B族维生素干预对高同型半胱氨酸血症脑梗死患者认知功能的影响

Effect of B vitamins on cognitive function of cerebral infarction patients with hyperhomocysteinemia

目的评价B族维生素对高同型半胱氨酸血症(Hhcy)脑梗死患者认知功能的影响。方法采取前瞻、开放、平行对照研究方法,1 000例Hhcy脑梗死患者分为治疗组和对照组,各500例。对照组仅采用常规治疗,治疗组在常规治疗的基础上加用多种B族维生素,即每日口服叶酸片2.5 mg、维生素B12片0.5 mg、维生素B6片25 mg,共治疗2年,随访观察2年。记录治疗前、治疗后3、12、24个月的空腹血浆总同型半胱氨酸(tHcy)水平,并记录治疗前、随访0.5、3、6、12、18、24个月MMSE的评分,观察两组MMSE下降≥2分病例发生的例数及发生率。结果治疗后3、12、24个月,治疗组比对照组tHcy明显降低,差异有统计学意义(P<0.01)。随访0.5、3、6、12、18个月时治疗组MMSE评分均高于对照组,两组间差异有统计学意义(P<0.05)。随访24个月时,两组MMSE评分比较差异无统计学意义。治疗组随访全程中曾出现过MMSE较治疗前水平下降≥2分的患者,两组间差异无统计学意义。随访24个月时,两组MMSE较治疗前水平下降≥2分的患者例数比较差异无统计学意义。随访3个月时,两组新发生的MMSE较治疗前水平下降≥2分的患者例数比较差异有统计学意义(P<0.05);其他随访时间点两组新发生的MMSE较治疗前水平下降≥2分的患者例数差异均无统计学意义。结论 B族维生素干预可能有助于减缓患者脑梗死后近期认知功能的衰退,但对远期的干预作用尚需进一步观察。

Objective To assess the effect of B vitamins on cognitive function of cerebral infarction patients with hyperhomocy- steinemia （Hhcy）.MethodsA prospective, open, case-controlled clinical trial was used. Cerebral infarction patients （1 000 cases） with Hhcy were randomly divided into treatment and control groups （500 cases in each group）. The patients in the control group were given conventional therapy. On the basis of conventional therapy, the patients in the treatment group were given a daily dose of B vitamins （folic acid 2.5 mg, B12 500μg, and B6 25 mg） for two years. The patients were followed up for two years. The total homocysteine （tHcy） level was recorded before treatment, 3, 12, and 24 months after treatment. MMSE scores were recorded before treatment, 0.5, 3, 6, 12, 18, and 24 months after followed up. The number and incidence of patients whose MMSE level reduced≥ 2 scores were marked.Results After 3, 12, and 24 months of treatment, the tHcy levels in the treatment group reduced significantly compared to those in the control group （P 〈 0.01）. After followed up for 0.5, 3, 6, 12, and 18 months, MMSE scores in the treatment group were higher than those in the control group, and there was significant differences between the two groups （P 〈 0.05）. After followed up for 24 months, there was no significant difference between two groups. During the whole course of followed up, MMSE level in the treatment group ever reduced≥2 scores, and there was no significant difference between two groups. After followed up for 24 months, there was no significant difference between two groups in the number of patients whose MMSE level reduced≥ 2 scores. After followed up for 3 months, the number of new patients whose MMSE level reduced≥ 2 scores was lower than that in the control group, with significant difference （P 〈 0.05）. During the other time of following up, there was no significant difference between two groups.Conclusion B vitamins supplementation is likely to avail to alleviate the recession of recent cognitive function of cerebral infarction patients, while the long term intervention effect is to be further observed.