补充叶酸及B族维生素对冠心病患者血管内皮功能的影响

Effects of supplementation of folic acid and B Vitamins on endothelial function in coronary heart disease patients

目的探讨在常规治疗基础上补充叶酸及B族维生素是否能改善冠心病（CHD）患者的血管内皮功能。方法经冠脉造影检查至少一支冠状动脉狭窄t〉50％的连续CHD患者87例，在包括阿司匹林及他汀类调脂药等的常规治疗基础上随机分为两组。试药组（45例）：在常规治疗的基础上加服叶酸15mg／d；维生素K30mg／d；维生素B12：75μg／d；对照组（42例）：常规治疗。治疗半年，于治疗前后采用HP SONOS 5500型彩色超声显像仪和3．0～117．0MH：的线阵探头，分别测量患者休息时、反应性充血后肱动脉内径。比较治疗前后内皮依赖性血管舒张功能（flow-mediated dilation，FMD）的变化。结果治疗前，试药组与对照组间肱动脉基础内径[（4．2±0．5）mm vs（4．6±0．4）mm]及反应充血引起的肱动脉内径变化差异无统计学意义[（3．9±0．9）％ vs （4．1±0．5）％]。半年后两组患者反应充血引起的肱动脉内径变化均较自身治疗前明显改善[试药组（3．9±0．9）％ vs （15．5±5．4）％，P〈0．01；对照组[（4．1±5）％ vs （14．0±6．3）％，P〈0．01]，但两组反应充血引起的肱动脉内径变化差异无统计学意义[（15．5±5．4）％ vs （14．0±6．3）％]。结论含阿司匹林及他汀类调脂药的CHD常规治疗能明显改善CHD患者的血管内皮功能，在常规治疗基础上补充叶酸及B族维生素对改善CHD患者血管内皮功能的作用不优于CHD常规治疗。

AIM To explore whether supplementation of folic acid and B vitamins will improve endothelial dysfunction in patients with coronary heart disease （CHD）. METHODS Vascular ultrasound was used to assess the effect of folic acid and B vitamins on brachial artery flow-mediated dilation （FMD）. Eighty-seven patients with CHD （ documented by coronary angiography at least one coronary artery＇ s stenosis ≥50% ） were randomized equally to two groups： routine treatment （include aspirin and statins） and routine treatment pulse folic acid and B vitamins （ folic acid 15 mg/d, vitamin B12 75 μg/d, vitamin B6 30 mg/d）. The patients were treated for six months. FMD were measured before and after the six months of treatment. RESULTS Before treatment, there were no significant differences between control and treatment groups in diameter of brachial artery [ （4.2 ± 0.5 ） mm vs （4.6 ± 0.4 ） mm ] and FMD [ （3.9 ± 0. 9） % vs （4.1 ± 0.5 ） % ]. After the six-month treatment, FMD showed significantly improvement in both groups： in routine treatment group from （ 4.1 ± 0.5 ） % to （ 14.0 ± 6.3 ） % （ P 〈 0.01 ） and in routine treatment pulse folic acid and B vitamins group from （3.9 ± 0.9 ）% to （15.5 ± 5.4 ）% （P〈0. 01 ）. But there was no significant difference in FMD＇s improvement between the two groups [（15.5 ±5.4）% vs （14.0 ±6.3）%]. CONCLUSION Routine treatment, including aspirin and st- atins, significantly improves endothelial dysfunction in patients with CHD. Supplementation of folic acid and B vitamins does not further improve endothelial dysfunction.