叶酸、B族维生素对高同型半胱氨酸血症的急性心肌梗死患者左心室重构及心功能的影响

Influence of folic acid and B-vitamins on left ventricular remodeling and cardiac function in AMI patients with hyperhomocysteinemia

目的:通过观察叶酸、B族维生素对伴有高同型半胱氨酸(Hcy)血症的急性心机梗死(AMI)患者左心室重构及心功能的影响,阐述Hcy与AMI预后的关系。方法:应用高效液相色谱荧光检测法测定AMI患者血浆Hcy,筛选出102例高Hcy血症的AMI患者,随机分治疗组(60例)及对照组(42例),两组均给予AMI常规治疗,治疗组每日加用叶酸5mg、VitB120.5mg、B640mg;对照组给予安慰剂。追踪观察1个月,分别于入院后72h及用药后30d再次检测两组血浆Hcy水平。结果:AMI患者Hcy明显高于正常值,AMI发生后1个月内40%左右的患者出现左心室重构及不同程度的心功能障碍。补充叶酸、B族维生素可明显降低AMI血浆Hcy水平,有利于改善、逆转左心室重构,改善舒张功能,两组比较有显著性差异(P<0.01)。对收缩功能及血压无明显影响。结论:高Hcy血症可能是AMI发生、发展以及影响预后的主要原因之一。叶酸、B族维生素能够明显降低AMI患者血浆Hcy水平,改善AMI患者的预后。

Objective To evaluate the relationship of folic acid, B-vatamins, hyperhomocysteinemia （hcy） and prognosis of AMI by observing the influence of folic acid and B-vatamins on left ventricular remodeling （LVR） and cardiac function in AMI patients with hyperhomocysteinemia. Method To measure the plasma homocysteine levels of AMI patients by high pressure liquid chromatography （HPLC） and to screen 102 cases with high level homocysteine,these cases were randomly divided into two groups,therapeutic group （60 cases） and control group （42cases）.While the latter took placebo ,the former additionally took 5mg folic acid ,0.5mg vitamin B12 and 40mg vitamin B6 perday except routine management. Through Cardiac Color Doppler to determine the indexes about left ventricular remodeling and the systolic diastolic function at 72h after being hospitalized and 30 days later after taking the medicines. The homocysteine levels were measured after 30 days. Results The homocysteine levels of AMI patients were evidently higher than the normal （15umol/L）. About 40% patients at 1 month after the occurence of AMI would have left ventricular remodeling （LVR） and various degrees of cardiac disfunction.After taking folic acid and B-vatamins ,the level of homocysteine of AMI patients was apparently lower than before and these medicines would benefit LVR and diastolic function （P〈0.01）,but have no influence on systolic function. Conclusion Hyperhomocysteinemia （hcy） may be one of main factors to evaluate the occurrence , development and prognosis of AMI; Supplements of folic acid and B-Vitamins could degrade the level of hcy and improve the prognosis in AMI patients.