组合维生素干预对脑梗死高同型半胱氨酸血症的临床意义

Clinical significance of the combination therapy in cerebral infaction patients with hyperhomocysteine

目的观察叶酸、B族维生素、拜阿司匹灵、立普妥干预对脑梗死高同型半胱氨酸(Hcy)血症患者的临床意义。方法 120例脑梗死高Hcy血症患者随机分为对照组(常规治疗:静点奥扎格雷80mg、舒血宁20ml,1/d;口服拜阿司匹灵0.1,1/d)和观察组(常规治疗+叶酸5mg/d、维生素B6 10mg/d、维生素B12 0.5mg/d、立普妥20mg/d),每组60例。治疗前及治疗后半年检测血浆Hcy浓度和颈动脉彩超;行神经功能缺损评分(NIHSS),观察脑梗死复发率。结果治疗前两组Hcy水平均增高(P>0.01);与对照组比较,半年后观察组Hcy水平明显降低、颈动脉软斑面积明显缩小(P<0.01);观察组NIHSS、脑梗死复发率均显著降低(P<0.01)。结论脑梗死高Hcy血症患者经维生素类联合干预治疗可降低Hcy水平,缩小、稳定颈动脉斑块,改善NIHSS评分、降低脑梗死远期复发率。

Objective To observe the clinical significance of the combination therapy of Folic acid,Vitamin B,aspirin and lipitor in cerebral infaction patients with hyperhomocysteine.Methods 120 cerebral infaction patients with hyperhomocysteine were randomly divided into control group（normal treatment）,observation group（normal treatment,folic acid 5 mg/d,vitB6 10mg/d,vitB12 500 μg/d,lipitor 20 mg/d）,60 cases in each group.The plasma homocysteine（Hcy） concentration,carotid ultrasonography were detected before treatment and after half a year.The patients were followed up for half a year.The recurrence of cerebral vascular events and curative effect（NIHSS） were recorded during follow up.Results Before treatment,the plasma homocysteine concentrations were high in 2 groups（P0.01）.After treatment,compared with control group,the plasma homocysteine concentration and the areas of carotid unstable plaques were significantly reduced after half a year in observation group（P0.01）.NIHSS and the recurrence rate of cerebral vascular events were lower in observation group than that in control group（P0.01）.Conclusion Curative effects of the combination therapy in cerebral infaction patients with hyperhomocysteine can decrease homocysteine concentration,reduce the areas of unstable plaques,lower NIHSS and the recurrence rate of cerebral vascular events.