干预Hhcy、高血压病对高血压病合并Hhcy脑梗死复发的影响

目的探讨干预高血压病、高同型半胱氨酸血症对高血压病合并Hhcy脑梗死复发的影响。方法采用前瞻平行对照法将300例高血压病合并Hhcy脑梗死分为A组150例，依那普利叶酸＋常规治疗（依那普利叶酸10mg：0.8mg／d），每日1次；B组150例：常规治疗（不含B族维生素）。随访2年观察联合干预高血压病、Hhcy对高血压病合并Hhcy脑梗死复发的影响。结果在6、12、24个月随访期间依那普利、叶酸＋常规治疗组（A组）Hey水平显著低于常规治疗组（B组）（P〈0.05），血压水平2组无明显的差异（P〉0.05）；依那普利、叶酸＋常规治疗组（A组）脑梗死复发率为15.15％；常规治疗组复发率为17.85％，2组间差异明显（P〈0.05）。Logistic回归分析显示HCy降低、血压下降是高血压病合并Hhcy脑梗死复发的保护性因素，0R值分别为0.665、0.542。结论同时控制高血压病、Hhcy可降低高血压病合并Hhcy脑梗死的复发。

Effect of treatment of high blood pressure and hyperhomocysteinemia on the recurrence of cerebral infarction

Objective To investigate the effects of treatment of high blood pressure and hyperhomocysteinemia on the recurrence of cerebral infarction in patients with stroke. Methods The study is a prospective parallel randomized controlled trial. 300 patients with cerebral infarction, hyperhomoeysteinemia and high blood pressure were randomly assigned to enalapri combined folic acid group（ 10mg enalapril plus 0. 8mg folic acid, n = 150） or enalapri group （n = 150）. The plasma Hcy levels and the occurrence of patients with cerebral infarction were evaluated at 6 months, 12 months and 24 months follow up. Results The plasma Hcy levels of the enalapril combined folic acid group were significantly lower than those of the enalapril group at at 6 months, 12 months and 24 months follow up（P〈0. 05）, while the blood pressure levels had no significant difference between the two groups（P〉0. 05）. The recurrent rates of cerebral infarction at 24 months follow up had significant difference between the enalapril combined folic acid group and the enalapril group （15.15 vs 17. 85% ,P〈0.05） . With Logistic regression analysis, treatment of hyperhomoeysteinemia or high blood pressure were found to be independent protective factors of the recurrence of cerebral infarction （OR = 0. 665 vs 0. 542, P〈0. 05）. Conclusions Treatment of hyperhomocysteinemia and blood pressure would reduce the recurrence of cerebral infarction.