叶酸、维生素B12和多奈哌齐治疗高同型半胱氨酸血症阿尔茨海默病患者的对照研究

Comparative study of the effect of folic acid,vitamin B12 and donepezil in Alzheimer's disease patients with hyperhomocysteinemia

目的:探讨叶酸、维生素B12和多奈哌齐联合应用对高同型半胱氨酸血症(HHcy)阿尔茨海默病(AD)患者的影响。方法:100例AD患者依就诊顺序随机分为3组:联合治疗组(叶酸、维生素B12和多奈哌齐联合治疗)34例、多奈哌齐治疗组(单用多奈哌齐)33例、对照组(仅常规治疗)33例,观察3个月。分别于治疗前和治疗3个月进行简易精神状态检查表(MMSE)、日常生活能力量表(ADL)评分及血清Hcy浓度检测。结果:治疗后,MMSE、ADL评分及血清Hcy浓度组间效应有统计学意义(F=29.71,F=6.06,F=6.62;P均<0.01)。联合治疗组MMSE评分减分值、ADL评分减分值、血清Hcy浓度减分值均明显高于多奈哌齐治疗组(t=-3.48,t=-2.26,t=2.25;P均<0.05或P<0.01)及对照组(t=-9.14,t=-5.73,t=5.01;P均<0.01)。治疗后Hcy浓度减分值与MMSE评分减分值、ADL评分减分值呈正相关(r=0.423,P<0.01;r=0.240,P<0.05)。结论:叶酸、维生素B12和多奈哌齐联合治疗可降低血清Hcy浓度,并改善AD患者的认知功能和行为能力。

Objective：To investigate the effects of combination therapy with folic acid,vitamin B12 and donepezil in Alzheimer′s disease（ AD）patients with hyperhomocysteinemia（ HHch）. Method：One hundred AD patients with HHch were randomly divided into 3 groups：combination treatment group（ 34 cases,treated with folic acid,vitamin B12 and donepezil）,donepezil group（33 cases,treated with donepezil alone）and the control group（33 cases,conventional treatment without any anti_dementia drug）according to the order of treat_ment for 3 months.All the patients were assessed by scales of Mini mental state examination（ MMSE）and ac_tivity of daily living（ ADL）;and the level of serum homocysteine（ Hcy）of them were detected before treatment and 3 months after treatment respectively. Results：After treatment,the group effect in scores of MMSE,ADL and the level of serum Hcy among the groups had statistical significance（F=29.71,F=6.06,F=6.62;all P〈0.01）.The decrease value of MMSE and ADL scores,and the level of serum Hcy in combination treatment group were significantly higher than donepezil group（t= -3.48,t= -2.26,t=2.25,all P 〈0.05 or P〈0.01）and the control group（t= -9.14,t= -5.73,t=5.01,all P〈0.01）.After treatment,the decrease value of serum Hcy was positively correlated with the decrease value of MMSE and ADL scores（ r =0.423,P 〈0.01;r =0.240,P〈0.05）. Conclusion：Conbination therapy of folic acid,vitamin B12 and donepezil can reduce the serum Hcy concentration and improve congnitive function and behavior ability in AD patient with HHch.