甲钴胺、叶酸及维生素B_(6)三联降同型半胱氨酸治疗对缺血性脑卒中患者颈动脉斑块的影响

Effects of lowering homocysteine by combination of methylcobalamin,folic acid and vitamin B_(6) on carotid plaques in acute ischemic stroke patients

目的探讨甲钴胺、叶酸及维生素B_(6)三联降同型半胱氨酸(homocysteine,Hcy)治疗对急性缺血性脑卒中(acute ischemic stroke,AIS)患者颈动脉斑块的影响。方法202例住院AIS患者根据入院时血Hcy水平分为高Hcy组(167例)和对照组(35例),比较两组患者之间血管性危险因素,颈动脉斑块数量、性质,及斑块总面积的差别。高Hcy组每日服用甲钴胺1 mg、维生素B_(6)20 mg和叶酸5 mg,分别于6及12个月后随访血Hcy水平和颈动脉斑块的变化。结果基线状态下,高Hcy组和对照组的血Hcy水平分别为(16.66±7.89)和(8.53±1.05)μmol/L。高Hcy组男性患者居多,血叶酸、维生素B_(12)平均显著低于对照组(P<0.01);高Hcy组的斑块数量和斑块总面积虽较对照组为高,但并无统计学差异。吸烟和饮酒患者的血Hcy水平显著高于非吸烟和非饮酒者(P<0.05)。甲钴胺、叶酸及维生素B_(6)、三联治疗1年内,高Hcy组患者的血Hcy水平、斑块数目及斑块总面积均显著性降低,斑块稳定性增加。结论AIS患者高Hcy者非常多见,血Hcy水平与颈动脉斑块数量、斑块总面积相关联,1年的三联降Hcy治疗显著降低Hcy水平,并可使颈动脉斑块数量减少、面积缩小并更加稳定。

Objective To investigate the effects of lowering homocysteine(Hcy)by methylcobalamin,folic acid and vitamin B6 on carotid plaque in patients with acute ischemic stroke(AIS).Methods A total of 202 hospitalized AIS patients were divided into high-Hcy group(n=167)and control group(n=35)according to the blood Hcy level at admission.The difference in vascular risk factors,the number,gray-scale median and total plaque area(TPA)of carotid plaques were compared between the two groups.The patients in high-Hcy group were treated by 1 mg mecobalamin,20 mg vitamin B6 and 5 mg of folic acid daily,and the changes of blood Hcy levels and carotid plaques were followed at 6 and 12 months respectively.Results Before treatment,the levels of blood Hcy in high-Hcy group and the control group were(16.66±7.89)and(8.53±1.05)μmol/L,respectively.There were more male patients in high-Hcy group,and the serum levels of folic acid and vitamin B_(12)levels were significantly lower than those in control group(P<0.01);Although the number and the total area of plaques in high-Hcy group were higher than those in control group,there was no statistical difference.The blood Hey level of smoking and drinking patients was significantly higher than that of non-smokers and non-drinkers(P<0.05).Within one year of triple therapy of methylcobalamin,folic acid and vitamin B_(6),the blood Hcy level,the number of plaques and total plaque area in the high-Hcy group were significantly reduced,and the plaque stability was increased.Conclusion High Hcy is very common in AIS patients,and the blood Hcy level is correlated with the number and the total area of carotid plaques.One-year triple Hcy lowering treatment can significantly reduce the Hcy level and reduce the number and the area of carotid plaques and make them more stable.