叶酸联合维生素B_6对老年H型高血压患者内皮功能及预后的影响

Effect of Folic Acid and Vitamin B_6 on Endothelial Function and Prognosis in the Treatment of Patients with Hyperhomocysteinima-related Hypertention

目的观察叶酸联合维生素B6治疗老年H型高血压患者的疗效及对内皮功能和预后的影响。方法选择2012年10月—2013年3月本院接诊的135例符合入组标准的H型老年高血压患者作为研究对象,按随机数字表分为观察组67例和对照组68例,对照组患者给予降压、降脂等基础药物及强调生活方式的改变,观察组患者在对照组的基础上再给予叶酸联合维生素B6治疗,两组均观察12周,治疗前后进行血浆Hcy、NO和内皮素水平检测,采用动脉硬化检测仪测定肱踝脉搏波传导速度(ba PWV),所有患者均随访12个月,记录主要心血管事件发生情况(非致死性心肌梗塞、脑梗塞及心血管疾病死亡)。结果观察组治疗后血浆Hcy、内皮素和ba PWV水平均较治疗前明显降低,P均<0.05,NO较治疗前明显升高,P<0.05,观察组治疗后Hcy、内皮素和ba PWV水平明显低于对照组,P<0.05,NO明显高于对照组。对照组上述指标治疗前后无明显改善,P均>0.05。对照组发生脑卒中10例,心肌梗塞2例,心血管病死亡2例,心血管事件发生率为17.65%,观察组发生脑卒中3例,心肌梗塞1例,心血管事件发生率为5.97%,差异具有统计学意义,χ2=4.405,P<0.05。结论叶酸联合维生素B6干预可明显降低H型老年高血压患者的Hcy水平,改善血管内皮功能,预防或减轻动脉粥样硬化程度,降低心血管病的发生率,值得在临床推广。

OBJECTIVE To observe the effect of Folic acid and vitamin B6 on endothelial function and prognosis in the treatment of patients with hyperhomocysteinima-related hypertention. METHODS 135 patients with hyperhomocysteinima-related hypertention met the inclusion criteria were included research subjects from October 2012 - March 2013 in our hospital, all patients were randomly di- vided into 67 cases of observation group and 67 cases of the control group, the control group were treated with antihypertensive drugs, lipid-lowering drugs and Lifestyle changes. The observation group were given Folic acid and vitamin B6 on the basis of the control group, both groups were observed for 12 weeks, the plasma Hcy, NO, endothelin levels were detected before and after treat- ment, brachial-ankle pulse wave velocity （baPWV） were measured by Arteriosclerosis detector, all patients had been followed up for 12 months, the occurrence of major cardiovascular events （nonfatal myocardial infarction, cerebral infarction and cardiovascular death） were recorded. RESULT The plasma Hcy, endothelin, baPWV of observation group after treatment were significantly lower than be- fore treatment, P 〈0.05, NO was significantly higher than before treatment, P 〈0.05, the plasma Hcy, endothelin, baPWV of the obser- vation group after treatment were significantly lower than the control group, P 〈0.05, NO was significantly higher than the control group ,the The above-mentioned index of the control group had no significant improvement, P 〉 0.05. There were 10 cases of stroke, Two cases of myocardial infarction, two cases of cardiovascular death, the rate of cardiovascular events was 17.65%, in the observa- tion group ,three were 3 cases of stroke, one cases of myocardial infarction, the rate of cardiovascular events was 5.97 %, the differ- ence was statistically significant, X2 = 4.405, P〈0.05. CONCLUSION Folic acid and vitamin B6 could significantly reduce Hcy levels in patients with hyperhomocysteinima-related hypertention, improve endothelial function and prevent or mitigate mitigate the extent of atherosclerosis and reduce the incidence of cardiovascular events, worthy of promotion.