B族维生素对高同型半胱氨酸血症脑梗死患者神经功能的影响  

Effect of B-Vitamin Therapy on Neurological Dysfunction of Brain Infarction in Patients with Hyperhomocysteinemia

作　　者：朱炬[1] 张哲成[1] 张静[1] 王素红[1] 王渝[1] 

机构地区：[1]天津市第三中心医院神经内科,300170

出　　处：《天津医药》2013年第8期744-746,共3页Tianjin Medical Journal

基　　金：天津市科技支撑计划项目(项目编号:07ZCGYSF03700)

摘　　要：【摘要】目的评价应用复合B族维生素对高同型半胱氨酸血症（Hhcy）脑梗死患者神经功能预后的影响。方法将1000例Hhcy脑梗死患者分为干预组与对照组，各500例。干预组在常规二级预防基础上加用复合B族维生素，对照组仅行常规治疗，随访2年。以美国国立卫生研究院卒中量表（NIHSS）评分评价神经功能缺损程度，BarthelIndex（BI评分）评价日常生活行为能力。采用高效液相荧光检测法检测血浆tHcy水平。随访24个月时干预组中tHcy下降明显（较人组时下降≥3μmol／L）者为干预亚组。结果干预组tHcy明显降低，除入组时2组差异无统计学意义外，随访3、12、24个月时干预组均低于对照组（P〈0．05）。随访12、18和24个月时干预组NIHSS评分均低于对照组（P〈0．05），其余时点2组间差异无统计学意义（P〉0．05）。不同时点2组BI评分差异无统计学意义（P〉0．05）。干预亚组NIHSS评分低于对照组，BI评分高于对照组。结论复合B族维生素干预降低tHcy可能有利于脑梗死1-2年后神经功能缺损的改善，血浆tHcy水平明显下降者可能获益更多。Objective To investigate whether vitamin B complex supplements would reduce stroke-related disabili- ty in hyperhomocysteinemia （I-Ihcy） patients with recent ischemic stroke. Methods One thousand patients with brain infarc- tion and Hhcy were assigned to receive either a daily dose of vitamin B complex （treatment group, n=500） or not （control group, n=500） on the base of conventional secondary prevention medications for a period of 2 years. The neurological dys- function was assessed by National Institutes of Health Stroke Scale （NIHSS） and stroke disability was evaluated by Barthel Index （BI） score. High performance hquid chromatographic method with fluorescence detection was used for the determina- tion of total plasma homocysteine levels. After 2 years of follow-up, the patients in the treatment group, whose tHcy level was reduced by 3-~tmol/L or more, was defined as the treatment subgroup. Results The homocysteine levels were significantly reduced after 3, 12 and 24-month treatment than those of control group （P 〈 0.05）. A lower NIHSS scale was found at 12, 18 and 24-month in treatment group compared with that in control group （P 〈 0.05）, no significant differences at other time points between two groups （P 〉 0.05）. For the BI score, there were no significant differences at any time points between two groups （P 〉 0.05）. After 2 years of vitamin B complex supplementation, there were lower NIHSS scale and higher BI scale in treatment subgroup than those of control group （P 〈 0.05）. Conclusion The lower level of tHcy induced by vitamin B inter- vention may be beneficial to the improvement of neurological deficit in patients with ischemic stroke.

关 键 词：维生素B 复合 高同种半胱氨酸血症 脑梗死 总同型半胱氨酸 神经功能缺损 NIHSS评分 BI评分 

分 类 号：R743.33[医药卫生—神经病学与精神病学]