叶酸、维生素B12对伴有高同种半胱氨酸血症的中青年急性缺血性卒中患者血浆高半胱氨酸水平和神经功能的影响

Effect of folic acid and vitamin B12 on the plasma homocysteine levels and neurological function in young and middle-aged acute ischemic stroke patients with hyperhomocysteinemia

目的 探讨叶酸、维生素B12对伴有高同种半胱氨酸血症（hyperhomocysteinemia,HHcy）的中青年急性缺血性卒中患者血浆高半胱氨酸（homocysteine,Hcy）水平和神经功能的影响.方法 纳入伴HHcy的中青年急性缺血性卒中患者,随机分为干预组和对照组.两组均给予脑梗死常规治疗,干预组同时给予叶酸5 mg和维生素B1225 μg,3次/d,连续4周,对照组则给予安慰剂.在入院次日以及此后每周检测1次血浆Hcy水平,在入院时及治疗4周后利用美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale,NIHSS）评价神经功能缺损情况.结果 共纳入78例伴HHcy的中青年急性缺血性卒中患者,治疗组和对照组各39例.所有患者基线血浆Hcy水平与NIHSS评分存在显著线性相关联系（r=0.717;P＜0.01）.治疗4周后,干预组血浆Hcy水平显著性低于对照组[（15.07 ±2.01）μmol/L对（21.29±2.48） μmol/L;t=4.539,P＜0.05],但NIHSS评分无显著性差异[（4.87±2.17）分对（5.13±1.67）分;=0.585,P=0.560].结论 基线血浆Hcy水平与卒中严重程度呈正相关,叶酸联合维生素B12治疗能有效降低伴有HHcy的中青年急性缺血性卒中患者的血浆Hcy水平,但对神经功能改善无显著影响.

Objective To investigate folic acid and vitamin B12 on the plasma homocysteine （Hcy） levels and neurological function in young and middle-aged acute ischemic stroke patients with hyperhomocysteinemia （HHcy）.Methods Young and middle-aged acute ischemic stroke patients with HHcy were enrolled.They were randomly divided into either an intervention group or a control group.The patients with cerebral infarction in both groups were treated with conventional treatment.At the same time,the patients in the intervention group were treated with folic acid 5 mg and vitamin B12 25 μg,3 times a day for 4 weeks.Those in the control group were given placebo.The next day after admission and thereafter,the plasma Hcy levels were determined once every week.At the time of admission and after 4-week treatment,the National Institutes of Health Stroke Scale （NIHSS） was used to evaluate neurological deficits.Results A total of 78young and middle-aged acute lschemic stroke patients with HHcy were enrolled （n =39 in each group）.The baseline plasma Hcy levels and the NIHSS scores in all patients had significant linear correlation （r =0.717;P＜0.01）.Four weeks after treatment,the plasma Hcy levels of the intervention group were significantly lower than those of the control group （15.07 ± 2.01μmol/L vs.21.29 ± 2.48 μmol/L; t =4.539; P ＜0.05）,but there was no significant difference in the NIHSS scores （4.87 ± 2.17 vs.5.13 ± 1.67; t =0.585,P =0.560）.Conclusions The baseline plasma Hcy level was positively correlated with the severity of stroke.Folic acid in combination with vitamin B12 could effectively decrease the plasma Hey level in young and middle-aged acute ischemic stroke patients with HHcy,but it had no significant effect on the improvement of neurological function.