不同剂量叶酸对不同MTHFR基因型缺血性脑卒中伴高同型半胱氨酸血症患者同型半胱氨酸水平的影响

Effects of different doses of folic acid on homocysteine levels in patients with different MTHFR genotypes of ischemic stroke with hyperhomocysteinemia

目的探讨不同剂量的叶酸对不同亚甲基四氢叶酸还原酶基因型缺血性脑卒中患者的高同型半胱氨酸血症的治疗效果,寻找合适的叶酸治疗方案。方法选取2017年1月—2019年12月新疆医科大学第一附属医院神经内科、康复医学科收治的伴有高同型半胱氨酸血症的缺血性脑卒中患者376例,将其进行亚甲基四氢叶酸还原酶C677T位点基因检测,分为TT型、CT型和CC型。根据随机数字表法分成高剂量叶酸组(188例,5.0 mg/d)与低剂量叶酸组(188例,0.8 mg/d),在治疗前、治疗4周后、治疗3个月后复测血清同型半胱氨酸水平。结果对CT及TT基因型,高剂量叶酸组在治疗4周后同型半胱氨酸水平低于低剂量叶酸组,差异有统计学意义(P<0.05);治疗3个月后两组同型半胱氨酸水平比较,差异无统计学意义(P>0.05);对CC基因型,在治疗前、治疗4周和3个月后,两组同型半胱氨酸水平比较,差异无统计学意义(P>0.05)。对于三种基因型,治疗4周、3个月后,两组同型半胱氨酸水平低于治疗前,治疗3个月后两组同型半胱氨酸水平低于治疗4周后,差异均有统计学意义(P<0.017)。结论对伴有高同型半胱氨酸血症缺血性脑卒中患者,应根据不同亚甲基四氢叶酸还原酶C677T基因型制订个性化叶酸治疗方案。

Objective To investigate the therapeutic effect of different doses of folic acid on the treatment of hyperhomocysteinemia in patients with different methylene tetrahydrofolate reductase genotypes of ischemic stroke,and to find an appropriate folic acid treatment scheme.Methods A total of 376 ischemic stroke patients with hyperhomocysteinemia who were admitted to the Department of Neurology and Rehabilitation Medicine of the First Affiliated Hospital of Xinjiang Medical University from January 2017 to December 2019 were selected.Methylene tetrahydrofolate reductase C677T site gene was detected,and they were divided into TT type,CT type and CC type.According to random number table,they were divided into high-dose folic acid group(188 cases,5.0 mg/d)and low-dose folic acid group(188 cases,0.8 mg/d).Blood homocysteine level was measured before treatment,four weeks after treatment,and three months after treatment.Results For CT and TT genotypes,the homocysteine level of the high-dose folic acid group was lower than that of the low-dose folic acid group after four weeks of treatment,the difference was statistically significant(P<0.05).After three months of treatment,there was no significant difference in homocysteine levels between the two groups(P>0.05).For CC genotype,there was no significant difference in homocysteine levels between the two groups before treatment,after four weeks and three months of treatment(P>0.05).For the three genotypes,after four weeks and three months of treatment,the homocysteine level in the two groups was lower than that before treatment,after three months of treatment,the homocysteine level in the two groups was lower than that after four weeks of treatment,the differences were statistically significant(P<0.017).Conclusion For patients with ischemic stroke with hyperhomocysteinemia,personalized folic acid therapy should be developed according to different methylene tetrahydrofolate reductase C677T genotypes.