B族维生素干预高同型半胱氨酸血症在缺血性卒中二级预防中的效果评价

目的评价B族维生素干预Hhcy在IS二级预防中的效果,为IS的二级预防提供更多的临床证据。方法 141例符合试验条件的汉族男性IS患者,随机纳入安慰剂对照组（在常规治疗的基础上添加安慰剂）或维生素干预组（在常规治疗的基础之上添加叶酸5mg/d＋维生素B620mg/d＋甲钴胺1.0mg/d）,检测入组后4周和6月时的血浆Hcy水平,同时追踪观察2组患者2a内IS再发及IS相关性死亡事件发生的情况。结果在入组后4周和6月时,维生素干预组的血浆Hcy水平明显低于安慰剂对照组（P〈0.01）;至2a随访期末,安慰剂对照组与维生素干预组IS的再发率分别为25.00%和8.82%（P〈0.05）,其中TIA的再发率分别为8.33%和2.94%（P〉0.05）,脑梗死的再发率分别为16.67%和5.88%（P〉0.05）;安慰剂对照组与维生素干预组IS相关性死亡事件的发生率分别为3.33%和1.47%（P〉0.05）。Logistic回归分析显示B族维生素干预Hhcy是IS再发的独立保护因素（OR=0.258,P〈0.05）。结论 B族维生素干预能有效降低合并Hhcy的汉族老年男性IS患者的血浆Hcy水平及IS的再发风险。

Effective evaluation of vitamin B on interfering hyperhomocysteinemia in the secondary prevention of ischemic stroke

Objective To evaluate the effect of vitamin B on interfering hyperhomocysteinemia in the secondary prevention of ischemic stroke,in order to get more clinical evidence for the secondary prevention of ischemic stroke. Methods One hundred and forty-one cases with inclusion criteria were randomly divided into placebo group or vitamin B intervention group.The plasma Hcy levels were measured at post-treatment 4 weeks and 6 months,within a 2-year follow-up period,the occurrence of patients with ischemic stroke and ischemic stroke related death events in the two groups were observed. Results The plasma Hcy levels of the vitamin B intervention group were significantly lower than those of the placebo group at post-treatment 4 weeks and 6 months（P0.01）.The incidence of recurrent ischemic stroke of the placebo group and vitamin B intervention group was 25.00% and 8.82%,respectively（P0.05）,which of TIA was 8.33% and 2.94%,respectively（P0.05）,which of cerebral infarction was 16.67% and 5.88%,respectively（P0.05）.The ischemic stroke related mortality of the two groups was 3.33% and 1.47%,respectively（P0.05）.By forward stepwise logistic analysis,it was found that vitamin B on interfering hyperhomocysteinemia was an independent protective factor of recurrent ischemic stroke（OR=0.258,P0.05）. Conclusion The vitamin B intervention can decrease the plasma Hcy levels effectively and reduce relapse risk of ischemic stroke effectively in elderly Han male with ischemic stroke and hyperhomocysteinemia.