老年脑梗死患者血清同型半胱氨酸水平及药物干预研究(英文)

目的了解正常人颈动脉硬化患者及脑梗死患者血清同型半胱氨酸(serumtotalnomocysteine,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。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,各组均随机分为两组,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,1次/d,口服10个月后复查上述各项指标。结果治疗前3组血tHcy水平各不相同,脑梗死组为(16±5)μmol/L,颈动脉硬化组为(14±5)μmol/L,正常老年人组为(12±3)μmol/L,3组比较差异有显著意义。血tHcy含量增高,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含量均有所下降。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对血管的素性作用。

The total homocysteine concentrati on in the patients with ischemic stro ke or carotid atherosclerosis disease,a nd intervention study

Aim To investigate total homocysteine(tHcy) concentration in ischemic stroke patients and in carotid atherosclerosis patients in comparison with normal control elders and to evaluate whether providing foliate and vitamin B12 could decrease serum homocysteine concentration.Methods The sample in this study was obtained from the inpatients and outpatients of geriatric department, HuaShan hospital.160 patients were recruited and were divided into two groups with smoking controlled.Thyroid gland abnormality and renal failure were excluded.One group consisted of 71 male and 9 female ischemic stroke patients aged 73 years on average.There were 71 males,9 females carotid atherosclerosis disease patients,aged 72 years on average in the second group.Hypertension and mellitus diabetes were controlled to avoid the influence of the conditions on these patients.The third group consisted of 72 males and 8 females normal control elders,aged 71 years on average.Besides fast serum total homocysteine,every patient took laboratory and physical examinations,including plasma folate, vitamin B12,free plasma glucose,creatinine,cholesterol,triglyceride,blood pressure and blood mass index.Each group was randomly divided further into two subgroups in which one subgroup was provided with folic acid 1.25 mg once every other day and vitamin B12 8 μ g once per day while the other was not.These patients were reexamined after 10 months.Results The serum tHcy concentration was (16± 5) μ mol/L in ischemic stroke group and (14± 5) μ mol/L in carotid atherosclerosis group compared with (12± 3) μ mol/L in normal control elders(P=0.0001).The plasma folate level was lower in ischemic stroke and carotid atherosclerosis patients,and there were no significant differences in other laboratory examination results.Correlation analysis showed that tHcy was negatively correlated with folate and vitamin B12 level,r=- 0.392, - 0.36 respectively in ischemic stroke group, r=- 0.287, - 0.339 respectively in carotid atherosclerosis group, and r=- 0.338, - 0.227 in normal control group.The tHcy concentration was lower in the groups provided with folate and vitamin B12 than that in the groups without folate and vitamin B12 (P=0.0001),even in the normal elders.Conclusion The tHcy concentration is higher in the patients with ischemic stroke and carotid atherosclerosis.Folate supplement could moderately lower serum tHcy level.