B族维生素在肾移植受者高同型半胱氨酸血症及内皮功能异常治疗中的应用

Treatment of hyperhomocysteinemia and endothelial dysfunction in renal-transplant recipients with vitamin B

目的探讨B族维生素治疗肾移植受者高同型半胱氨酸血症效果,对内皮功能的影响。方法将36例接受首次肾移植后的高同型半胱氨酸患者,随机分为两组,观察组18例,口服叶酸5mg/d,维生素B650mg/d及维生素B121000μg/d,连续6个月;对照组18例。分别于治疗前和治疗6个月时观察血肌酐水平和肌酐清除率,平均血压值,血胆固醇、甘油三酯和同型半胱氨酸水平变化,应用彩色多普勒超声测定内皮功能。结果观察组患者治疗后同型半胱氨酸与治疗前相比显著降低[(13±4)μmol/L与(20±5)μmol/L,t=5.3,P<0.01];肱动脉反应性充血时内径变化百分率[(12±5)%与(9±5)%,t=2.9,P<0.01]和含服硝酸甘油后肱动脉内径变化百分率[(18±4)%与(12±5)%,t=3.4,P<0.01]均显著增加。其他指标无显著改变。对照组6个月后各项指标与治疗前相比差异无统计学意义;肱动脉反应性充血时内径变化百分率为(9±6)%,含服硝酸甘油后肱动脉内径变化百分率为(12±5)%,均显著低于观察组(t=2.8,P<0.01;t=3.5,P<0.01)。结论应用叶酸、维生素B6及维生素B12能够有效治疗肾移植受者的高同型半胱氨酸血症,并使内皮功能获得明显改善。

Objective To study the effect of vitamin B on treatment of hyperhomocysteinemia and endothelial dysfunction in renal-transplant recipients.Methods Thirty-six stable hyperhomocysteinemic renal-transplant recipients were randomly assigned to vitamin treatment(group A, n=18, folic acid 5mg/d,vitamin B_6 50mg/d,B_ 12 1000 μg/d) or controlled group (group B,n=18) for 6 months. All subjects underwent assessment of levels for creatinine,creatinine clearance,average pressure, total cholesterol,triglyceride and fasting homocysteine.Endothelial function was evaluated using high-resolution vascular ultrasound. Results The levels of homocysteine markedly decreased in group A [(13±4)μmol/L vs (20±5)μmol/L,t=5.3,P<0.01]after treatment, whereas no significant changes were observed in group B. In group A, endothelium dependent [(12±5)% vs (9±5)%,t=2.9,P<0.01]and independent [(18±4)% vs (12±5)%,t=3.4,P<0.01]vasodilatation responses significantly increased after treatment, no significant changes were observed in group B.Endothelium dependent[(9±6)%,t=2.8,P<0.01]and independent [(12±5) %, t=3.5,P<0.01]vasodilatation responses of group A were significantly lower than that of group B after treatment. Conclusions Vitamin B supplementation can reduce the levels of homocysteine and improve the endothelial function in hyperhomocysteinemic renal-transplant recipients.