摘要
目的探讨卒中合并高同型半胱氨酸血症(hyperhomocysteinemia,Hhcy)患者伴发高血压的情况和药物降低同型半胱氨酸(homocysteine,Hcy)的效果。方法选取2016年3月至2018年12月中国康复研究中心北京博爱医院198例卒中合并Hhcy的患者(卒中组),188例健康体检者(对照组)纳入本研究。采用聚合酶链反应-限制性片段长度多态性(polymerase chain reaction-restriction fragment length polymorphism,PCR-RFLP)技术检测亚甲基四氢叶酸还原酶(meth-ylenetetrahydrofolate reductase,MTHFR)基因型。分析两组之间的MTHFR分布差异、高血压伴发情况,以及脑梗死和脑出血患者MTHFR分布情况;对Hhcy卒中患者采用叶酸、维生素B6、甲钴胺治疗,观察疗效。结果卒中组MTHFR基因纯合型CC、杂合基因型CT和TT分布频率分别为7.6%、33.3%和59.1%,对照组分别为19.1%、54.3%和26.6%,分布差异有统计学意义(P<0.01);卒中组伴发高血压患者比例高于对照组(86.9%比35.6%)。叶酸、维生素B6、甲钴胺可降低大多数患者Hcy水平;但3组不同基因型的卒中患者降低Hcy疗效组间差异无统计学意义(P>0.05)。部分患者对常规治疗反应欠佳,以TT基因型者为主。结论脑梗死和脑出血Hhcy患者的MTHFRC677TT基因型多见,伴发高血压比例高。叶酸、维生素B6、甲钴胺治疗对大部分Hhcy卒中患者有降低Hcy的作用,而部分患者需要更长的服药周期或者增加给药种类。
Objective To investigate the hyperhomocysteinemia(Hhcy)associated with hypertension in patients with stroke and the effect of drugs in reducing homocysteine(Hcy).Methods From March 2016 to December 2018,198 patients with stroke combined with Hhcy and 188 healthy people were included in this study.MTHFR genotype was detected by polymerase chain reaction-restriction fragment length polymorphism(PCR-RFLP).The differences in MTHFR distribution between the two groups,the incidence of hypertension,and the distribution of MTHFR in patients with cerebral infarction and cerebral hemorrhage were analyzed.For stroke patients with Hhcy,folic acid,vitamin B6,and mecobalamin were used to reduce the level of Hcy,and the effect was observed.Results The frequency of homozygous CC,heterozygous genotype CT and T allele TT in the stroke group were 7.6%,33.3%and 59.1%,respectively.The control group was 19.1%,54.3%and26.6%,respectively.There was a significant difference in distribution(P<0.0001);the proportion of patients with hypertension associated with stroke was higher than the control group(86.9%vs.35.6%);there were no significant differences in the treatment results among the stroke patients with three different genotypes.Folic acid,vitamin B6,and mecobalamin reduced Hcy levels in most stroke patients with Hhcy.Some TT genotype patients did not respond well to treatment.Conclusions MTHFRC677 TT genotype is more common in the stroke patients with Hhcy,and the incidence of hypertension is higher in those patients with MTHFRC677 TT genotype.Folic acid,vitamin B6,and methylcobalamin have a tendency to reduce Hcy for most patients with Hhcy,but some patients may require longer medication period or increase doses.
作者
杜晓霞
肖琳
孙蓉
王强
米海霞
李晁金子
李鹏锟
梁林
刘志忠
宋鲁平
Du Xiaoxia;XiaoLin;Sun Rong;Wang Qiang;Mi Haixia;Li Chaojinzi;Li Pengkun;Liang Lin;Liu Zhizhong;Song Luping(Department of Neurorehabilitation,School of Rehabilitation Medicine,Capital Medical University,Beijing Boai Hospital China Rehabilitation Research Center,Beijing 100068,China)
出处
《北京医学》
CAS
2020年第5期379-382,386,共5页
Beijing Medical Journal
基金
中国康复研究中心课题(2015zx-21
2016zx-15
2018zx-3)。