叶酸联合维生素B_(12)对血透患者同型半胱氨酸水平的影响

Effect of high dose folic acid combined with Vitamin B_(12) to homocysteine plasma level in maintenance hemodialysis patients

目的探讨大剂量叶酸(FA)联合维生素B12对维持性血液透析(MHD)患者同型半胱氨酸(Hcy)血浆水平的影响。方法52例MHD患者随机分为四组,每天分别口服0、15、30、60mg的FA,服FA患者同时每天肌注维生素B12500μg,治疗3个月。用放射免疫法测0、1、2、3个月及停药后3个月FA和维生素B12的血浆水平,用荧光偏振免疫分析法测同时间点总同型半胱氨酸(tHcy)血浆水平。结果MHD患者tHcy血浆水平[(22.13±8.03)μmol/L]明显高于健康人[(7.23±1.97)μmol/L],大剂量与常规剂量FA均能降低血浆tHcy水平,但不能使tHcy恢复到正常,不同剂量FA合并维生素B12均能明显提高血浆FA和维生素B12水平。结论MHD患者普遍存在高同型半胱氨酸血症(HHcy),常规剂量FA加维生素B12可降低血浆tHcy水平,但不能完全正常化。

Objective To investigagte the effect of high dose folic acid（FA） combined with vitamin B12 to homocysteine plasma level in maintenance hemodialysis（MHD） patients. Methods 52 MHD patients were randomly divided into 4 groups, receiving of FA 0,15,30,60mg/d orally for 3 months and those who receiced folic acid were given vitamin B12 500μg/d,im.The levels of plasma FA, vitamin B12 and total homocysteine（tHcy） at 0,1,2,3,6 month were detemined by radioimmunoassay and flurescence polarization immunoassay respectively. Results Levels of tHcy in MHD patients were significantly higher than those in healthy controls. Both high dose and low dose FA could lower tHcy plasma concentrations,but had no significant difference in homocysteine reduction ratio, and could not normalize it. Three doses of FA combined with vitamin B12 treatment could effectively increase The plasma FA and vitamin B12 concentrations. Conclusion tHcy is elevated in the majority of MIlD patients. Low dose of FA combined with vitamin B12 can decrease tHcy plasma levels,but cannot normalize it.