高血压及叶酸、维生素B_(12)干预对脑梗死患者血管内皮功能和血同型半胱氨酸、一氧化氮水平的影响  

Effects of hypertension and folic acid,vitamin B_(12) intervention on endothelial function and blood homocysteine,nitric oxide levels in patients with cerebral infarction

作　　者：邓远琼[1] 邓远琪[1] 刘伯胜[1] 胡志彪[1] 刘贞[1] 范华[1] 胡建新[1] 王海荣[1] 吕雪[1] 

机构地区：[1]南昌大学第四附属医院功能科,330003

出　　处：《临床神经病学杂志》2013年第6期411-414,共4页Journal of Clinical Neurology

基　　金：江西省科技计划项目(20122BBG70146)

摘　　要：目的探讨高血压及叶酸、维生素B12干预对脑梗死患者血管内皮功能和血同型半胱氨酸(Hcy)、一氧化氮(NO)水平的影响。方法选取高血压脑梗死(高血压脑梗死组)和血压正常脑梗死(血压正常脑梗死组)患者各80例,两组再随机分为叶酸、维生素B12的干预亚组和未干预亚组,每组40例。另选取我院体检中心健康体检者80例作为正常对照组。在脑梗死患者治疗前、治疗2周、24周后,检测肱动脉血流介导的内皮依赖性血管舒张功能(FMD)、颈动脉内-中膜厚度(IMT)、Hcy、NO、内皮型NO合成酶(eNOS),与正常对照组进行比较。结果与正常对照组比较,治疗前高血压及血压正常脑梗死组的颈动脉IMT、血Hcy水平明显增高,FMD和血NO、eNOS水平明显降低(均P<0.01)。而高血压脑梗死组的颈动脉IMT、血Hcy水平明显高于,FMD和血NO、eNOS水平明显低于血压正常脑梗死组(均P<0.01)。两干预亚组治疗2周、24周后的血Hcy水平明显低于,血NO、eNOS水平明显高于治疗前(均P<0.01);并且治疗24周后的血NO、eNOS水平明显高于两未干预亚组(均P<0.01)。高血压与血压正常脑梗死组各亚组,以及各时间点FMD的差异均无统计学意义。结论合并高血压的脑梗死患者的血Hcy水平更高、NO、eNOS水平和FMD更低。而用叶酸和维生素B12干预可使患者的血Hcy水平降低,NO、eNOS水平提高,内皮功能得到改善。Objective To explore the effects of hypertension and folic acid, vitamin B12 intervention on endothelial function and serum homocysteine （Hcy）, nitric oxide （NO） levels in patients with cerebral infarction（CI）. Methods Eighty hypertension CI patients （hypertension CI group） and 80 CI patients with normal blood pressure （normal blood pressure CI group） were randomly divided into intervention subgroup with folic acid, vitamin B12 and non-intervention subgroup ,40 cases in each group. Chooseing another 80 healthy subjects of our physical examination center as normal control group . The datas of braehial artery flow-mediated dilation （FMD） , carotid intima media thickness （IMT） , serum Hey, NO and endothelid mitric oxide synthase （eNOS） were collected from CI group before, 2 weeks and 24 weeks after treatment;The statistics were compared with normal control group. Results Compared with normal control group, before treatment the carotid IMT, serum Hcy levels of hypertension and normal blood pressure CI group increased significantly, while FMD and serum NO, eNOS levels were significantly lower （ all P 〈 0. 01 ）. The carotid IMT, serum Hcy levels of hypertensive CI group were significantly higher, while FMD and serum NO,eNOS levels decreased significantly than the normal blood pressure CI group （all P 〈 0. 01 ）. Treated by folic acid, vitamin B l2 after 2 and 24 weeks, the serum Hcy levels of two intervention subgroups were significantly lower, while the serum NO ,eNOS levels were significantly higher ,than that before treatment （all P 〈 0. 01 ） ;and the levels of serum NO, eNOS of two intervention subgroups were significantly higher than non-intervention subgroups , treated after 24 weeks（ all P 〈 0. 01 ）. There was no statistical significance of FMD among all subgroups of hypertension and normal blood pressure CI group at each time point （ all P 〉 0. 05 ）. Conclusions The serum Hcy of CI with hypertension is higher,while the NO ,eNOS and FMD are lower. The

关 键 词：脑梗死 血管内皮功能 同型半胱氨酸 叶酸 维生素B12 

分 类 号：R743.3[医药卫生—神经病学与精神病学]