同型半胱氨酸浓度对脑梗死复发的影响

Effect of homocysteine concentration on the recurrence of cerebral infarction

目的 探讨同型半胱氨酸的血浆浓度对脑梗塞患者复发的影响。方法 122例伴有高同型半胱氨酸血症的首次发作的脑梗死患者进行随机分A,B两组,A组62例,B组60例。两组接受治疗前都查血糖、血脂、肝功能、肾功能、血常规。所有患者均根据缺血性卒中诊治指南给予常规治疗。A组将同型半胱氨酸血浆浓度控制在10~15μmol/L,B组控制在10μmol/L以下,两组都用叶酸片5mg/次,3次/d;维生素B6 20mg/次,3次/d;维生素B12 25mg/次,2次/d,治疗后15d后复查血浆同型半胱氨酸,hcy控制在要求的血浆水平后即停用抗hcy药物,以后每3个月复查同型半胱氨酸1次,确定两组同型半胱氨酸的血浆浓度控制在各自要求的水平,如出现升高者再予上述方法降到要求水平,观察1年后两组脑梗塞复发率。结果 A组复发10例,复发率为16.13%,B组复发3例,复发率为5.00%,两组具有统计学差异（P〈0.05）。两组在年龄,性别比较均无显著性差异（P〉0.05）。两组患者治疗前的血压、血脂、血糖、同型半胱氨酸、肾功能、肝功能、血红蛋白比较均无显著性差异（P〉0.05）,两组在控制同型半胱氨酸的过程中均未出现严重不良反应。结论 同型半胱氨酸的血浆浓度控制在10μmol/L以下,能明显减少脑梗塞复发率,两组具有显著性差异（P〈0.05）。

Objective To investigate the effects of plasma concentrations of homocysteine in patients with recurrent cerebral infarction. Methods 122 cases with high homocysteine in patients with cerebral infarction were randomly divided first episode AB groups,A group of 62 cases,group B 60 cases.Treatment groups are checked before accepting blood sugar,blood lipids, liver function,kidney function,blood.All patients were given conventional treatment according to ischemic stroke treatment guidelines.A group of the homocysteine plasma concentration at 10-15 μ mol/L,group B control in 10 μ mol/L or less,both groups with folic acid tablets 5mg/time, 3times/day;B6 20mg/times,3 times/day;B12 25mg/times,2 times/day.After treatment,15 days after the review of plasma homocysteine,hcy control disable anti hey in plasma levels of the drug required after every subsequent three months later homocysteine 1,to determine the two homocysteine Plasma concentrations of control in their required level,such as the re-emergence of elevated levels of these methods reduced requirements.Recurrence rate of cerebral infarction were observed after 1 year. Results Recurrence rate was 16.13% in group A,group B,the recurrence rate was 5.00%,with a significant difference between the two groups（P 〈 0.05）.The two groups in age,gender, showed no significant difference（P 〉 0.05）.Two groups of patients before treatment lipids,hypertension,blood glucose,homocysteine,renal function,liver function,hemoglobin showed no significant difference（P 〉 0.05）,the two groups were not there in the control process homocysteine serious adverse reactions. Conclusion Plasma homocysteine concentration control in 10 μmol/L or less,can significantly reduce the recurrence rate of cerebral infarction,the two groups have significant difference（P 〈 0.05）.