甲钴胺治疗老年脑梗死伴高同型半胱氨酸血症及卒中后抑郁的临床效果

Clinical effect of mecobalamin on post-stroke depression in senile patients with cerebral infarction accompanied by hyperhomocysteinemia

目的 探讨甲钴胺治疗老年脑梗死伴高同型半胱氨酸（Hcy）血症、卒中后抑郁的临床效果及对血浆Hcy水平和生活质量的影响。方法 选取2015年2月至2017年2月广西医科大学第一附属医院门诊及住院治疗的103例老年脑梗死伴高Hcy血症卒中后抑郁患者，依据随机数字表法分为对照组（51例）和观察组（52例）。对照组予以常规治疗，观察组于常规治疗基础上给予甲钴胺治疗，2组均治疗14 d。观察并比较2组临床治疗效果、血浆Hcy水平变化情况及症状自评量表（人际关系、焦虑、抑郁、躯体化、恐怖及其他）评分、不良反应发生情况及生活质量综合评定问卷（GQOLI）评分。结果 观察组治疗总有效率高于对照组［86.5%（45/52）比66.7%（34/51）］，差异有统计学意义（P＜0.05）。治疗14 d后，观察组血浆Hcy水平低于对照组［（15.8±3.0）μmol/L比（20.4±2.2）μmol/L］，差异均有统计学意义（均P＜0.05）。观察组治疗14 d后人际关系、躯体化、焦虑、抑郁、恐怖及其他因子评分均高于对照组（P＜0.05）。2组不良反应发生率比较，差异无统计学意义（χ2=0.090, P=0.764）。治疗14 d后，观察组GQOLI评分高于对照组［（220±11）分比（188±10）分］，差异有统计学意义（P＜0.05）。结论 甲钴胺治疗老年脑梗死伴高Hcy血症卒中后抑郁，效果明显，安全性高，可降低血浆Hcy水平，改善患者心理状况及生活质量。

Objective To analyze the effect of mecobalamin on plasma level of homocysteine（Hcy） and quality of life in post-stroke depressive senile patients with hyperhomocysteinemia. Methods Totally 103 senile patients with post-stroke depression accompanied by hyperhomocysteinemia from February 2015 to February 2017 in the First Affiliated Hospital of Guangxi Medical University were randomly divided into control group（n=51） and observation group（n=52）. The control group had routine therapy; the observation group was treated with mecobalamin on the basis of conventional therapy. After 14 d of treatment, clinical effective rate, plasma level of Hcy, scores of the Symptom Checklist（interpersonal relationship, anxiety, depression, somatization, terror and other factors）, adverse reaction rate and score of the Greneric Quarity of Life Inventor（GQOLI） were analyzed. Results The total effective rate in observation group was significantly higher than that in control group[86.5%（45/52） vs 66.7%（34/51）]（P〈0.05）. Plasma level of Hcy after treatment in observation group was significantly lower than that in control group[（15.8±3.0）μmol/L vs （20.4±2.2）μmol/L]（P〈0.05）. Scores of interpersonal relationship, somatization, anxiety, depression, terror and other factors after treatment in observation group were significantly higher than those in control group（P〈0.05）. The adverse reaction rate had no significant difference between groups（P〉0.05）. The GQOLI score in observation group was significantly higher than that in control group[（220±11）scores vs （188±10）scores]（P〈0.05）. Conclusion Mecobalamin treating post-stroke depression in senile patients with cerebral infarction accompanied by hyperhomocysteinemia is safe and effective in lowering plasma Hcy level and improving patients′ psychological status and quality of life.