不同剂量叶酸对老年高同型半胱氨酸血症患者的疗效比较

Clinical efficacy of different doses of folic acid in elderly patients with hyperhomocysteinemia

目的 观察不同剂量的叶酸对于老年高同型半胱氨酸血症患者的临床疗效。方法 入选2013年1月~2015年12月收治的老年高血压伴高（Hcy）血症患者70例，随机分为高剂量组（n=23）、中剂量组（n=25）、低剂量组（n=22）三组，分别给予叶酸5 mg，0.8 mg，0.4 mg 1/日剂量口服，入选患者基础治疗均相同，在干预3个月及12个月时比较三组患者治疗前后的血浆Hcy变化及相应临床效果。结果 与治疗前相比，治疗12月时高剂量组血压下降显著，收缩压[（149.8±7.8）mmHg vs. （120.2±5.8）mmHg，（1mmHg=0.133kPa）]，舒张压[（104.6±6.0）mmHg vs. （79.8±8.2）mmHg]具有显著的统计学意义（P＜0.05）。治疗3个月时，高剂量组血压下降幅度显著大于低、中剂量组（P＜0.05）。治疗12个月较治疗前，高剂量组的血Hcy下降[（24.7±4.9）μmol/L vs. （16.9±4.4）μmol/L]具有统计学差异（P＜0.05）。治疗12个月较治疗前，各组颈动脉斑块评分均明显下降：高剂量组（4.66±1.23 vs. 3.60±2.08），中剂量组（4.60±1.19 vs. 3.80±2.11）；低剂量组（4.56±1.21 vs. 3.89±2.06），其中中高剂量组改善情况均较低、中剂量组更为明显，差异均具有统计学意义（P＜0.05）。 结论 老年高Hcy血症应用高剂量叶酸进行治疗可加快血压、血浆Hcy下降速度，进一步改善患者动脉硬化。

Objective To explore the clinical efficacy of different doses of folic acid in elderly patients withhyperhomocysteinemia. Method 70 elderly patients with hyperhomocysteinemia were included form Jan 2013 toDec 2015, and divided into 3 groups according to different doses of folic acid administration: low dosage group(23 patients, 0.4 mg/d), medium dosage group (25 patients, 0.8 mg/d) and high dosage group (22 patients, 5 mg/d). All the groups were given the same basic treatment. The change of plasma homocysteine and relative clinicalefficacy were compared after intervention for 3 months and 12 months. Results After treatment for 12 months,the blood pressure of high dosage group reduced significantly (systolic pressure: 149.8±7.8 mmHg vs. 120.2±5.8 mmHg; diastolic pressure: 104.6±6.0 mmHg vs. 79.8±8.2mmHg, P<0.05), as well as plasma homocysteine(24.7±4.9μmol/L vs. 16.9±4.4μmol/L, P<0.05). After treatment for 3 months, the decreasing of blood pressureof high dosage group was significantly than other two groups (P<0.05). The artery plague scores were all reducedafter treatment for 12 months: high dosage group (4.66±1.23 vs. 3.60±2.08), medium dosage group (4.60±1.19vs. 3.80±2.11) and low dosage group (4.56±1.21 vs. 3.89±2.06). Conclusion Treatment using high dosage of folic acid could accelerate the speed of blood pressure and plasma homocysteine reducing, and improve status ofarteriosclerosis.