冠心病、脑梗死患者血浆同型半胱氨酸浓度变化及相关研究

[目的]探讨冠心病、脑梗死患者血浆同型半胱氨酸（Hcy）浓度及相关因子与发病危险因素的关系。[方法]2002-2004年在北京铁路总医院筛选出冠心病组、脑梗死组及正常对照组进行血浆Hcy浓度、血清叶酸、维生素B12质量浓度、血糖、血脂测定,观察各组与指标间的关系。[结果]冠心病组、脑梗死组血浆Hcy浓度比正常对照组明显增高,均有显著差异性（P〈0.05）;冠心病组、脑梗死组血清叶酸、维生素B12质量浓度与正常对照组比较,差异均无显著性（P〉0.05）;血脂、血糖升高患者中血浆Hcy浓度与血脂、血糖正常患者比较,差异均无显著性（P〉0.05）。[结论]高同型半胱氨酸血症是心脑血管疾病的独立危险因素。     

脑卒中患者血同型半胱氨酸、叶酸及维生素B12水平的分析

目的探讨血同型半胱氨酸（Hcy）水平与脑卒中发生的相关性,以及脑卒中患者血清叶酸、维生素B12（（V itB12）水平的变化。方法分别测定60例脑卒中患者（47例脑梗死、13例脑出血）及60名健康对照者的血Hcy水平并同时检测叶酸、V itB12以及血脂、血糖等。结果脑卒中组血Hcy水平显著高于对照组,而2组之间血糖及血脂水平无差异。脑梗死和脑出血患者血Hcy水平无差异。血清叶酸及V itB12水平与血Hcy呈负相关（r=-0.33,P〈0.01;r=-0.27,P〈0.05）。结论高血Hcy是脑卒中的独立危险因素,低水平的血清叶酸、V itB12可能是导致高Hcy血症的原因之一。     

脑血管病患者高Hcy血症与叶酸和维生素B12的相关性研究

目的探讨脑血管病患者高同型半胱氨酸(Hcy)血症与叶酸、维生素B12之间的相关性。方法分别检测脑血管病患者和健康对照者血清Hcy、叶酸和维生素B12水平。结果脑血管病组血清Hcy水平显著高于对照组(P<0.01),其中脑梗塞组的血清Hcy水平明显高于脑出血组(P<0.01)。与之相反,脑血管病组的血清叶酸和维生素B12水平明显低于对照组(P<0.01)。相关分析结果显示,脑血管病组的血清叶酸和维生素B12水平与Hcy水平呈负相关(r1=-0.80,r2=-0.83)。结论高Hcy血症与叶酸、维生素B12之间存在负反馈的调节机制可能正是导致脑血管病发生的关键因素。     

冠心病患者血浆同型半胱氨酸水平与血清叶酸、维生素B12和维生素B6的关系及干预试验研究

目的：研究冠心病患者血浆同型半胱氨酸水平与血清叶酸、维生素B12和维生素B6的关系并进行干预试验研究。方法：测定50例正常对照者及134例冠心病患者血浆总同型半胱氨酸（tHcy)水平血清叶酸、维生素B12和维生素B6水平，测定134例冠心病患者和55例对照者给予口服复合叶酸制剂10－20周年的血浆tHcy水平和血清叶酸、维生素B12和维生素B6水平。结果：研究结果显示血浆tHcy水平患者组明显高于对照组（P＜0．001），血清叶酸、维生素B12和维生素B6水平患者线显著低于对照组（P＜0．001）；给予口服复合叶酸制剂能显著降低血浆tHcy水平（P＜0．001）。结论：冠心病患血浆同型半胱氨酸水平升高与血清叶酸，维生素B12和维生素B6水平降低有关，给予口服复合叶酸制剂能显著降低血浆同型半胱氨酸水平。     

血浆Hcy与血管性帕金森综合征的相关性分析

目的 探讨血浆同型半胱氨酸(Hcy)对血管性帕金森综合征(VP)影响及临床意义.方法 测定56例血管性帕金森综合征患者及52例健康对照者的血浆Hcy、叶酸(FA)、维生素B12水平.对Hcy增高的VP患者予以叶酸、维生素B12等药物治疗,并记录治疗前后的Webster评分.结果 VP组的Hcy水平显著高于对照组(P＜0.05);血浆FA、维生素B12的水平低于对照组(P＜0.05);Hcy水平增高的VP患者Webster评分明显高于Hcy水平正常的患者(P＜0.05);而经药物治疗后,Webster评分较治疗前明显降低(P＜0.05).结论 Hcy与VP发病及VP的严重程度可能存在相关性;对Hcy增高的VP患者常规给予降低Hcy治疗,对VP患者的治疗和预后有益.     

高同型半胱氨酸血症与急性脑血管病及颈动脉狭窄的关系

目的研究高同型半胱氨酸血症（HHcy）与急性脑血管病及颈动脉狭窄的关系。方法应用荧光定量分析法测定68例急性脑梗死（ACI组）、52例急性脑出血（AICH组）患者血浆同型半胱氨酸（Hey）浓度，放免方法测定各组的叶酸、维生素B12水平，并与正常对照组比较。对脑梗死患者采用彩色多普勒超声进行颈动脉检测。结果ACI组、AICH组的血浆Hey水平均显著高于正常对照组（均P〈0．01），而叶酸、维生素B，2水平均显著低于正常对照组（均P〈0．05）。单因素相关分析显示ACI组、AICH组血浆Hey水平与叶酸水平均呈负相关（r=-037、-0．34，P〈0．01），与维生素B12水平也均呈负相关（r=-0．33、-0．29，P〈0．01）。ACI组中，颈动脉重度狭窄者血浆Hey浓度显著高于中度狭窄者及无狭窄或轻度狭窄者（均P〈0．01），中度狭窄者血浆Hcy浓度显著高于无狭窄或轻度狭窄者（P〈0．01）。结论HHcy是急性脑血管病的一个新的重要危险因素。Hcy水平受叶酸、维生素B12的影响，Hcy水平与脑梗死患者颈动脉狭窄的严重程度有关。     

血浆同型半胱氨酸和2型糖尿病及并发症的关系

目的研究血浆同型半胱氨酸（Hcy）在2型糖尿病（DM）及其并发症中的变化,同时探讨叶酸（FA）、维生素B12（VitB12）与Hcy的关系。方法将57例2型DM患者分为单纯DM组（25例）和DM合并并发症组（27例）,以45名健康者作为正常对照组,测定各组血浆Hcy浓度并作比较。同时应用化学发光分析法测定各组FA及VitB12浓度。结果DM合并并发症组血浆Hcy水平高于正常对照组及单纯DM组（P〈0.01）。2型DM患者血浆Hcy与FA、VitB12水平呈负相关（r=-0.6381、r=0.6721,P〈0.05）,DM合并并发平患者血浆Hcy与FA、VitB12呈明显负相关（r=0.7622、r=-0.7896,P〈0.01）。结论高Hcy与DM慢性并发症明显相关,血浆FA及VitB12浓度是影响血浆Hcy水平的重要因素。     

糖尿病心脏病患者血清同型半胱氨酸水平及其干预研究

目的：探讨糖尿病心脏病（DC）患者血清同型半胱氨酸（Hcy）水平,观察叶酸、维生素B12和甲钴铵治疗高同型半胱氨酸血症的疗效。方法：确诊的DC患者（干预组）36例及正常对照组36例,用高效液相色谱法测定血浆Hcy水平,用放免法测定血浆叶酸和维生素B12浓度。其中高Hcy血症患者每天服用叶酸5mg,每日3次,甲钴胺针0.5 mg肌肉注射,每日1次,2周后改为口服甲钴胺片500μg,每日3次。观察4周血浆Hcy、叶酸和维生素B12水平变化。结果：DC患者血浆Hcy水平明显高于正常对照组（P〈0.05）,叶酸和维生素B12水平则明显低于正常对照组（P〈0.05）;干预治疗4周后,干预组血浆Hcy水平明显下降（P〈0.05）;叶酸和维生素B12水平则明显升高（P〈0.05）。结论：DC患者血浆Hcy水平明显高于正常人,高Hcy血症是DC的危险因素之一,叶酸和甲钴铵干预治疗可使DC患者血浆Hcy浓度明显降低。     

血清同型半胱氨酸水平与巨幼细胞性贫血相关研究

目的探讨血清同型半胱氨酸（Hcy）与巨幼细胞性贫血（MA）关系,观察不同维生素B12与叶酸浓度改变对巨幼细胞性贫血的同型半胱氨酸水平改变及意义。方法采用正常对照组30例,单纯缺铁性贫血（IDA）30例,巨幼细胞性贫血86例（其中单纯性叶酸缺乏性贫血23例,单纯性维生素B12缺乏性贫血35例,叶酸和维生素B12同时缺乏性贫血28例）,测定叶酸、维生素B12、同型半胱氨酸采用化学发光微粒子免疫检测方法。结果巨幼细胞性贫血组血浆Hcy水平均高于对照组和单纯缺铁性贫血组（P〈0.01）,其中单纯性叶酸缺乏贫血、单纯性维生素B12缺乏性贫血、叶酸和维生素B12同时缺乏性贫血之间Hcy水平差异无统计意义（P〉0.05）。结论通过检测血清Hcy变化可指导巨幼细胞性贫血治疗和了解其预后。     

联合补充叶酸、维生素B6和B12对冠心病患者高同型半胱氨酸血症的影响

目的观察联合补充叶酸、维生索珑和维生素B12对冠心病合并高同型半胱氨酸血症患者降低血浆同型半胱氨酸（Hey）水平的影响。方法采用高压液相色谱法测定空腹血浆Hcy水平，应用放免分析法测定基础血浆叶酸及维生素B12浓度。冠心病患者中Hcy水平高于15μmol／L者为高I司型半胱氨酸血症，随机分为治疗组（55例）和对照组（43例），治疗组予以每日补充叶酸5mg，维生素B6 20mg 3次，维生素B12 0．5mg，对照组不予此三种药物治疗，4周后患者复查血浆Hcy水平。结果治疗组4周后Hcy水平平均降低了37．7％，治疗前后Hcy水平比较有显著差异（P〈0．01），治疗组中，治疗前后差值即经治疗后Hcy水平降低的幅度与基础叶酸浓度呈负相关（r=-0．386，P〈0．05）。结论联合补充叶酸、维生素B6和维生素B12可明显降低冠心病合并高同型半胱氨酸血症患者的血浆Hey水平，而且治疗前血浆叶酸浓度越低，Hcy水平降低的幅度越大，补充治疗的效果越好。     

深圳地区营养性巨幼细胞性贫血与同型半胱氨酸水平的相关性研究

目的 探讨血清同型半胱氨酸(homocysteine,Hcy)水平与营养性巨幼细胞性贫血(megaloblastic anemia,MA)之间的关系,评价检测Hcy在MA诊断治疗、预后及监测等方面的应用。方法 检测实验组(192例营养性MA患者其中包括单纯叶酸缺乏贫血患者69例、单纯维生素B12缺乏贫血患者60例,同时缺乏叶酸和单纯维生素B12缺乏贫血患者63例)、对照组(200例来自深圳市福田区人民医院体检且体检结果正常的健康人)和治愈组(已治愈实验组的192例单纯营养性MA患者)叶酸、维生素B12、Hcy水平。结果 实验组与对照组做比较,血清中的叶酸、维生素B12,Hcy水平比较差异均有统计学意义(t=3.56,3.21,2.78,P<0.01); 对照组与治愈组做比较,血清中的叶酸、维生素B12,Hcy水平比较差异无统计学意义(t=1.23,0.98,0.77,P>0.05); 营养性MA患者不同缺乏物质各组间Hcy水平差异无统计学意义(t=1.42,P>0.05)。结论 营养性MA患者血清中的Hcy水平高于健康人血清中的Hcy水平,高水平Hcy与营养性MA存在相关性,可通过监测血清中Hcy的水平变化指导营养性MA的治疗。     

孕妇血清叶酸、维生素B12及铁蛋白水平的分析

目的：探讨早、中期妊娠妇女血清叶酸、维生素B12及铁蛋白的含量水平。方法将新疆察布查尔县800例进行产前检查的孕妇按孕期的不同分为2组：早孕组（220例）和中孕组（580例）。选择同期体检的非妊娠健康妇女800例为对照组。对各组研究对象空腹血清中的叶酸、维生素B12和铁蛋白的含量进行测定,并对各数据进行统计分析。结果早孕组叶酸、维生素B12和铁蛋白含量与对照组比较差异均无统计学意义（均P＞0.05）;中孕组叶酸、维生素B12和铁蛋白含量均明显低于对照组[（7.9±30.2） ng·mL-1、（432.1±48.3） pg·mL-1和（58.5±39.6）ng·mL-1比（9.2±35.1）ng· mL-1、（598.5±60.9） pg·mL-1和（101.7±49.7）ng·mL-1,均P＜0.05]。孕妇分娩前红细胞内叶酸、维生素B12和铁蛋白与新生儿体质量无显著的相关性（r=0.021、0.016、0.037,均P＞0.05）。结论中期妊娠孕妇血清中的叶酸、维生素B12和铁蛋白的含量明显降低,及早采取补充或干预性治疗,对减少或杜绝缺陷新生儿的出生率、提高优生优育有极其重要的意义。     

脑卒中与血浆同型半胱氨酸水平的关系

背景很多研究表明高同型半胱氨酸血症可能是导致脑卒中发病的独立危险因素.目的探讨高同型半胱氨酸血症与脑梗死和脑出血发生之间的关系,并分析可能影响同型半胱氨酸水平的相关因素.设计病例-对照实验.单位浙江大学医学院附属第二医院神经内科.对象选择2003-01/11在浙江大学医学院附属第二医院的住院患者57例,其中脑卒中57例(脑出血组21例,脑梗死组36例),并以同期到本院作体检的健康人28例作为对照组.方法所有被试者均晨起空腹抽取静脉血2 mL,测定血浆同型半胱氨酸、维生素B12、叶酸、肌酐等含量,并对所有患者进行临床神经功能缺损程度评分,脑出血组患者根据CT摄片计算出每例患者的血肿体积.主要观察指标①各组被试者血浆同型半胱氨酸水平.②血浆同型半胱氨酸水平与叶酸,维生素B12,临床神经功能缺损程度评分及血肿体积的相关性.结果57例脑卒中患者和28例健康者全部进入结果分析.①脑梗死组、脑出血组男性和女性同型半胱氨酸的水平均高于同性别对照组[(25.2±21.4),(18.3±10.9),(11.5±2.9)μ mol/L;(22.8±18.9),(14.7±7.4),(10.8±2.6)μ mol/L,P＜0.05-0.01].脑梗死组和脑出血组基本接近(P＞0.05).②脑梗死组、脑出血组患者同型半胱氨酸水平与叶酸水平呈极显著负相关(r=-0.442,-0.531,P＜0.05),与维生素B12水平无显著相关性(r=-0.086,-0.111,P＞0.05).脑梗死组同型半胱氨酸水平与临床神经功能缺损程度评分无显著相关性(r=-0.139,P＞0.05),脑出血组同型半胱氨酸水平与临床神经功能缺损程度评分和血肿体积无显著相关性(r=0.225,0.425,P＞0.05).结论高同型半胱氨酸血症是脑梗死和脑出血的危险因素.血浆同型半胱氨酸水平与叶酸水平呈负相关,与维生素B12、临床神经功能缺损程度评分、血肿体积无显著相关.     

Hyperhomocysteinaemia is not associated with increased levels of asymmetric dimethylarginine in patients with ischaemic heart disease

BACKGROUND: Elevated plasma total homocysteine appears to be related to endothelial dysfunction and impaired nitric oxide production. We aimed to investigate [1] whether elevated levels of plasma total homocysteine are associated with high plasma levels of asymmetric dimethylarginine, an endogenous inhibitor of nitric oxide synthase, and [2] whether reduction of plasma total homocysteine levels by folate and vitamin B supplementation lowers plasma concentration of asymmetric dimethylarginine. MATERIALS AND METHODS: Sixty patients with ischaemic heart disease and with plasma total homocysteine levels of 15.0 micromol L-1 were randomized to open therapy with folic acid, pyridoxine and cyancobalamin for 3 months (n = 30) or to no treatment (n = 30). Samples were also obtained from 34 patients with plasma total homocysteine levels of 8.0 micromol L-1 on admission. RESULTS: Plasma asymmetric dimethylarginine concentrations in patients with elevated total homocysteine levels were not significantly higher (0.68 +/- 0.19 micromol L-1) than in patients with low total homocysteine levels (0.61 +/- 0.10 micromol L-1; P = 0.08). Plasma asymmetric dimethylarginine level in the vitamin supplemented group was 0.65 +/- 0.12 micromol L-1 before, and 0.64 +/- 0.12 micromol L-1 after 3 months of vitamin supplementation (NS). Plasma asymmetric dimethylarginine levels were correlated with serum cystatin C levels (P < 0.001). CONCLUSION: A nonsignificant trend to increased plasma levels of asymmetric dimethylarginine in patients with high plasma total homocysteine levels may be explained by concomitant subtle renal dysfunction. Substantial reduction of plasma total homocysteine did not affect the level of plasma asymmetric dimethylarginine.     

Waist-to-hip ratio correlates with homocysteine levels in male patients with coronary artery disease

BACKGROUND: Obesity and homocysteine are important risk factors for cardiovascular disease. The relation between pattern of obesity and homocysteine is unclear. The objective of this study was to investigate the relation between pattern of obesity and plasma total homocysteine (tHcy) level in male patients with coronary artery disease (CAD). METHODS: A total of 63 male patients (mean age 66.2 years) with angiographically documented CAD were enrolled. Overnight fasting blood samples were measured for plasma tHcy, serum folic acid and serum vitamin B12 levels. Anthropometric measurements included waist-to-hip ratio (WHR) and body mass index (BMI). RESULTS: The mean WHR was 0.90+/-0.05, mean BMI 24.6+/-3.3 kg/m2 and the mean plasma tHcy level 11.6+/-3.2 micromol/L. In univariate analysis, plasma tHcy level correlated significantly with serum vitamin B12 level, serum folic acid level, WHR, estimated creatinine clearance, aspirin use and fibrate use. There was no significant association between plasma tHcy level and BMI. In multivariate analysis, only WHR (beta-value 22.263, p<0.001), serum level of vitamin B12 (beta-value -0.004, p=0.003), estimated creatinine clearance (beta-value -4.154, p=0.003) and use of fibrates (beta-value 2.307, p=0.031) were independent predictors of plasma tHcy level. CONCLUSIONS: WHR, but not BMI, is a strong independent predictor of plasma tHcy level in male patients with CAD.     

补充叶酸、维生素B12对缺血性脑卒中复发的影响

目的探讨缺血性脑卒中（ICS）复发与高同型半胱氨酸（Hcy）的关系及口服叶酸、维生素B12对ICS复发的影响。方法将150例ICS患者随机分为2组：对照组70例和研究组80例。对照组给予降压、降脂、降糖及抗血小板聚集等综合治疗;研究组在对照组治疗的基础上口服叶酸片10 mg,1次.d-1;维生素B120.5 mg,1次.d-1。2组疗程均为2年。观察2组治疗前,治疗后6、12、18、24个月血浆Hcy水平的变化及治疗后6、12、18、24个月ICS复发等情况,ICS复发与血浆Hcy水平变化的相关性。结果研究组治疗前、治疗后6个月血浆Hcy水平与对照组比较差异均无统计学意义（均P〉0.05）,而治疗后12、18、24个月血浆Hcy水平均明显低于对照组（P〈0.05或P〈0.01）。研究组、对照组总复发率分别为16.25%、37.14%,2组比较差异有统计学意义（P〈0.05）。Logistic多元回归分析结果显示,ICS复发与糖尿病、高Hcy血症均有关（P〈0.05或P〈0.01）,高Hcy血症是ICS复发的独立危险因素。结论高Hcy血症与ICS复发相关;口服叶酸及维生素B12能显著降低血浆Hcy水平,减少ICS复发率,在二级预防中具有重要意义。     

Efficacy of multivitamin supplementation containing vitamins B6 and B12 and folic acid as adjunctive treatment with a cholinesterase inhibitor in Alzheimer's disease: a 26-week, randomized, double-blind, placebo-controlled study in Taiwanese patients

BACKGROUND: Elevated serum homocysteine levels have been associated with the development of Alzheimer's dementia (AD). The combined use of a mecobalamin capsule preparation, which contains vitamin B12 0.5 mg with an active methyl base, and an over-the-counter nutritional supplement that contains folic acid 1 mg and pyridoxine hyperchloride 5 mg may be effective as a homocysteine-lowering vitamin regimen. OBJECTIVE: The aim of this study was to determine whether oral multivitamin supplementation containing vitamins B6 and B12 and folic acid would improve cognitive function and reduce serum homocysteine levels in patients with mild to moderate AD. METHODS: This randomized, double-blind, placebocontrolled trial was conducted at En Chu Kong Hospital, Taipei, Taiwan. Male and female patients aged >50 years with mild to moderate AD and normal folic acid and vitamin B12 concentrations were enrolled. All patients received treatment with an acetylcholinesterase inhibitor and were randomized to receive add-on mecobalamin (B12) 500 mg + multivitamin supplement, or placebos, PO QD for 26 weeks. The multivitamin contained pyridoxine (B6) 5 mg, folic acid 1 mg, and other vitamins and iron. Serum homocysteine level was measured and cognitive tests were conducted at baseline and after 26 weeks. The primary efficacy outcome was change in cognition, measured as the change in score from baseline to week 26 on the Alzheimer's Disease Assessment Scale 11-item Cognition subscale. Secondary efficacy outcomes included changes in function in performance of activities of daily living (ADLs) and concentrations of homocysteine, B12, and folic acid. Tolerability was assessed by comparing the 2 study groups with respect to physical examination findings, including changes in vital signs, laboratory test abnormalities, concomitant medication use, and compliance of study medication was assessed using an interview with the patient's caregiver, as well as the monitoring of adverse events (AEs) throughout the study. RESULTS: Eighty-nine patients (45 men, 44 women; all Taiwanese; mean [SD] age, 75 [7.3] years) were enrolled and randomized. Overall, there were no significant differences in cognition or ADL function scores between the 2 groups. At week 26, the mean (SD) between-group difference in serum homocysteine concentration versus placebo was -2.25 (2.85) micromol/L (P = 0.008), and the mean serum concentrations of vitamin B12 and folic acid were significantly higher (but within normal range) in the multivitamin group compared with placebo (., +536.9 [694.4] pg/mL [P < 0.001] and +13.84 ng/mL [11.17] [P = 0.012] at 26 weeks, respectively). The 2 most common AEs were muscle pain (11.1% and 6.8%) and insomnia (8.9% and 9.1%) in the multivitamin and placebo groups, respectively. CONCLUSIONS: In this population of patients with mild to moderate AD in Taiwan, a multivitamin supplement containing vitamins B(6) and B(12) and folic acid for 26 weeks decreased homocysteine concentrations. No statistically significant beneficial effects on cognition or ADL function were found between multivitamin and placebo at 26 weeks.     

血浆Hcy、FA、VB12水平在冠心病及合并糖耐量异常患者中的应用分析

目的：探讨血浆同型半胱氨酸（Hcy）、叶酸（FA）、维生素B12（VB12）水平在冠心病（CHD）及合并糖耐量异常（IGT）患者中的应用价值。方法按纳入标准筛选的试验者80例,分为单纯CHD组36例,CHD合并IGT组44例;健康对照者70例作为对照组。测定 Hcy、FA、VB12水平,对检测结果进行统计学分析。结果两组患者Hcy水平均高于对照组,差异有统计学意义（P＜0．05）,单纯CHD组阳性率为94．4％,CHD合并IGT组阳性率为88．6％;FA水平均低于对照组,与Hcy水平呈负相关（P＜0．05）;3组VB12水平比较差异无统计学意义（P＞0．05）,两组Hcy水平与VB12相关性分析无统计学意义（P＞0．05）。结论血浆Hcy 水平在CHD 及合并IGT 中非常高且与FA 呈负相关,动态检测其水平对CHD 及合并IGT 的预警和治疗具有重要意义。