叶酸和维生素B6/B12联合使用对老年H型高血压病人心功能的影响

Effects of folic acid and vitamin B6/B12 on cardiac function in elderly patients with H-hypertension

目的评价老年H型高血压病人血压达标基础上补充叶酸、维生素B6和B12对心脏结构和功能的影响。方法入选年龄≥60岁血压控制达标的H型高血压病人177例,随机分为2组,叶酸联合治疗组94例,男51例,女43例,年龄(77.861±7.79)岁,对照组83例,男43例,女40例,年龄(75.44±9.72)岁。叶酸联合治疗组:在常规降压基础上口服叶酸5 mg/d,维生素B6,10 mg/d,维生素B12,0.5 mg/次,3次/d;对照组:仅行常规降压治疗。观察2组病人的血浆同型半胱氨酸(Hcy)水平及室间隔(IVST)、左室后壁厚度(LVPWT)、舒张末期左室内径(LVDd)、左室收缩末内径(LVDs)、左室短轴缩短率(FS)、每搏量、左室射血分数(LVEF)等心脏超声指标变化。结果 2组治疗前血压、血脂等一般资料差异无统计学意义,叶酸联合治疗组Hcy由(15.33±5.36)μmol/L下降到(13.33±5.46)μmol/L(6月后)及(10.59±3.51)μmol/L(12月后),对照组Hcy由(15.26±5.15)μmol/L上升到(15.36±5.23)μmol/L(6月后)及(16.39±3.60)μmol/L(12月后),12月后2组间Hcy比较,差异有统计学意义(P<0.05)。叶酸联合治疗组12月后IVST、LVDd、LVDs分别是(8.61±1.04)mm、(46.67±5.40)mm、(29.84±5.01)mm,低于治疗前的(8.84±0.96)mm、(47.16±5.80)mm、(30.42±5.54)mm,差异有统计学意义(P<0.05);叶酸联合治疗组12月后LVEF值为(65.83±6.26)%,高于治疗前的(63.15±9.89)%,差异有统计学意义(P<0.05);治疗12月后2组间LVEF比较,差异亦有统计学意义(P<0.05)。结论老年H型高血压降压达标治疗基础上加用叶酸及小剂量维生素B6、B12能有效改善心脏结构和功能。

Objective To assess the effects of folic acid,vitamin B6 and B12 on left ventricular structure and function in elderly patients with H-hypertension. Methods 177 patients aged 60 years or over with H-hypertension,whose blood pressure had been controlled,were enrolled. Patients in combined therapy group were treated with combined therapy（ 5 mg of folic acid,10 mg of vitamin B6,1. 5 mg of vitamin B12） and conventional therapy for hypertension,and the patients in control group were treated with conventional therapy for hypertension for one year. Homocysteine（ Hcy）,interventricular septal thickness（ IVST）,left ventricular posterior wall thickness（ LVPWT）,left ventricular end diastolic dimension（ LVDd）,left ventricular end-systolic dimension（ LVDs）,fractional shortening（ FS）,stroke volume,left ventricular ejection fraction（ LVEF） were detected and then compared between two groups.Results After treatment,the level of Hcy in combined therapy group was decreased from（ 15. 33 ±5. 36） μmol/L to（ 13. 33±5. 46） μmol/L（ 6 months） and（ 10. 59±3. 51） μmol/L（ 12 months）（ P〈0. 05）. By contrast,the level of Hcy in control group was increased from（ 15. 26 ± 5. 15） μmol/L to（ 15. 36±5. 23） μmol/L（ 6 months） and（ 16. 39±3. 60） μmol/L（ 12 months）. There were significant differences in Hcy between two groups（ P〈0. 05）. After treatment,IVST,LVDd,LVDs of combined therapy group were decreased [（ 8. 61±1. 04） vs（ 8. 84±0. 96） mm,（ 46. 67±5. 40） vs（ 47. 16±5. 80）mm,（ 29. 84±5. 01） vs（ 30. 42 ± 5. 54） mm]. After 12 months treatment,LVEF of combined therapy group was higher than that of control group [（ 65. 83 ± 6. 26） % vs（ 63. 15 ± 9. 89） %,P〈0. 05].Conclusions Folic acid combined with vitamin B6 and B12 treatment show effects on cardiac structure and function,which should be recommended as a treatment in elderly patients with H-hypertension.