叶酸、维生素B12对非酒精性脂肪肝伴高同型半胱氨酸患者的疗效观察

Observation on Effects of Folic Acid and Vitamin B12 in NAFLD Patients Combined with Hyperhomocysteinemia

目的应用维生素B 12、叶酸对非酒精性脂肪肝合并高同型半胱氨酸患者的临床疗效观察。方法病例来源于锦州医科大学附属第一医院门诊120名非酒精性脂肪肝伴HHcy患者,随机数字表法分为两组,对照组60人,给予饮食+适当运动+复方二氯醋酸二异丙胺口服治疗,试验组60人,在对照组治疗基础上+维生素B 12+叶酸治疗,治疗期间无脱落,连续治疗3个月。观察治疗前后肝功能[天门冬氨酸氨基转移酶(AST),丙氨酸氨基转移酶(ALT)],血浆同型半胱氨酸(Hcy),血脂[总胆固醇(TC),总甘油三酯(TG),低密度脂蛋白胆固醇(LDL-C),高密度脂蛋白(HDL)],叶酸,维生素B 12,肝脏彩色多普勒超声,临床有效率,不良反应发生率。结果各组患者治疗前各项指标无差异。治疗后两组TC、TG、LDL-C、Hcy、ALT、AST较本组治疗前明显降低(P<0.05);HDL明显升高(P<0.05);试验组各项指标的改善情况与对照组相比,明显优于对照组患者(P<0.05);两组治疗后AST、ALT无明显差异(P>0.05);试验组总有效率85.00%;对照组总有效率56.67%;试验组明显优于对照组,二者差异具有统计学意义(P<0.05)。结论应用复方二氯醋酸二异丙胺片、维生素B 12及叶酸可以使NAFLD伴高同型半胱氨酸血症患者的Hcy、肝功能、血脂以及肝脏脂肪变性情况得到有效的改善,达到很好的临床效果。

Objective To observe clinical effects of folic acid and vitamin B 12 in patients with nonalcoholic fatty liver disease combined with hyperhomocysteinemia.Methods 120 NAFLD patients combined with hyperhomocysteinemia admitted in the outpatient department of the First Affiliated Hospital of Jinzhou Medical University were selected as subjects,and they were divided into two groups according to random digital table method.60 cases in the control group were given diet+appropriate exercise+compound diisopropylamine dichloroacetate oral treatment,while 60 cases in the experimental group were treated with folic acid+vitamin B 12 on the basis of the control group.There was no shedding during the treatment in the two groups,and the treatment continued for 3 months.The following indicators were observed before and after treatment:liver function[aspartate aminotransferase(AST),alanine aminotransferase(ALT)],homocysteine(Hcy),blood lipid[total cholesterol(TC),triglyceride(TG),low density lipid protein cholesterol(LDL-C),high density lipoprotein(HDL)],folic acid,vitamin B 12,liver color Doppler ultrasound,clinical efficacy and incidence of adverse reactions.Results Before treatment,there were no differences in the indicators of each group.After treatment,TC,TG,LDL-C,Hcy,ALT,AST in the two groups were significantly lower than those before treatment(P<0.05);HDL was significantly higher than before(P<0.05);the improvement of each indicator in the experimental group was significantly obvious compared with that in the control group(P<0.05);there were no significant differences in AST and ALT between the two groups after treatment(P>0.05);the total effective rate of the experimental group was 85.00%while that of the control group was 56.67%;the experimental group was significantly better than the control group,and the difference was statistically significant(P<0.05).Conclusion Compound diisopropylamine dichloroacetate,vitamin B 12 and folic acid can effectively improve Hcy,liver function,blood lipids and hepatic steatosis in NAFLD patients combined with hyperhomocysteinemia,which will achieve significant clinical effects.