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。

Effect of Added Folic Acid and Vitamin B12 of the Recurrence with Ischemic Stroke

Objective To explore the relationship between recurrence in ischemic stroke（ICS） and high homocysteine（Hcy）,and the effecf of vitamin B12 and oral folic acid in recurrence with ICS.Methods 150 cases in patients of ICS were randomly divided into two groups：70 cases patients in control group and 80 cases in study group.The control group was given blood pressure,lipid-lowering,hypoglycemic and anti-platelet aggregation and other comprehensive treatment;study group in the control group on the basis of the treatment of oral folic acid tablets 10 mg,once a day;Vitamin B12 0.5 mg once a day.Group 2 course of treatment were 2 years.Observed groups 2 before treatment,and after treatment 6,12,18,24 month changes in plasma Hcy levels and after treatment,6,12,18,24 month ICS recurrence,ICS recurrence and plasma Hcy levels in the correlation.Results The study group before treatment and 6 months after treatment of plasma Hcy levels compared with the control group were no significant differences（all P0.05）,the 12,18,24 months after treatment of plasma Hcy were significantly lower than the control group（P0.05 or P0.01）.Study group and control group recurrence rates were 16.25%,37.14%,difference between the groups 2 was statistically significant（P0.05）.Logistic regression analysis results showed,ICS recurrence of diabetes mellitus.high Hcy hyperlipidemia related（P0.05 or P0.01）,high Hcy hyperlipidemia is an independent risk factor.Conclusion High Hcy hyperlipidemia in recurrence with ICS;oral folic acid and vitamin B12 can significantly lower plasma levels of Hcy to reduce the recurrence rate of ICS,the secondary prevention of important significance.