叶酸、Vit B_(12)干预对高Hcy的急性脑梗死近期预后的影响

The influence of folic acid,Vit B_(12) intervention on the recent prognosis of acute cerebral infarction with high homocysteine

目的观察叶酸、维生素B12干预治疗是否能降低高同型半胱氨酸血症的急性脑梗死患者的Hcy水平以及对患者近期预后的影响。方法根据血浆Hcy水平将急性脑梗死患者分为正常组(92例),干预组(39例)及对照组(37例),干预组除常规治疗外给予叶酸5mg.d-1和维生素B12500ug.d-1,其他两组仅予常规治疗。随访患者1年,观察血浆Hcy水平以及患者预后(NIHSS以及不良预后事件)。结果干预组Hcy水平显著降低(P=0.008),但是NIHSS评分较对照组无显著改善,不良预后事件发生率无差异。结论叶酸及维生素B12治疗能显著降低患者血浆Hcy水平,但是不能改善患者预后,考虑可能与维生素治疗不能改善炎症反应有关。维生素治疗能否降低心脑血管病的发生及复发需要进一步研究。

Objective To observe the efficiency of homocysteine-lowering therapy with folic acid and vitamin B12 in ischemic stroke and the recent prognosis of these patients.Methods According to the level of plasma Hcy,patients with acute cerebral infarction were divided into normal group（92 cases）,the intervention group（39 cases） and control group（37 cases）.The intervention group were given folic acid（5mg.d-1） and vitamin B12（500ug.d-1） as well as routine therapy,the other two groups received routine therapy alone.Patients were followed up 1 year to observe the change of plasma Hcy level and the prognosis（NIHSS and the adverse outcome events）.Results Hcy levels of the intervention group were significantly lower than the control group（P=0.008）.But no significant improvement of NIHSS score was observed,and no difference was seen in the incidence of adverse outcome events.Conclusion Folic acid and vitamin B12 therapy can significantly reduce the level of plasma Hcy,but can not improve the inflammatory response.It requires further study about the efficiency in reducing the recent prognosis of patients.It might be correlated with that vitamin therapy can not improve the incidence and recurrence with vitamin therapy in stroke patients.