叶酸、B族维生素对青年脑卒中高同型半胱氨酸血症的干预作用

The homocysteine concentration in the patients with stroke and intervention study

目的:了解石家庄地区青年脑梗死和TIA患者(年龄≤45岁〉血清同型半胱氨酸(homocysteine,HCY)水平及给予叶酸、B族维生素治疗后HCY含量的变化。方法:采用荧光偏振免疫分析法,对80例脑梗死患者,80例TIA患者及80例健康人进行血清HCY的检测,同时测定其叶酸、维生素B12水平后,各组均随机分成干预治疗组与非干预治疗组,每组40例,干预治疗组给予叶酸5mg,隔日1次,维生素B12250ug,1日1次,维生素B610mg,1日1次,口服6个月后复查上述各指标。结果:治疗前三组血清HCY水平各不相同,脑梗死组为(16.5±5.4)mmol/L,TIA组为(14.4±5.0)mmol/L,与正常对照组(12.1±2.9)mmol/L比较,具有显著性差异(P<0.01)。相关分析发现,血HCY水平与叶酸、维生素B12呈负相关。干预治疗后,治疗组患者的血HCY水平均有下降。结论:高HCY血症是青年脑梗死及TIA患者的独立致病因素,补充营养元素有助于降低血HCY水平。

Objective：To investigate homocysteine（HCY） concentration in ischemic stroke patients and TIA patients in comparison with normal controls and to evaluate whether providing folate and vitaminB12 could decrease serum homocysteine concentration.Methods：Serum HCY levels of 80 patients with cerebral infarction and 80 patients with TIA and 80 normal controls were measured by using fluorescence polarization immunoassay（FPIA）.Besides serum homocysteine,every patient measured plasma folate,vitaminB12.Then each group was randomly subdivided into two groups in which one group was provided with folate 5mg qod,and vitaminB12 250ug qd and vitaminB6 10mg qd.while the other was not provided with folate and vitamin B12.These patients were reexamined after 6 months.Results：The mean serum HCY level was（16.5±5.4）mmol/L for cerebral infarction patients,（14.4±5.0） mmol/L for TIA,and（12.1±2.9） mmol/L for normal subjects.Statistically,the mean serum HCY levels of cerebral infarction and TIA patients were significantly higher than those of the normal subjects（P〈0.01）.The plasma folate was low in ischemic stroke and TIA patients.Correlation analysis showed that HCY was negatively correlated with foliate and vitaminB12.The HCY concentration was lower in the groups provided with folate and vitaminB12 than that in the groups without Foliate and vitaminB（P=0.0001）,even in the normal youngers.Conclusion：The HCY concentration was higher in the patients with ischemic stroke and with TIA.Folate supplement could moderately lower HCY.