叶酸和甲钴胺对高同型半胱氨酸血症缺血性脑卒中复发的影响

Effects of folic acid and vitamin B12 on the recurrence of cerebral ischemic stroke in patients with hyperhomocysteinemia

目的探讨叶酸和甲钴胺(维生素B12)对高同型半胱氨酸血症(Hhcy)患者缺血性脑卒中(ICS)复发的影响。方法伴有Hhcy的ICS患者195例,分为治疗组112例和对照组83例。两组均给予常规治疗;治疗组加用叶酸片2 mg/d、维生素B625 mg/d及维生素B12500μg/d。随访2年,比较治疗前后同型半胱氨酸(Hcy)水平,评价ICS患者的再发性脑血管事件发生率。结果 2年后,对照组血浆Hcy水平与常规治疗前相仿[(16.6±5.2)μmol/L vs.(16.1±4.7)μmol/L](P>0.05),而治疗组血浆Hcy水平明显较治疗前降低[(8.2±4.7)μmol/L vs.(17.6±5.9)μmol/L](P<0.05)。治疗组脑血管事件复发率低于对照组(6.3%vs.8.4%)(P<0.05)。结论口服叶酸加维生素B6和维生素B12可降低Hhcy,改善ICS患者的远期预后。

Objective To investigate the effects of folic acid and vitamin B12 on the recurrence of cerebral ischemic stroke in patients with hyperhomocysteinemia（Hhcy）.Methods A total of 195 patients with Hhcy associated with cerebral ischemic stroke were randomly divided into two groups of control（83 cases,treated with conventional therapy） and therapy（112 cases,treated with additional folic acid 2 mg/d,vitamin B6 25 mg/d,and vitamin B12 500 μg/d）.The patients were followed up for two years.Plasma homocysteine（Hcy） was measured before and two years later and the recurrence of cerebral vascular events was recorded during follow up.Results Compared to before,plasma concentration of Hcy was significantly reduced after two years in therapy group[（17.6±5.9） μmol/L vs.（8.2±4.7） μmol/L]（P0.05）,which was not in control group[（16.6±5.2） μmol/L vs.（16.1±4.7） μmol/L]（P0.05）.The recurrence rate of cerebral vascular events was lower in therapy group than that in control group（6.3% vs.8.4%）（P0.05）.Conclusion B-vitamin supplements can decrease plasma Hcy levels and improve long-term outcomes in the patients with Hhcy associated with cerebral ischemic stroke.