叶酸对老年脑梗死伴高同型半胱氨酸血症患者血管内皮功能的影响  

Effect of folic acid on vascular endothelial function in elderly cerebral infarction patients with hyperhomocysteinemia

作　　者：宋文娟[1] 吴俊[1] 

机构地区：[1]南京市市级机关医院神经内科,210018

出　　处：《中国脑血管病杂志》2014年第9期466-469,共4页Chinese Journal of Cerebrovascular Diseases

摘　　要：目的探讨叶酸对老年脑梗死伴高同型半胱氨酸(Hcy)血症患者血浆Hcy水平和血管内皮功能的影响。方法前瞻性纳入2012年11月—2013年10月南京市市级机关医院神经内科住院腔隙性脑梗死伴高Hcy血症老年患者112例,按随机数字法分成两组,两组患者同时接受缺血性卒中常规药物治疗。A组56例,口服叶酸20mg,1次/d;B组56例,未口服叶酸治疗。检测两组患者入院时、治疗后24周血浆Hcy水平。采用高分辨率超声检测肱动脉介导内皮依赖性舒张功能(FMD),并同时检测一氧化氮(NO)、一氧化氮合酶(NOS)、内皮素(ET)水平。结果治疗后24周A组血浆Hcy水平较治疗前明显降低[分别为(12.2±4.2)和(22.6±3.7)μmol/L,P<0.05],同时低于B组同期水平[(21.8±4.0)μmol/L,P<0.05)];A组FMD水平明显高于治疗前及B组同期水平[分别为(11.2±3.6)、(9.2±3.3)、(9.3±3.3)%,P<0.05]。A组治疗后24周NO、NOS水平明显高于治疗前及B组同期水平[分别为(76.2±9.4)、(49.2±9.0)、(50.0±9.1)μmol/L;(47.6±9.5)、(38.4±7.5)、(37.8±8.8)kU/L,P<0.05)],A组ET水平较治疗前及B组降低[(81.3±20.5)、(105.6±25.2)、(105.3±21.8)ng/L,P<0.05)]。结论较大剂量叶酸能够明显降低老年脑梗死伴高Hcy血症患者血浆Hcy水平,降低FMD水平,改善血管内皮功能。Objective To investigate the effect of folic acid on plasmahomocysteine（Hcy）levels and vascular endothelial function in elderly cerebral infarction patients with hyperhomocysteinemia. Methods This study was aprospective controlled trial.A total of 112 elderly lacunar infarction patients with high hyperhomocysteinemia admitted to the Department of Neurology,Nanjing Municipal Government Hospital from November 2012 to October 2013 were enrolled. The patients were divided into two groups according to the method of random number table. The patients of both groups received the conventional drug treatment of ischemic stroke at the same time. Fifty-six patients were in group A,and they were treated with folic acid 20 mg,once a day;56 patients were in group B,and they did not treat with folic acid. The Hcy levels on admission and after 24 weeks treatment were measured. Brachial artery flow-mediated endothelium-dependent dilation （FMD）was measured by high resolution ultrasound,and nitric oxide （NO）, nitric oxide synthase（NOS）,and endothelin（ET） were detected at the sametime.Results Twenty-four weeks after treatment,the plasma Hcy level in group A was significantly decreased as compared with prior treatment （12. 2 ± 4. 2 vs. 22. 6 ± 3. 7μmol/L;P〈0. 05）,moreover,it was lower than the level of group B at the same period （12. 2 ± 4. 2 vs. 21. 8 ± 4. 0μmol/L;P 〈0. 05 ）. The FMD level of group A was significantly higher than that of prior treatment and group B （11. 2 ± 3. 6 vs. 9. 2 ± 3. 3,9. 3 ± 3. 3;P〈0. 05）. The NO and NOS levels of group A at 24 weeks after treatment were significantly higher than those of prior treatment and group B at the same period （76. 2 ± 9. 4 vs. 49. 2 ± 9. 0,50. 0 ± 9. 1μmol/L,47. 6 ± 9. 5 vs.38. 4 ± 7. 5,37. 8 ± 8. 8 kU/L;P〈0.05）. The ET level of group A was decreased as compared with that of prior treatment and group B at the same period （81. 3 ± 20. 5 vs. 105. 6 ± 25. 2,105. 3 ± 21. 8 ng/L;P〈0.05）.No adverse reaction was found du

关 键 词：脑梗死 老年 叶酸 同型半胱氨酸 血管内皮功能 

分 类 号：R743.3[医药卫生—神经病学与精神病学]