同型半胱氨酸在缺血性脑血管病中的应用研究

Application study of homocysteine in ischemic cerebrovascular disease

目的探讨同型半胱氨酸(Hcy)与缺血性脑血管病的关系及B族维生素的干预作用。方法选择缺血性脑血管病(包括脑梗死、短暂性脑缺血发作)为观察组,对照组为体检正常的健康人,观察组中Hcy水平高者再分为观察A组、观察B组;两组均接受抗血小板等常规治疗,观察A组同时服用维生素B6、B12、叶酸,分别测定治疗前后脉搏波传导速度(PWV)、颈内动脉内膜中层厚度(CIMT),同时比较两组患者1年内缺血性脑血管病的复发率。结果观察组血浆Hcy水平显著高于对照组(P<0.05),且服用叶酸及维生素B6、B12能有效降低Hcy、PWV及CIMT(P<0.05),观察1年内缺血性脑血管病复发率与未服用B族维生素者差异无统计学意义(P>0.05)。结论脑梗死的发生与血浆中Hcy浓度之间存在密切相关性,因此在脑血管病危险人群中广泛开展Hcy的浓度筛查,超过正常值者积极予B族维生素干预,将会有效降低动脉粥样硬化及其并发症的发生率。

Objective To explore the relationship between homocysteine（Hcy）and ischemic cerebrovascular disease,and the effect of B vitamins intervention.Methods Patients with ischemic cerebrovascular disease,including cerebral infarction,transient ischemic attack,were selected as observation group and normal healthy people were selected as control group.Observation group was then divided into two sub-groups based on the level of Hcy：observation group 1and observation group 2.Both sub-groups had antiplatelet therapy and other conventional therapy,meanwhile,observation group 1took additionally vitamin B6,vitamin B12 and folic acid.The level of Hcy,PWV,CIMT before and after treatment were determined and the recurrence rate of ischemic cerebrovascular disease was compared between groups within 1year.Results The level of Hcy in patients with cerebral infarction plasma was significantly higher than that of the control group（P〈0.05）.Folic acid and vitamin B6,B12 can effectivly reduce the levels of Hcy,PWV and CIMT（P〈0.05）.The recurrence rate of ischemic cerebrovascular disease had no significant difference between sub-groups within one year（P〈0.05）.Conclusion There is a close correlation between the occurrence of cerebral infarction and Hcy concentration.Extensive screening of Hcy concentration in high-risk population of cerebrovascular disease and active intervention with B vitamins in people with high level of Hcy will effectively reduce the incidence of atherosclerosis and its complications.