叶酸联合缬沙坦治疗伴有高同型半胱氨酸血症的原发性高血压疗效分析

目的探讨上海市嘉定区江桥地区伴有高同型半胱氨酸血症的原发性高血压人群血清同型半胱氨酸(homocysteine,Hcy)水平及应用叶酸联合缬沙坦治疗后的效果。方法选取2012年1月—2015年1月上海市嘉定区江桥地区成年伴有高同型半胱氨酸血症的原发性高血压患者300例,按照随机数表法分为观察组和对照组,每组150例,给予对照组缬沙坦80 mg/d;观察组在其基础上给予叶酸治疗,0.4 mg/d,疗程为24个月。观察并比较两组治疗6、12、18、24个月的血压、血清Hcy水平及心血管事件发生情况。结果 300例患者中完成随访287例,其中观察组140例,对照组147例。与治疗前基线水平相比,两组治疗6、12、18和24个月后收缩压和舒张压均有所下降,差异均有统计学意义(P<0.05),相同时间点组间比较差异无统计学意义(P>0.05)。与治疗前基线水平相比,观察组治疗6、12、18和24个月后血清Hcy水平均有所下降,且随着时间延长逐渐降低,差异均有统计学意义(P<0.05),相同时间点观察组血清Hcy水平低于对照组,差异均有统计学意义(P<0.05)。随访期间,观察组发生心脑血管事件的比例[3.57%(5/140)]低于对照组[12.24%(18/147)],差异有统计学意义(P<0.05)。结论对于上海市嘉定区江桥地区伴有高同型半胱氨酸血症的原发性高血压的患者,在缬沙坦基础上给予叶酸治疗可进一步降低血清Hcy水平,同时降低心血管事件的风险。     

单用叶酸与联合维生素B12治疗高同型半胱氨酸血症的疗效比较

同型半胱氨酸(homocysteine，Hcy)是体内蛋氨酸代谢途径中形成的一种含硫氨基酸。近年临床资料及流行病学表明．高同型半胱氨酸血症(hyperhomocysteinemia，HHcy)已成为继高血压、高血脂、糖尿病、吸烟、肥胖等因素之后动脉粥样硬化的又一独立危险因子。降低Hcy能有效地减少冠心病的发生。本文通过单独应用叶酸和叶酸联合维生素B12分别治疗HHcy患者，对比二种疗效,并探讨其临床意义。     

叶酸拮抗高同型半胱氨酸血症大鼠Bcl-2基因低甲基化研究

目的探讨叶酸对蛋氨酸饮食诱导高同型半胱氨酸血症(Hhcy)大鼠主动脉组织Bcl-2基因甲基化水平影响。方法健康6周龄雄性wistar大鼠36只,体重(160±10)g,适应性喂养一周后随机分为对照组、高同型半胱氨酸组、叶酸干预组、每组12只。对照组给予AIN-93G配方饲料,高同型半胱氨酸组饲以含1.7%蛋氨酸的AIN-93G配方饲料,叶酸干预组饲以含1.7%蛋氨酸和0.008%叶酸的AIN-93G配方饲料。喂养18周后,全自动生化仪测定血浆Hcy浓度、叶酸浓度和维生素B12浓度;免疫组化检测大鼠主动脉组织Bcl-2表达;巢式降落式PCR联合甲基化特异性PCR检测Bcl-2基因启动子区甲基化水平,荧光RT-PCR检测主动脉组织Bcl-2基因mRNA表达。结果 18周蛋氨酸饮食可以诱导大鼠高同型半胱氨酸血症(P<0.01),叶酸摄入可以拮抗血浆同型半胱氨酸水平升高(P<0.01);与对照组比较,高Hcy组大鼠主动脉组织Bcl-2阳性细胞数目增加,Bcl-2基因启动子区甲基化水平降低(P<0.05),Bcl-2 mRNA表达增加(P<0.05)。叶酸干预后,主动脉组织Bcl-2阳性细胞数目减少,Bcl-2基因启动启动子区甲基化水平高于高Hcy组(P<0.05),Bcl-2 mRNA表达低于高Hcy组(P<0.05)。结论叶酸摄入可以拮抗高同型半胱氨酸血症大鼠主动脉组织Bcl-2低甲基化,使Bcl-2表达减弱,可能是其参与抗动脉粥样硬化形成的分子机制之一。     

叶酸和B族维生素对冠心病心力衰竭合并高同型半胱氨酸血症患者的疗效

目的探讨叶酸和B族维生素对冠心病心力衰竭合并高同型半胱氨酸血症患者的疗效。方法选取2017年6月至2018年12月本院收治的冠心病心力衰竭合并高同型半胱氨酸血症患者200例。随机分为观察组与对照组,每组100例。对照组采用对症药物常规治疗,观察组在此基础上加叶酸、维生素B6及维生素B12。分别于治疗前和治疗4、8 W后检测同型半胱氨酸水平,放射免疫法测定N末端脑钠肽(NT-proBNP)水平,超声心动图检测心功能和心室结构水平。结果治疗4、8 w后观察组患者同型半胱氨酸水平为(14.32±2.50)、(12.78±1.92)μmol/L,明显低于治疗前和同期对照组,差异均有统计学意义(均P<0.05)。治疗4、8w后观察组患者同型半胱氨酸水平明显低于治疗前和同期对照组,差异均有统计学意义(均P<0.05)。治疗8 w后,观察组患者E/A明显高于治疗前和同期对照组,差异有统计学意义(P<0.05)。治疗8 w后,观察组患者E/A值明显高于治疗前和同期对照组,差异均有统计学意义(均P<0.05)。结论叶酸联合B族维生素可有效降低冠心病心力衰竭合并高同型半胱氨酸血症患者的同型半胱氨酸和NT-proBNP水平,改善E/A值。     

癫痫伴高同型半胱氨酸血症10例分析

目的:探讨癫痫伴高同型半胱氨酸血症分析。方法:回顾性分析2012年1月-12月收治的10例癫痫合并高同型半胱氨酸血症患者的临床资料。结果:10例患者临床发作形式9例以强直-痉挛大发作为主,1列以失神发作为主;3例为正常脑电图;2例患者表现为轻度异常主要是清醒时脑电背景以θ波为主;1例患者(脑出血)广泛重度异常脑电监测。结论:癫痫临床发作以强直-痉挛大发作为主,癫痫患者中合并有高同型半胱氨酸血症,HHcy的兴奋性神经毒性作用和氧化应激是促进癫痫发作的原因,Hcy水平增加有促使癫痫发作和神经退行性疾病的发生率。     

癫痫伴高同型半胱氨酸血症10例分析

目的：探讨癫痫伴高同型半胱氨酸血症分析。方法：回顾性分析2012年1月-12月收治的10例癫痫合并高同型半胱氨酸血症患者的临床资料。结果：10例患者临床发作形式9例以强直-痉挛大发作为主,1列以失神发作为主;3例为正常脑电图;2例患者表现为轻度异常主要是清醒时脑电背景以θ波为主;1例患者（脑出血）广泛重度异常脑电监测。结论：癫痫临床发作以强直-痉挛大发作为主,癫痫患者中合并有高同型半胱氨酸血症,HHcy的兴奋性神经毒性作用和氧化应激是促进癫痫发作的原因,Hcy水平增加有促使癫痫发作和神经退行性疾病的发生率。     

叶酸干预对精神分裂症伴高同型半胱氨酸血症患者认知功能的影响

目的探索叶酸干预对精神分裂症伴高同型半胱氨酸血症(HHcy)患者认知功能的影响。方法选取90例伴有HHcy的精神分裂症患者,随机分为研究组与对照组各45例,两组患者均常规予以利培酮治疗,在此基础上,对照组给予口服安慰剂,研究组则采用叶酸干预,连续治疗及观察6个月,比较治疗前后患者HHcy及认知功能变化。结果治疗6个月后,研究组MoCA评分结果与治疗前比较变化不显著(P>0.05);对照组MoCA评分结果与治疗前及研究组治疗6个月后比较均明显下降(P<0.05);但两组MMSE评分与治疗前比较,差异均无统计学意义(P>0.05)。治疗6个月后,对照组Hcy及叶酸水平与治疗前比较,差异均无统计学意义(P>0.05);但研究组Hcy水平与治疗前比较明显下降(P<0.05);研究组叶酸水平与治疗前比较明显上升(P<0.05);治疗6个月后,研究组Hcy及叶酸水平与对照组比较,差异均有统计学意义(P<0.05);两组治疗后阳性、阴性症状及一般精神病理评分均较治疗前显著降低(P<0.05);其中研究组阳性、阴性症状及一般精神病理评分较对照组降低更为显著(P<0.05)。结论精神分裂症伴HHcy患者常规治疗同时辅助叶酸治疗,有助于降低Hcy及炎症因子水平,改善精神症状,提升患者认知功能。     

酗酒引起重症高同型半胱氨酸血症

同型半胱氨酸和 /或其他代谢产物半胱氨酸水平过高 ,可诱发神经细胞损伤 ,其机制是与兴奋性氨基酸毒性有关 ,酒精引起严重高同型半胱氨血症与其醇脱氢酶不足以完全降解酒精 ,致使脑细胞微粒体细胞色素ＣＹＰ 2Ｅ1及ｉＮＯＳ表达亢进 ,自由基生成过多损伤神经细胞。作者报告一对夫妇酗酒发生严重的Ｓ-腺苷同型半胱氨酸以同型半胱氨酸水平过高 ,Ｓ -腺苷甲硫氨酸 /Ｓ -腺苷同型半胱氨酸比例下降 ,这与血清、酒精浓度升高密切相关 ,也与酒精的戒断状态有联系。作者指出汹酒者钴胺素缺乏 ,因而转甲基与转硫作用下降 ,产生巨幼红细胞增多贫血 ,高…     

叶酸对伴有高同型半胱氨酸血症的农村高血压患者内生肌酐清除率的影响

目的探讨叶酸对伴有高同型半胱氨酸血症(hyperhomocysteinemia,Hhcy)的农村高血压患者内生肌酐清除率(creatinine clearance rate,Ccr)的影响。方法入选2012年1月—2014年1月收治的农村高血压患者152例,按就诊先后顺序分为观察组与对照组各76例,两组患者均低盐饮食,服用氨氯地平及美托洛尔将血压控制在130/80mm Hg(1mm Hg=0.133 kPa)以下。观察组在此基础上口服叶酸治疗,5 mg/d。4周为1疗程,共治疗1疗程。比较两组患者治疗前后血压变化、Scr、BUN、Ccr及Hcy水平。计量资料比较采用t检验,计数资料采用百分数表示,比较采用χ2检验,P0.05为差异有统计学意义。结果观察组治疗后血压[(138.6±10.5)、(89.2±3.5)mm Hg]均显著低于对照组[(142.5±11.2)、(90.7±3.6)mm Hg],差异均有统计学意义(均P0.05)。观察组治疗后BUN、Hcy及Scr[(5.2±1.2)mmol/L、(9.7±3.4)μmol/L、(58.7±18.4)μmol/L]均显著低于对照组[(7.5±1.5)mmol/L、(33.8±6.6)μmol/L、(89.1±16.0)μmol/L],Ccr[(80.2±11.9)%]显著高于对照组[(59.2±7.6)%],差异均具有统计学意义(均P0.05)。结论高血压伴HHcy患者补充叶酸有效降低Hcy水平,提高Ccr,从而改善肾功能。     

补充叶酸:防治高同型半胱氨酸血症

叶酸是我们可以从食物中摄取的一种B族维生素。叶酸又是一个老药.多年来.血液科医生用它治疗"巨幼红细胞性贫血",妇产科医生建议孕妇适量服用叶酸以保证胎儿神经系统的正常发育。随着大家防治心脑血管病的意识不断增强.一个叫起来有些拗口的病——"高同型半胱氨酸血症".受到了关注,叶酸是治疗该病的首选药物。于是,这味老药也有些"升温"了。下面就来说说关于这个老药的新话题吧。     

血清同型半胱氨酸及叶酸水平与先天性心脏病的关系

目的了解先天性心脏病(CHD)患者及其父母血清同型半胱氨酸(Hcy)及叶酸水平与CHD发生的关系。方法以核心家庭为基础的病例对照设计,在辽宁省选择CHD患者151人及其生物学父母作为病例组,另选取同地区无出生缺陷病史及家族史的98名正常人及其生物学父母作为相应对照。采用荧光免疫偏振法检测部分子代及其母亲的血清总Hcy(tHcy)水平,放射免疫法测定全部对象血清叶酸和维生素B12(VB12)水平。结果CHD患者及其母亲血清tHcy水平与对照组相比无明显差异;两组血清叶酸水平及叶酸缺乏率(<7nmolL)差异亦无显著性;与对照组相比,CHD患者血清VB12水平明显较高(315.36pmolL和185.34pmolL,P<0.05),VB12缺乏率(<150pmolL)明显较低,CHD组父亲血清VB12缺乏率也低于相应对照。分类型分析显示室间隔缺损患者血清tHcy水平明显低于对照组,而VB12水平明显高于对照;动脉导管未闭组父母血清叶酸水平均高于相应对照(P<0.05)。相关性分析表明亲代叶酸、VB12水平与子代呈明显正相关;病例组母亲tHcy水平与子代tHcy正相关,子代tHcy与叶酸水平负相关;对照组子代tHcy与VB12水平负相关(P<0.05)。结论叶酸及VB12是影响血清Hcy水平的重要因素,呈明显负相关;本研究尚不能得出叶酸及Hcy与CHD相关的结论,有待进一步研究。     

Nutritional interpretation of folic acid interventions

Folate is an essential micronutrient, and its nutritional inadequacy is widespread; hence, programs to increase its intake are necessary. However, many concerns about possible adverse effects due to excesses have been raised. Serum folate levels are directly correlated with intake and, when low, are associated with neural tube defects (NTD), high blood homocysteine levels, and megaloblastic anemia. Serum folate cutoff points have been identified for each abnormality, and all can be associated with intakes related to the current recommended dietary parameters. Likewise, high intakes that overwhelm the physiological capacity to process folic acid into biologically active folate derivatives are near the recommended tolerable upper intake level. Although we do not know with certainty the minimum efficacious dose that prevents all folate-dependent NTD, it may actually be much lower than the current recommendation, especially when provided through food fortification; supplemental intakes around 100 µg/day appear to be appropriate.     

同型半胱氨酸、叶酸浓度与妊娠期糖尿病的关联研究

目的探讨血浆同型半胱氨酸(Hcy)、叶酸水平与妊娠期糖尿病(GDM)的相关性。方法选取2012年4月至2015年2月在陕西省汉中市三二〇一医院产科确诊的314例GDM患者作为GDM组,随机选取同期健康孕妇347例作为对照组。通过标准化问卷收集孕妇的一般资料,血浆Hcy水平检测采用循环酶法,血浆叶酸水平检测采用电化学发光法。结果GDM组Hcy水平高于对照组(t=23.301),叶酸水平低于对照组(t=22.811),差异均有统计学意义(均P<0.05)。GDM组孕24~26⁺⁶周、孕27~29⁺⁶周、孕30~32⁺⁶周Hcy水平均高于对照组(t值分别为14.123、16.039、9.277),叶酸水平均低于对照组(t值分别为12.650、15.842、10.608),差异均有统计学意义(均P<0.05)。Pearson相关性分析发现,GDM孕妇血浆Hcy水平与叶酸水平呈显著性负相关(r=-0.431,P<0.05)。结论血浆Hcy和叶酸水平可能与GDM密切相关,并且Hcy水平和叶酸水平呈负相关。     

叶酸对孤独症儿童的辅助治疗效果研究

目的 探讨叶酸对参与结构化教育的孤独症儿童的辅助治疗效果,为进行靶向营养干预及综合辅助治疗提供科学依据。方法 采用开放性试验方法。随访66名参与结构化教学的孤独症儿童,遵循自愿原则分为叶酸干预组和对照组,采用孤独症行为量表（Autism Behavior Scale,ABC）、儿童孤独症评定量表（Children's Autism Rating Scale,CARS）、孤独症治疗评估量表（Autism Treatment Evaluation Checklist,ATEC）和自闭症儿童心理教育评核第3版（PEP 3）对其3个月前后的发育水平进行评估比较。结果 经过3个月的康复训练后,两组儿童ABC、CARS、ATEC量表总分均降低,PEP 3量表各项得分（除行为特征 非语言外）均有提高,且差异具有统计学意义（P<0.05）;训练前后各量表差值显示,叶酸干预组孤独症儿童ATEC量表中的语言交流项、PEP 3量表中的认知、语言理解和语言表达项的差值高于对照组,且差异具有统计学意义（P<0.05）。结论 孤独症儿童在参与结构化教学的同时补充叶酸,对认知和语言交流的改善作用优于单纯参与结构化教学。     

Supplementation with [6S]-5-methyltetrahydrofolate or folic acid equally reduces serum homocysteine concentrations in older adults

Folic acid (FA) supplementation reduces the elevated serum homocysteine (Hcy) concentrations. [6?S]-5-methyltetrahydrofolate ([6?S]-5-MTHF) is an alternative to FA due to possible advantages, that is, no masking cobalamin deficiency. The study aim was to evaluate the effectiveness of [6?S]-5-MTHF in relations to FA supplementation in reducing the serum Hcy. Healthy volunteers, aged 50–65, had normal serum folate and did not use supplements with B-vitamins for 6?months. Forty subjects were divided into two groups: receiving 400?μg/d FA or the equimolar amount of [6?S]-5-MTHF. Blood was collected at baseline and after 4?weeks. In both groups, a significant decrease in the mean Hcy level after intervention period was observed. Supplementation with [6?S]-5-MTHF was slightly less effective, but not significantly, in Hcy lowering than FA (p?=?.243 between the groups), that is, by 7.8% and 13.4%, respectively. The [6?S]-5-MTHF was shown to be an adequate alternative to FA in reducing Hcy concentrations.     

An update on folates and folic acid: contribution of MAFF‐funded research

The Ministry of Agriculture, Fisheries and Food (MAFF) recently commissioned the British Nutrition Foundation to review critically its Optimal Nutrition Status programme and identify future research requirements. MAFF describes two main scientific objectives for this programme: (a) to understand the links between optimal nutrition status and the maintenance of good health, and (b) to develop accurate measures of bioavailability of micronutrients from foods. Five projects funded under this programme have been concerned with folates and folic acid. The B vitamin folate/folic acid occurs in food as folic acid (the synthetic form used for fortification and dietary supplements) and a range of naturally occurring folate vitamers (folates). Measurement of folates in foods and biological samples has been difficult because of the different natural forms of folate. Several MAFF‐funded projects have addressed this difficulty and new assays for food folates and folates in biological samples have been developed. There is good evidence that the synthetic form of the vitamin, folic acid, in its free form as in supplements, is stable and more bioavailable than the naturally occurring folates at typical intake levels, but its bioavailability from fortified foods is less well established. Understanding of the bioavailability of endogenous food folates is also incomplete, and it is not possible at this time to predict the bioavailability for a given diet. Stable isotopic methods, as used in some of the MAFF‐funded projects, show great promise for the determination of folate bioavailability in whole diets, fortified foods and dietary supplements. An understanding of the function and metabolism of folates/folic acid is critical in identifying indicators of status. Recent and current research (some funded by MAFF), especially that relating to plasma homocysteine as a functional marker, is described in this paper. Human intervention studies that are being used to determine dose response of both natural food folates, and folic acid in fortified foods and supplements are also described. As yet there is insufficient evidence to determine functional markers of optimal nutrition status of folates/folic acid in population groups and hence to be in a position to review the Dietary Reference Values. Further research requirements were identified in the review and refined at a workshop of experts. These are set out under individual MAFF programme objectives in a table at the end of the paper.     

Examination of selected national policies towards mandatory folic acid fortification

The purpose of this paper is to present an examination of the contrasting policies towards mandatory folic acid fortification in six countries from different regions of the world. Three questions are addressed: 1) What is the policy of the country? 2) Why was the policy adopted? 3) What lessons have been learned? Policy contrasts among countries were assessed as reflecting different interpretations of the potential risks and benefits associated with folic acid fortification. Although commonalities were identified, it was considered unlikely that there could be a standard policy response for all countries. Instead, a country-by-country policy response based on national circumstances is indicated.     

孕妇服用叶酸行为影响因素研究

目的分析孕妇服用叶酸的影响因素,为提高叶酸干预效果提供基础数据。方法采用医院及入户调查方法,抽取甘肃省两个县内2094名孕后三个月至产后一年的妇女进行面对面匿名问卷调查。结果 2094名调查对象中,叶酸服用率为25.4%。叶酸认知水平、年龄、出生缺陷生育史及孕后去医院检查、文化程度、计划妊娠、流产史、孕前去医院检查等是影响孕妇叶酸服用行为的主要影响因素。结论孕妇生育史及对叶酸的认知水平是影响其叶酸服用的重要原因;对育龄人群广泛开展叶酸认知教育,倡导健康的计划生育观念应成为干预的重点措施;而如何找到提高孕前叶酸服用的有效途径还有待探讨。     

Estimating the impact of mandatory folic acid fortification on the folic acid intake of Australian women of childbearing age

Objective : The primary aim of this study was to estimate the impact of mandatory folic acid (FA) fortification of bread‐making flour on the FA intake of Australian women of childbearing age (16–44 years). The secondary objective was to investigate the relationship between estimated FA intake and socio‐economic status (SES) and age. Method : Dietary modelling was used to estimate FA intake under four mandatory fortification scenarios – no supplement use, supplement use unrelated to FA intake, supplement use only among the highest consumers of bread, and increased supplement use. Data were obtained from the 1995 National Nutrition Survey for food intake patterns, the 2007 Victorian Population Health Survey for FA supplement use, and a marketplace survey. Results : It is estimated that the National Health and Medical Research Council (NHMRC) recommendation for an additional 400 mg/day FA will be achieved by a minimum of 3.9, 25.4, 21.7 and 30% of the target population under scenarios 1–4, respectively. The FA upper level of intake is exceeded by a maximum of 0.1, 1.7, 6.1 and 4.1% of the target population for scenarios 1–4, respectively. Conclusions : Mandatory FA fortification is not sufficient for the NHMRC recommendations for minimum and maximum intakes to be met by all of the target population under a number of plausible behaviour scenarios. Implications : Targeted nutrition education campaigns are needed for SES and age sub‐groups and research of this nature should be extended to other population groups. Monitoring and evaluation of this policy will be important to ensure appropriate FA intake.