Hcy,采用离子捕获法测定患者叶酸（Fol）、维生素B12（VitB12）等指标,与40名健康对照者比较。结果 脑梗死组血浆Hcy水平和甘油三酯（TG）明显高于对照组,而Fol及VitB12水平则低于对照组,差异有统计学意义（P〈0.05）。高Hcy血症与脑梗死相关,相对危险度OR为8.921（95%CI 2.16～30.32）,脑梗死组和对照组血浆Hcy水平与血Fol、VitB12水平均呈显著负相关。结论 高同型半胱氨酸血症是脑梗死的独立危险因素。     

血浆同型半胱氨酸与颅内动脉瘤的关系

目的 探讨血浆同型半胱氨酸(Hcy)、血清叶酸、维生素B12水平与颅内动脉瘤的关系.方法 采用化学发光法检测80例颅内动脉瘤患者和60例对照者血浆Hcy、血清叶酸、维生素B12水平,相关危险因索用logistic回归分析.结果 颅内动脉瘤组平均血浆Hcy水平明显高于对照组(P=0.005),两组中血浆Hcy升高分别有38例(48%)和9例(15%)(X2=16.239,P＜0.001);颅内动脉瘤组平均血清叶酸、维生素B12水平明显低于对照组(P=0.01;P=0.005);颅内动脉瘤患者血浆Hcy水平与血清叶酸、维生素B12水平呈负相关(P＜0.05).多因素logistic回归分析显示:血浆Hcy是颅内动脉瘤发病的独立危险因素,比值比(OR)=3.961[P=0.019,95%可信区间(CI):1.255～12.500].结论 高Hcy血症与颅内动脉瘤发病有密切关系,可能是颅内动脉瘤发病的一个独立危险因素;血浆Hcy水平升高可能与血清叶酸、维生素B12水平降低有关.     

Plasmatic homocysteine response to vitamin supplementation in elderly people

Homocysteine (Hcy) increase is now widely accepted as a risk factor for vascular disease. The effects of folic acid (FA) and vitamins B₁₂ and B₆ in lowering Hcy have been extensively studied, but there is still little data on the response to FA dietary administration. Our purpose was to evaluate the impact of the diet and the degree of response to different doses of pharmacological FA supplementation. In a prospective, randomized, and simple blind study, 50 elderly subjects were given a 400-μg/day FA diet and were randomly assigned to one of the following treatments: Group I=placebo tablet; Group II=tablet containing 1-mg folic acid, 1-mg B₁₂, and 25-mg B₆; and Group III=tablet containing 2.5-mg folic acid and same B₆ and B₁₂ doses as Group II. Forty-four subjects completed the study, and their plasmas were evaluated. Hcy concentration significantly decreased even in patients with normal basal values, and there were no differences in the response between individuals receiving diet plus placebo and those receiving diet plus pharmacological supplementation. After the treatment, the mean decrease of plasmatic Hcy levels was 10.8 (9.4, 12.5) μmol/l, geometric mean [95% confidence interval (95% CI)], and particularly, the values for Group I were 10.6 (7.4, 14.8) μmol/l. In 31% of the subjects, the post-treatment Hcy levels were ≤5 μmol/l. These results show that a special diet, with or without pharmacological FA and B₁₂ and B₆ supplementation, significantly decreases the Hcy levels in elderly people. Therefore, a diet with high contents of FA might have an enormous impact on the morbidity and mortality of atherothrombosis.     

叶酸在高同型半胱氨酸血症脑梗死患者中的应用

目的观察服用不同剂量叶酸联合维生素B6、维生素B12治疗对急性脑梗死患者血浆同型半胱氨酸的影响。方法伴高同型半胱氨酸血症急性脑梗死患者60例,随机分为A、B2组,每组30例,各给予不同剂量的叶酸,A组2．5mg,1次／d,B组5．0mg,1次／d。2组均同时联合服用维生素战10mg,1次／d;维生素B12 0．5mg,1次／d。分别于治疗前（人院48h内）、治疗15d后采血检测Hcy浓度。结果（1）各组血浆Hcy浓度与治疗前比较均明显降低,差异有统计学意义（P〈0．01）。（2）不同剂量叶酸治疗后血浆Hcy浓度变化差异无统计学意义（P〉0．05）。结论叶酸治疗急性脑梗死伴高Hcy血症有明显效果;应用叶酸2．5mg即可明显降低Hcy。     

同型半胱氨酸与高原地区急性脑梗死关系的探讨

目的 探讨不同高海拔地区急性脑梗死（acute cerebral infarction,ACI）与血浆同型半胱氨酸（Homocysteine,Hcy）水平的关系.方法 采用发光免疫法测定高海拔地区ACI患者40例,中度海拔地区ACI患者48例及70例不同海拔健康对照组血浆Hcy、叶酸（FA）和维生素B12（VitB12）浓度.结果 不同海拔地区ACI组患者血浆Hcy水平明显升高,FA水平明显低于各对照组（P＜0.01）.与中度海拔ACI组相比,高海拔ACI组Hcy水平显著增高,FA的含量显著降低.健康对照组随着海拔增高Hcy的含量增高而FA的含量降低.VitB12在4组间变化不大.ACI组Hcy与FA间呈负相关（r=-0.034,P＜0.05）.与VitB12相关不显著.结论 高Hcy血症与高原地区急性脑梗死有密切关系.     

Current trends in antiepileptic drug therapy

Summary: Over the last two decades, drug therapy for epilepsy has improved substantially. This can be ascribed to a large extent to three factors, including the demonstration of the advantages of monotherapy; the realization of the need for dosage tailoring, coupled [for some antiepileptic drugs (AEDs)] with control of pharmacokinetic variability through therapeutic drug monitoring; and the introduction of newer agents with improved tolerability profiles. What further advances should we expect for the future? Current trends that are expected to increasingly affect our prescribing patterns include greater reliance on evidence‐based medicine and treatment guidelines, a trend that will be facilitated by completion of therapeutically meaningful randomized trials (including cost‐effectiveness studies) and high‐quality observational studies (including multinational pregnancy registries), as well as initiatives from scientific societies and government organizations aimed at condensing the most relevant information into therapeutic guidelines. The explosion in communication technology will accelerate dissemination of this information and its application to clinical practice. Other factors include a more rational patient‐tailored AED selection and dose individualization, aided by characterization of predictors of outcome as defined by clinical parameters (sex, age, epilepsy syndrome, and etiology), pathophysiological mechanisms, and newly discovered genetic markers of outcome; improved definition of the role of new AEDs, resulting in their increased use in newly diagnosed epilepsy; and reappraisal of the value of combination therapy in refractory epilepsies, based on evidence produced by experimental and clinical studies designed to identify favorable pharmacodynamic interactions. Additional important developments may come from the discovery of novel, more efficacious AEDs and from exploration of potential new targets, such as prevention of epileptogenesis.     

同型半胱氨酸与兔脑动脉损伤的关系及维生素B6、B12、叶酸对其预防作用的探讨

目的探讨高蛋氨酸(Met)喂饲兔引发高同型半胱氨酸(Hcy)血症与脑动脉损伤的关系,同时观察补充VitB6、VitB12、叶酸对血Hcy水平和动脉损伤的影响.方法采用纯种雄性新西兰兔26只,分为三组对照组、高蛋氨酸组、干预组,分别喂以普通兔饲料每只200g/d、普通饲料添加0.5%Met、普通饲料每天每只兔添加0.5%Met、叶酸2.5mg、VitB6 10mg、VitB12 200mg,喂养6个月,测定血浆总Hcy(tHcy),光镜检测脑动脉组织学改变.结果实验前血浆tHcy浓度三组间无明显差异,实验后断食2 h和7 h血tHcy浓度高Met组明显高于对照组(P＜0.01),而干预组血tHcy浓度明显低于高Met组(P＜0.01),但仍高于对照组.光镜组织学检测发现高Met组和干预组脑动脉可见内皮细胞坏死、脱落、溃疡形成,附壁血栓,中膜平滑肌散乱疏松.结论高Met引发高Hcy血症对脑动脉有损伤,且VitB6、VitB12、叶酸的补充可以降低高Met引发的高Hcy浓度的水平.     

叶酸和维生素B_(12)对高Hcy急性脑梗死患者血Hcy水平及神经功能的影响

目的观察叶酸和维生素B12对高同型半胱氨酸(Hcy)急性脑梗死(ACI)患者血Hcy水平及神经功能的影响。方法选取100例高Hcy水平ACI患者为研究对象,随机分为观察组和对照组各50例。对照组患者给予常规治疗,观察组患者在常规治疗的基础上加用口服叶酸和维生素B12治疗。观察和比较2组患者治疗前后的血浆Hcy水平、血清一氧化氮(NO)水平、血清内皮素(ET)水平、日常生活能力量表(ADL)评分、美国国立卫生研究院卒中量表(NIHSS)评分。结果观察组患者治疗后血浆Hcy水平、血清NO水平、血清ET水平均较治疗前显著改善(t=25.146、-11.405、15.493,P0.05),且均优于对照组(t=-26.364、10.550、-15.181,P0.05);2组患者治疗后NIHSS评分、ADL评分均较治疗前显著改善(t=22.802、16.870、-22.181、-11.871,P0.05),且观察组患者治疗后的NIHSS评分、ADL评分均显著优于对照组(t=-7.798、10.516,P0.05)。结论应用叶酸和维生素B12治疗ACI,能够降低血浆Hcy水平,改善血管内皮功能,促进神经功能的恢复,增强日常生活能力,有助于改善患者的生存质量和预后。     

Elevated plasma concentrations of lipoprotein(a) in medicated epileptic patients

Lipoprotein(a) [Lp(a)] has been identified as an independent risk factor for vascular diseases. There are no data on Lp(a) levels in patients on long-term medication with carbamazepine, phenytoin, phenobarbital, or valproate. To investigate the effects of such treatment on Lp(a) levels and common carotid artery intima media thickness we studied 51 epileptic outpatients on long-term antiepileptic medication and 51 age- and sex-matched controls. Lp(a) levels above 45 mg/dl were found in 11 of 50 patients, but in only 4 of 51 controls (P<0.05). The mean serum concentration of Lp(a) was 33.0±7.0 mg/dl in patients and 16.9±2.7 mg/dl in controls (P<0.05). Epileptic patients also had a thicker intima media of the common carotid artery (0.79±0.04 mm) than controls (0.69±0.02 mm, P<0.05) as measured by B-mode ultrasonography. Our results suggest an untoward effect of long-term antiepileptic medication on Lp(a) serum concentrations. Elevated Lp(a) levels might be a risk factor for arteriosclerosis in epileptic patients. Received: 26 November 1999/Received in revised form: 16 March 2000/Accepted: 9 April 2000     

AD患者血清Hcy叶酸及维生素B_(12)与认知功能减退的关系研究

目的研究维生素B_(12)和叶酸水平以及同型半胱氨酸是否对阿尔茨海默症(AD)患者存在潜在影响。方法运用美国国立神经病学、语言障碍和卒中-阿尔茨海默病和相关疾病学会(NINCDS-ADRDA)标准严格筛选AD患者95例。从体检中心选取年龄、性别及受教育程度匹配的无脑血管病、无认知障碍的健康对照组76例。采用化学发光微粒子免疫分析法检测171例年龄≥50岁的老年痴呆患者血清维生素B_(12)和叶酸水平。采用肝素抗凝的血浆进行循环酶法Hcy测定。探讨血清低水平维生素B_(12)和叶酸以及高水平同型半胱氨酸是否是老年痴呆发生的危险因素。认知功能的评价采用目前通用的神经心理测试:中文版简易精神状态检查表(MMSE)。采用Logistic回归分析评估血清维生素B_(12)、叶酸以及同型半胱氨酸与老年痴呆患病风险的关系。结果 171例中153例叶酸正常,其中对照组79例(51.63%),实验组74例(43.27%);124例维生素B_(12)正常,其中对照组60例(48.39%),实验组64例(51.61%);101例同型半胱氨酸正常,其中对照组51例(50.50%),实验组50例(49.50%)。作各协变量调整后,AD患者血清维生素B_(12)及叶酸水平以及同型半胱氨酸与CMMES评分无相关性(P0.05)。但低血清维生素B_(12)水平以及低叶酸水平与AD患病风险相关。结论血清维生素B_(12)和叶酸水平以及同型半胱氨酸水平与AD患者认知功能之间无明显关联。低水平维生素B_(12)以及低水平叶酸可能通过某种机制增加AD患病风险,低水平同型半胱氨酸可能通过某种机制降低AD患病风险。