妊娠期高血压伴高同型半胱氨酸血症的干预治疗  

Interventional therapy on patients with hypertensive disorder complicating pregnancy accompanied with hyperhomocysteinemia

作　　者：杨红星 黄素然[2] 丁少波[3] 张建鸿[2] 肖丽娟[2] 吴雪玲[3] 

机构地区：[1]广东省东莞市万江医院妇产科,广东东莞523050 [2]广东省东莞市人民医院妇产科,广东东莞523018 [3]广东省东莞市人民医院临床药学研究室,广东东莞523018

出　　处：《同济大学学报（医学版）》2008年第2期90-93,共4页Journal of Tongji University(Medical Science)

基　　金：广东省科技计划基金资助项目(2007B080702046)

摘　　要：目的研究比较叶酸联合甲钴胺治疗和各自单一治疗妊娠期高血压疾病伴高同型半胱氨酸(homocys-teine,Hcy)血症的临床疗效。方法选择78例伴高Hcy血症的妊娠期高血压疾病患者,随机分成3组。叶酸治疗组(A组)26例,给予口服叶酸5 mg,1日3次,疗程1个月;甲钴胺治疗组(B组)24例,给予口服甲钴胺500μg,1日1次,疗程1个月;叶酸联合甲钴胺治疗组(C组)28例,给予口服叶酸5 mg,1日3次,同时予口服甲钴胺500μg,1日1次,疗程1个月;测定治疗前后所有患者血浆总同型半胱氨酸(tHcy)浓度,血清叶酸、VitB12浓度,同时测定其平均动脉压和24 h尿蛋白含量。结果(1)治疗后,血浆tHcy水平A组和C组较治疗前显著下降(P<0.05,P<0.01);血清叶酸水平A组和C组较治疗前显著升高(P<0.01);血清VitB12水平B组和C组较治疗前显著升高(P<0.01);(2)治疗后,血浆tHcy水平C组显著低于A组和B组(P<0.05,P<0.01),血清叶酸水平A组和C组显著高于B组(P<0.01),血清VitB12水平B组和C组显著高于A组(P<0.01);(3)治疗后,血浆tHcy水平复常率C组显著高于A组和B组(P<0.05,P<0.01);(4)治疗后,平均动脉压与24 h尿蛋白含量A组和C组较治疗前显著下降(P<0.05,P<0.01),且C组显著低于A组(P<0.05)。结论妊娠期高血压疾病患者血浆tHcy水平升高与血清叶酸、VitB12水平降低有关,叶酸联合甲钴胺对降低患者血浆tHcy水平明显优于它们各自单一应用。Objective To study the effects of single therapy or combination of folic acid and methylcobalamin in treating patients with hypertensive disorder complicating pregnancy accompanied with hyperhomocys-teinemia. Methods Seventy-eight cases of hypertensive disorder complicating pregnancy accompanied by hyperhomocysteinemia were randomly divided into three groups ： group A （ n = 26, folic acid 5 mg, po, tid for l month）, group B （ n = 24, methylcobalamin 500 μg, po, qd for I month）, group C （ n = 28, folic acid 5 mg, po, tid,and methylcobalamin,500 μg,po,qd for 1 month）. The levels of total plasma homocysteine（tHcy） and serum folic acid,VitB,2 in all patients were measured before and after treatments,and the mean arterial blood pressure and 24 h urine protein level were measured. Results （ 1 ） In group A and group C, the levels of plasma tHcy were significantly decreased after 1 month treatment compared with that before treatment （P 〈 0.05 ,P 〈 0.01 ）, and the levels of serum folic acid were significantly increased after 1 month treatment compared with that before treatment（ P 〈 0.01 ）. In group B and group C, the levels of serum VitB12 were significantly increased after 1 month treatment compared with that before treatment （ P 〈 0.01 ）. （2） After treatment, the levels of plasma tHcy were significantly decreased in group C than that in group A and group B （ P 〈 0.05 ,P 〈0.01 ）,the levels of serum folic acid increased significantly in group A and group C than that in group B（P 〈0.01 ） ,the levels of serum VitBl2 increased significantly in group B and group C than that in group A（ P 〈 0.01 ）. （3） After treatment, the normal rates of plasma tHcy levels were significantly higher in group C than that in group A and group B （ P 〈 0.05, P 〈 0.01 ）. （4） In group A and group C, the mean arterial blood pressure and 24 h urine protein level decreased significantly after 1 month treatment compared with that before treatment（ P 〈 0.05 ,P 〈 0.

关 键 词：妊娠期高血压疾病 同型半胱氨酸 叶酸 甲钴胺 

分 类 号：R714.25[医药卫生—妇产科学]