老年脑梗死患者血同型半胱氨酸水平调查及干预治疗

The total homocysteine concentration in the aged patients with ischemic stroke and intervention study

目的 了解正常老年人与脑梗死患者血总同型半胱氨酸 (serumtotalhomocysteine ,tHcy)水平的差异 ,并了解给予营养元素叶酸和维生素B12 治疗后血tHcy的变化。 方法 共有 2 14例入选者 ,脑梗死组 :112例 ,男91例 ,女 2 1例 ,63～ 80岁 ,平均 (73 2± 4 1)岁 ,符合脑梗死的诊断标准。正常老年人组 10 2例 ,男 84例 ,女 18例 ,61～ 78岁 ,平均 (72 5± 4 3 )岁 ,2组年龄及性别无显著差异 ,吸烟的程度及年份予以控制 ,甲状腺功能减退及肾功能减退者予除外 ,避免影响结果。入选者在测定各项检测指标后 ,各组各随机分成 2组 ,干预治疗组及非干预治疗组 ,干预治疗组患者予服用叶酸 1 2 5mgqod ,维生素B12 8μgqd ,10月后 ,再予复查各项指标。 结果 2组血tHcy水平不相同 ,脑梗死组 (16 0 3± 5 0 6) μmol·L-1,正常老年人组为 (11 69± 3 0 4) μmol·L-1,存在显著差异 (P <0 0 1) ;血tHcy水平越高 ,叶酸水平越低 ,相关分析发现血tHcy水平与叶酸、维生素B12 呈负相关 ,在脑梗死组分别为r =-0 413 ,-0 3 6;正常老年人组r =-0 3 2 9,-0 2 0 9。干预治疗后 ,治疗组患者的血tHcy水平均有下降 ,与非干预治疗组有显著差异 (P <0 0 1)。当血tHcy值超过老年人的正常值 (≥ 15 μmol·L-1)时 。

Objective To survey the serum total homocysteine(tHcy)concentration in ischemic stroke patients and compave them with normal control of the aged.To evaluate whether providing folate and Vit B 12 could lower serum homocysteine concentration. Methods The rescerch samples were drawn from the inpatients and outpatients of geriatric departemnt,Hua Shan Hospital.Tow hundred and fourteen patients were recruited with stomderdized smoking condition.Abnormal of thyroid gland and renal failure was excluded.The ischemic stroke group included 91 male and 21 female patients,average age (73 2±4 1),the normal control elders group had 84 male,18 female patients,average age(72 5±4 3).Besides fast serum total homocysteine,every patient took laboratory and physical examinations which included plasma foliate,Vit B 12 ,free plasma glucose,creatinine,cholesterol,triglyceride,blood pressure and blood mass index.Then each group was randomly subdivided into two groups,with one being provided with folate 1 25mg qod and Vit B 12 8 μg qd,the other without folate and Vit B 12 .These patients were reexamined after 10 months. Results The serum tHcy concentration was (16 03±5 06) μmol·L -1 in ischemic stroke group and (11 69±3 04) μmol·L -1 in normal control of the aged( P <0 01).The plasma foliate were lower in ischemic stroke.Correlation analysis was found that tHcy was negatively correlated with foliate and Vit B 12 ,with r =-0 413 and -0 36 respectively in ischemic stroke group r =-0 329 and -0 209 respectiuely in normal control group.The tHcy concentration was lower in the groups provided with foliate and Vit B 12 than those without foliate and Vit B 12 ( P <0 01),even in the normal elders. Conclusions The tHcy concentration was higher in the patients with ischemic stroke.Folate and Vit B 12 supplementation could lower moderately raised tHcy.