口服叶酸辅助治疗冠心病的临床研究

A Clinic Study of Oral Application of Folic Acid in Patients with Coronary Artery Disease

目的观察口服叶酸对冠心病患者的作用。方法选择冠心病患者60例,检测血清叶酸、同型半胱氨酸(Hcy)、丙二醛(MDA)、低密度脂蛋白胆固醇(LDLC)水平及血流介导的内皮舒张功能(FMD);随机分为安慰剂组和叶酸口服组,每组30例,所有患者在冠心病二级预防基础上分别再予5 mg/d叶酸或安慰剂口服,治疗4周、8周后复查前述指标,比较各组治疗前后及两组之间相关指标的差别。结果叶酸口服组与安慰剂组基础年龄、性别、高血压比例、糖尿病比例、血清叶酸、Hcy和LDLC水平、FMD无明显差别;规范的冠心病二级预防能在4周时显著降低患者血清LDLC水平,持续至8周后能显著降低血清MDA水平并显著提高FMD,但对血清叶酸和Hcy水平无明显影响;而在此基础上加用叶酸口服4周,在轻度降低血清Hcy水平、提高血清叶酸水平的同时已显著降低血清MDA水平并显著提高FMD,持续至8周时这一益处进一步显现;叶酸口服组治疗8周后血清叶酸水平与Hcy水平无相关性,与FMD呈正相关,与MDA水平呈负相关,Hcy水平与其他指标之间无明显相关。结论在规范冠心病二级预防基础上加用叶酸口服可进一步降低氧化应激水平并改善内皮功能;叶酸可能通过降低氧化应激改善冠心病患者内皮功能;这种作用与可能其降低Hcy无关。

Aim To observe the effect of peroral folic acid in patients with coronary artery disease（ CAD）.Methods Sixty patients with CAD were involved in the study,and were randomly divided into placebo and folic acid groups each with 30 patients. Backgrounds and levels of serum folic acid,homocysteine（ Hcy）,malondialdehyde（ MDA）,low density lipoprotein cholesterol（ LDLC） and flow-mediated vasodilation（ FMD） were measured,and the difference was detected. All patients were given medicines based on secondary prevention of CAD. Then patients were given 5 mg /d of folic acid or placebo orally respectively for 4 weeks until 8 weeks. After periods of treatments,indicators of the forementioned were measured and compared not only between the two groups,but also before and after treatments.Results There were＇t significant differences among basic factors. With rigorous secondary prevention,level of serum LDLC in the placebo group was significantly lowered after 4 weeks,but the decrease of MDA and the increase of FMD didn＇t appear obviously until 8 weeks. And it had no effect on level of serum folic acid and Hcy. While after folic acid added to the classic treatments,the decrease of MDA and the increase of FMD presented significantly after 4 weeks despite the mild change of folic and Hcy. And the benefit lasted and appeared more obviously until 8 weeks. Level of folic acid correlated positively with that of FMD,and inversely with that of MDA. Level of Hcy had no statistical correlation with other indicators. Conclusions On the basis of rigorously secondary prevention of CAD,oral folic acid could further reduce oxidative stress and improve endothelial function. Folic acid may improve endothelial function by reducing oxidative stress which may be independent of Hcy in patients with coronary heart disease.