B族维生素、叶酸对青年缺血性脑血管病高同型半胱氨酸血症的干预

Folate and Vitamin B Treatment on High Hyperhomocysteinemia in Young Patients with Ischemic Cerebrovascular disease

目的探讨年龄≤45岁的青年脑梗死和短暂性缺血发作(TIA)患者血浆同型半胱氨酸(HCY)水平及给予叶酸、B族维生素治疗后的变化。方法采用荧光偏振免疫分析法,对42例脑梗死患者、42例TIA患者及42例健康人进行血浆HCY检测,同时测定其叶酸、维生素B12水平后,脑梗死组和TIA组均根据随机数字表法分成治疗组与对照组,每组21例,治疗组给予叶酸5 mg,维生素B12500μg,维生素B610 mg,均每日1次,6个月后复查上述各指标。结果治疗前三组血浆HCY水平各不相同,脑梗死组、TIA组与正常对照组比较,差异具有统计学意义(P<0.05)。干预治疗后,各治疗组血浆HCY水平均有下降(P<0.05)。结论高HCY血症是急性脑梗死和TIA的独立危险因素,叶酸和B族维生素水平随着HCY水平的升高而降低;血浆HCY水平越高,临床症状越严重;HCY可能通过影响血脂代谢增高缺血性脑血管病的风险。

Objective To investigate homocysteine （HCY）concentration in young patients with either ischemic stroke or transient ischemic attack （TIA） （age ≤ 45 years）and to observe the changes after folate and vitamin B treatment. Methods HCY levels, plasma folate and vitamin B12 were measured in 42 patients with cerebral infarction and 42 patients with TIA and 42 normal controls using fluorescence polarization im- munoassay before and 6 months after treatment. Patients in ischemic stroke group and TIA group were further divided into two subgroups randomly ： treatment group and control group. Treatment group received folate 5 mg qd,and vitamin I312 500 p^g qd and vitamin B6 10mg qd,while control group did not. Results The mean HCY level were different in cerebral infarction patients, TIA and normal subjects, respectively. Statistically, the mean HCY levels in cerebral infarction and TIA patients were significantly higher than those in the nor- mal subjects（ P 〈 0.05 ）. The HCY concentration was lower in patients after treatment in different groups（ P 〈 0.05 ）. Conclusion High HCY concentration is an independent risk factor for ischemic stroke or TIA. Folate and vitamine B levels decrease along with HCY level increase ; the higher tha plasma HCY level, the severer the clinical symptoms;HCY might increase the ischemic stroke risk through influencing the lipid me- tabolism.