叶酸对血液透析患者动脉粥样硬化影响

Effect of folic acid on atherosclerosis in maintenance hemodialysis patients

目的通过比较维持性血液透析（maintenance hemodialysis,MHD）患者叶酸干预治疗前后的同型半胱氨酸（homocysteine,Hcy）及颈动脉动脉内膜-中层厚度（intima-media thickness, IMT）改变情况,旨在探讨叶酸对动脉粥样硬化的保护作用。方法选择 MHD治疗时间超过3个月患者60例,分为对照组和叶酸组,每组各30例。所有患者均进行普通低通量透析器透析,每周3次,每次4h,常规降压、纠正贫血、纠正酸碱失衡及电解质紊乱等处理,以及口服维生素 B121mg/d,叶酸组口服叶酸15mg/d,疗程为6个月,所有患者进入观察前及干预治疗半年后于透析前10 min,抽取空腹血10ml,比较治疗前后2组间Hcy值,并超声测量IMT的变化。结果①治疗半年后叶酸组 Hcy水平下降（P〈0.01）,对照组治疗前后 Hcy 水平变化不明显（P〉0.7）；且2组治疗半年后Hcy比较。②叶酸组治疗半年后颈动脉IMT值差异不明显（P〉0.05）,而对照组半年后IMT值明显升高（P〈0.05）,且半年后2组IMT值之间比较差异有统计学意义（P〈0.05）。结论叶酸组经干预治疗后 Hcy水平明显下降,而颈动脉 IMT值变化不明显；对照组 Hcy变化不明显,而颈动脉 IMT明显升高,提示 Hcy可能参与了动脉粥样硬化的发生和发展。推测叶酸可能通过下调 Hcy水平,起到延缓动脉粥样硬化病情发展的作用。

Objective By comparising homocysteine（Hcy） and intima-media thichness（IMT） in maintenance hemodyalysis （MHD）patients who treated with folic acid,to investigate the protective effect of folic acid on atherosclerosis.Methods Sixty patients receiving MHD more than 3 months were divided into two groups：control group and folic acid group.The folic acid group was orally ad-ministrated folic acid 15 mg every day for six months.Hcy level and carotid IMT change were compared between two groups.Results （1）Hcy levels in folic acid group was reduced at sixth month after treatment （P=0.01）.There was no significant difference in control group before and after treat-ment （P〉0.05）.There was significant difference in Hcy levels between two groups after six months （P=0.03）.（2）In folic acid group,carotid IMT values showed no obvious difference at 6th month af-ter treatment （P〉0.05）,and those in control group were significantly increased （P〈0.05）.There was significant difference in IMT values between two groups after six months （P 〈 0.05 ）. Conclusions After folic acid intervention,the Hcy levels are significantly decreased and carotid IMT values have no obvious changes,and in control group,the Hcy levels have no change significantly,but thecarotid IMT values are significantly increased,suggesting that Hcy may contribute to the develop-ment of atherosclerosis.Folic acid has a protective effect of delaying atherosclerotic disease progres-sion by reducing the Hcy levels.