不同剂量叶酸联合维生素B12治疗老年高血压合并高同型半胱氨酸血症的临床疗效分析

Clinical efficacy of different doses of folic acid combined with vitamin B12 in the treatment of senile hypertension with hyperhomocysteinemia

目的探讨不同剂量叶酸联合维生素B12治疗老年高血压合并高同型半胱氨酸(Hcy)血症(简称“H型高血压”)对患者Hcy、叶酸和血压水平的影响。方法本研究选取2015年1-5月于重庆市九龙坡区西彭镇体检的140例H型高血压患者为研究对象。将患者分为3组:对照组(n=36)、叶酸A组(n=60)和叶酸B组(n=44)。对照组患者治疗方案:常规降压治疗;叶酸A组患者治疗方案:常规降压治疗+叶酸(0.4mg/次)+维生素B12(500μg/次);叶酸B组患者治疗方案:常规降压治疗+叶酸(0.8mg/次)+维生素B12(500μg/次)。结果治疗12周时,对照组、叶酸A组和叶酸B组患者Hcy水平分别为(26.73±8.99)μmol/L,(16.26±5.71)μmol/L,(16.59±6.12)μmol/L。3组患者Hcy水平比较,差异有统计学意义(P<0.05)。叶酸A组、叶酸B组患者Hcy水平均低于治疗前,差异有统计学意义(P<0.05)。同时,叶酸A组、叶酸B组患者Hcy水平均低于对照组,差异均有统计学意义(P<0.05)。治疗12周时,对照组、叶酸A组和叶酸B组患者叶酸水平分别为(3.88±1.37)μg/L,(10.72±3.39)μg/L,(12.78±4.73)μg/L。3组患者叶酸水平比较,差异有统计学意义(P<0.05)。叶酸A组、叶酸B组患者叶酸水平均高于治疗前,差异有统计学意义(P<0.05)。同时,叶酸A组、叶酸B组患者叶酸水平均高于对照组,差异均有统计学意义(P<0.05)。叶酸B组患者叶酸水平高于叶酸A组,差异有统计学意义(P<0.05)。治疗12周时,对照组、叶酸A组和叶酸B组患者收缩压(SBP)水平分别为(141.2±10.9)mmHg(1mmHg=0.133kPa),(133.8±10.6)mmHg,(129.3±7.8)mmHg。3组患者SBP水平比较,差异有统计学意义(P<0.05)。叶酸A组和叶酸B组患者SBP水平均低于对照组,差异均有统计学意义(P<0.05)。此外,治疗过程中,3组患者均未出现药物过敏、肝肾损伤等药品不良反应。结论适当补充叶酸和维生素B12可显著降低Hcy水平,提高叶酸水平,改善血压水平,同时每天服用0.8mg叶酸在改善Hcy水平及SBP水平方面的效果优于每天服用0.4mg叶酸,值得在基层医疗机构中推广应用。

Objective To assess the effects of different doses of folic acid combined with vitamin B12 on the homocysteine (Hcy),folic acid,and blood pressure levels in elderly hypertensive patients complicated with hyperhomocysteinemia (also referred to as “H-type hypertension”).Methods A total of 140 patients with H-type hypertension who underwent health check-up in Xipeng Town,Jiulongpo District,Chongqing between January and May,2015 were included in this study.These patients were divided into the control group (routine anti-hypertensive treatment,n =36),folic acid group A (routine treatment+folic acid 0.4 mg +vitamin B12 500 μg,n =60),and folic acid group B (routine treatment+folic acid 0.8 mg+vitamin B12 500 μg,n =44).Results At week 12,the Hcy levels in the control group,folic acid group A,and folic acid group B were 26.73±8.99 μmol/L,16.26±5.71 μmol/L,and 16.59±6.12 μmol/L,respectively;and the differences were statistically significant among the three groups ( P <0.05).The Hcy levels were significantly reduced from baseline in both group A and group B ( P < 0.05),also significantly lower than that in the control group ( P <0.05).At week 12,the folic acid levels in the control group,folic acid group A,and folic acid group B were 3.88±1.37 μg/L,10.72±3.39 μg/L,and 12.78±4.73 μg/L,respectively;and the differences were statistically significant among the three groups ( P <0.05).The folic acid levels were significantly increased from baseline in both group A and group B ( P < 0.05),also significantly higher than that in the control group ( P <0.05).The folic acid level in group B was significantly higher than that in group A ( P <0.05).Also at week 12,the systolic blood pressure (SBP) levels in the control group,folic acid group A,and folic acid group B were 141.2± 10.9 mmHg (1 mmHg=0.133 kPa),133.8±10.6 mmHg,and 129.3±7.8 mmHg,respectively;and the differences were statistically significant among the three groups ( P <0.05).The SBP levels in both group A and group B were significantly lower than that in the control group ( P <0.05).Of note,no adverse reactions such as drug allergy,hepatic or renal toxicities were reported in any group during the study.Conclusion Proper doses of folic acid and vitamin B12 may significantly reduce the Hcy level,increase the folic acid level,and improve the blood pressure.Besides,folic acid 0.8 mg daily seems to be superior to 0.4 mg daily in reducing the Hcy and SBP levels,which deserves widespread application in primary healthcare settings.