甲钴胺治疗急性脑梗死伴高同型半胱氨酸血症和卒中后抑郁的疗效

Efficacy of mecobalamine in the treatment of acute cerebral infarction combined withhyperhomocysteinemia and post-stroke depression

目的探讨甲钴胺对脑梗死伴高同型半胱氨酸（Hcy）血症的治疗作用及对脑梗死患者恢复期情绪障碍的疗效。方法收集2010年1月至2011年12月在我院神经内科住院的急性脑梗死伴高Hcy血症患者160例，并随机分成甲钴胺组和对照组各80例，两组除进行急性脑梗死治疗的常规处理外，甲钴胺组选用甲钴胺针剂500μg（日本卫材株会社生产，批号：120476），肌肉注射，隔天1次，共8周，而对照组不进行其他治疗。采用酶免疫化学发光分析法测定血浆Hcy水平，应用症状自评量表SCL-90分析患者抑郁、焦虑和生活能力等方面的改善情况。结果对照组治疗前后血浆Hcy水平分别为（21．86±4．76）μmol／L和（18．67±3．81）μmol／L（t=0．40，P〉0．05），甲钴胺组患者治疗4周后血浆Hcy水平为（11．66±3．28）μmol／L，较治疗前（22．68±5．16）μmol／L明显下降（t=2．55，P〈0．01），与对照组治疗后比较差异也有统计学意义（t=7．40，P〈0．01）。甲钴胺组治疗后SCL-90总分、阳性项目、阳性总分和阳性均分均显著优于治疗前（t=2．04、2．97、5．45、4．21，均P〈0．05），与对照组治疗后比较差异也有统计学意义（t=7．40、7．58、12．78、4．15，均P〈0．05），对照组治疗前后比较差异均无统计学意义（均P〉0．05）。甲钴胺组治疗前后在躯体化、人际关系、抑郁、焦虑、恐怖及其他方面得分均高于治疗前（t=2．34、2．28、2．51、2．19、3．40、2．35，均P〈0.05）；与对照组治疗后在躯体化、人际关系、抑郁、焦虑、恐怖及其他方面得分比较差异也有统计学意义（t=4．10、5．04、5．12、4．18、5．48、5．20，均P〈0．05），而治疗前后偏执方面得分差异无统计学意义（t=1．40，P〉0．05），治疗组与对照组偏执方面得分差异无统计学意义（t=1．48，P〉0．05），对照组治疗前后比较差异均无统计学意义（均P〈0．05）。结论甲钴胺能有效降低急性脑梗死伴高Hcy血症患者血浆Hcy水平，对患者焦虑、抑郁、紧张等情绪有缓解作用。

Objective To study the effect of mecobalamine treatment on acute cerebral infarction combined with high homocysteine （Hcy） and post stroke depression. Methods A total of 160 cerebral infarction patients with high Hey were collected from January 2010 to December 2011 in our hospital. Patients were randomly divided into two groups： the control group （n= 80, with routine therapy） and the treatment group （n= 80, with routine therapy plus intramuscular injection with folie acid 500μg for 8 weeks）. The plasma concentration of Hey was determined by fluoresene polarization immunoassay. The improvement of depression, anxiety and life skills in patients were assessed by self- made questionnaires and self-reporting inventory （SLC-90）. Results There were no significant differences in plasma Hey level in control group before versus after treatment [（21.86±4.76） μmol/L vs. （18.67±3.81）μmol/L, t=0.40,P〉0.05]. Compared with before treatment, plasma Hey level in treatment group was significantly reduced 4 weeks after treatment [（11.66±3.28） μmol/L vs. （22.68±5.16） μmol/L, t=2.55, P〈0.01]. There was a significant difference in plasma Hey level between the treatment group and the control group after treatment （（11.66 ＋ 3.28） μmol/L vs.（18.67~3.81） μmol/L, t=7.40,P〈0. 01]. The SCL-90 total score, positive symptom iterus score, the total score and the average score of positive symptom items were significantly lower in treatment group after treatment than in treatment group before treatment （t=2.04, 2.97, 5.45, 4.21, all P〈0.05） and in control group after treatment （t 7.40, 7.58, 12.78, 4.15, all P〈20.05）. The improvement on symptomatic patterns including somatization, obsessive compulsive problems, interpersonal sensitivity, depression, anxiety and fear were better in treatment group after treatment than in treatment group before treatment （t=2.34, 2.28, 2.51, 2.19, 3.40, 2.35, all P〈0.05） and in control group after treatment （t=4.10, 5.04, 5.12, 4.18, 5.48, 5.20, all P〈0. 05）. There were no significant differences in the improvement in paranoid ideation between the treatment group before and after treatment （t = 1.40, P〉0.05）, between the treatment group and the control group after treatment （t= 1.48,P〉0.05）, and between the control group before and after treatment （P〉0.05）. Conclusions Mecobalamine can effectively reduce with high plasma Hcy, and alleviate the symptoms emotions. plasma Hcy level in cerebral infarction patients of anxiety, depression, nervousness and other