维生素B补充治疗对高Hcy癫痫患者临床症状的影响分析

Effects of vitamin B supplementation on clinical symptoms in patients with high Hcy epilepsy

目的探讨维生素B补充治疗对高同型半胱氨酸(Hcy)癫痫患者临床症状的影响。方法选择2012年1月~2016年6月在在我院诊断明确的癫痫患者264例,其中伴轻度高Hcy(15.0~30.0μmol/L)150例,伴中重度高Hcy(>30.0μmol/L)114例。以接受维生素B补充治疗的166例患者设为观察组,未接受维生素B补充治疗的98例患者设为对照组,并对两组患者随访1年,检测Hcy、叶酸、维生素B6、维生素B12水平,记录患者癫痫发作频率、抑郁症状、认知功能改变情况。结果中重度高Hcy患者的年龄、癫痫发作频率、癫痫持续状态、AEDs≥2种治疗以及高血压、糖尿病、吸烟的比例,Hcy水平均明显高于轻度高Hcy患者,叶酸水平、认知功能评分明显低于轻度高Hcy患者,差异均有统计学意义(P<0.05)。相关性分析显示,Hcy水平与年龄呈正相关,与叶酸水平呈负相关;Hcy水平与维生素B6、维生素B12无明显线性关系。两组患者入组时各项指标比较,差异无统计学意义(P>0.05)。治疗1年后,观察组Hcy水平、癫痫发作频率、抑郁症状评分明显降低,叶酸、维生素B6、维生素B12水平和认知功能明显增加,与治疗前比较差异均有统计学意义(P<0.05)。与同期对照组比较,Hcy水平明显降低,叶酸、维生素B12水平明显升高,差异均有统计学意义(P<0.05);抑郁症状评分、认知功能评分比较,差异无统计学意义(P>0.05)。合并轻度高Hcy的观察组患者治疗1年后与对照组比较,Hcy水平明显降低,叶酸、维生素B12水平明显升高,差异均有统计学意义(P<0.05);癫痫发作频率、抑郁症状评分、认知功能评分比较,差异无统计学意义(P>0.05)。合并中重度高Hcy的观察组患者治疗1年后与对照组比较,Hcy水平、癫痫发作频率、抑郁症状评分明显降低,叶酸、维生素B6、维生素B12、认知功能评分明显升高,差异均有统计学意义(P<0.05)。结论对合并中重度高Hcy癫痫患者给予维生素B补充治疗可有效控制癫痫发作,改善精神和认知功能障碍;对轻度高Hcy癫痫患者不必立即给予维生素B补充治疗,应密切监测Hcy水平。

Objective To investigate the effects of vitamin B supplementation on the clinical symptoms of patients with high Hcy epilepsy. Methods 264 patientsfrom January 2012 to June 2016 in the Xinxiang First People's Hospital with epilepsy clearly were prospectively collected,with mild high Hcy in 150 cases with severe high Hcy in 114 cases.Take vitamin B treatment of 166 cases of patients as the observation group,98 cases to the control group,after 1 years of follow-up,the levels of Hcy,folic acid,vitamin B6 and vitamin B12 were examined.The frequency of epileptic seizure,the change of depressive symptoms and cognitive function were recorded. ResultsHcy in patients with severe high age,seizures,status epilepticus,AEDs≥2,hypertension and diabetes,smoking,Hcy levels were significantly higher than those of mild Hcy patients;folic acid level,cognitive function score was significantly lower than that in mild Hcy patients(P<0.05).Correlation analysis showed that Hcy levels were positively correlated with age,negatively correlated with folic acid levels,and there was no significant linear relationship between Hcy levels and vitamin B6 and vitamin B12 levels.There was no significant difference in the indexes between the observation group and the control group(P>0.05).After 1 years of treatment,the Hcy level of the observation group,seizure frequency,depressive symptom score decreased,folic acid,vitamin B6,vitamin B12 levels and cognitive function increased significantly(P<0.05).Compared with control group,Hcy levels were significantly lower,folic acid and vitamin B12 levels were significantly higher(P<0.05),no significant depressive symptoms score,cognitive function score difference(P>0.05).The observation group patients with mild high Hcy after1 years of treatment compared with the control group,Hcy decreased significantly,folic acid and vitamin B12 were increased,the differences were statistically significant(P<0.05);seizure frequency,depressive symptoms,cognitive function score between the score difference was statistically significant(P>0.05).The patients in the observation group were combined with severe high Hcy after 1 years of treatment compared with the control group,Hcy,frequency of seizures,depression symptom score decreased,folic acid,vitamin B6,vitamin B12,cognitive function score was significantly higher(P<0.05). Conclusion Vitamin B supplementation can effectively control the seizures of epilepsy patients with severe Hcy,improve mental and cognitive dysfunction;for mild high Hcy epilepsy patients without immediately given vitamin B supplementation,should closely monitor the level of Hcy.