伴有同型半胱氨酸增高的老年癫痫患者维生素B补充治疗的临床价值  

Clinical value of vitamin B supplementation in senile epilepsy with hyperhomocysteinemia

作　　者：邹蓉[1] 赵合庆[1] 徐兴顺[1] 

机构地区：[1]苏州大学附属第二医院神经内科,215007

出　　处：《中华神经科杂志》2017年第4期250-254,共5页Chinese Journal of Neurology

基　　金：苏州市科技发展计划（应用基础）项目（SYS201549）

摘　　要：目的探讨维生素B补充治疗高同型半胱氨酸血症（HHcy）对老年癫痫患者血清同型半胱氨酸（Hcy）水平、癫痫发作频率以及抑郁症状、认知功能评分的影响。方法共纳入2013年1月至2015年7月就诊于苏州大学附属第二医院诊断明确的符合入组标准的合并有HHcy的老年癫痫患者132例。接受维生素B治疗（方案为叶酸2.5 mg/d，维生素B6 10.0 mg/d，维生素B12 1.5 mg/d）者83例，设为治疗组；未接受维生素B治疗者49例，设为对照组。随访1年，监测血清Hcy、叶酸、维生素B12水平以及癫痫发作频率、MMSE和汉密尔顿抑郁量表（HDMA）评分等指标。根据Hcy浓度及是否接受叶酸和维生素B补充治疗，分为轻度HHcy组（Hcy 15.0～29.9 μmol/L）75例（其中治疗组46例，对照组29例）和中重度HHcy组（Hcy ≥30.0 μmol/L）57例（其中治疗组37例，对照组20例）。分析Hcy的影响因素，比较各治疗组与对照组血清Hcy、叶酸、维生素B12水平以及癫痫发作频率、MMSE和HDMA评分的差异。结果相关分析显示Hcy与年龄呈正相关（r＝0.269，P＝0.002），与叶酸水平呈负相关（r＝－0.222，P＝0.010），与吸烟（χ2＝7.363，P＝0.007）、高血压（χ2＝6.187，P＝0.013）、2种及以上抗癫痫药物联合治疗（χ2＝4.708，P＝0.030）有关。中重度HHcy组中治疗组与对照组比较，Hcy明显降低[（15.68±4.85）、（31.14±11.18） μmol/L，t＝5.890，P〈0.01]，叶酸[（9.08±3.33）、（5.87±2.91） ng/ml，t＝3.618，P＝0.001]及维生素B12[（556.39±276.76）、（419.71±164.53） pg/ml，t＝2.336，P＝0.023]、维生素B6[（22.94±5.59）、（21.09±4.87）μmol/L，t＝2.029，P＝0.047]明显增高，癫痫发作频率明显减少[（4.85±2.78）、（6.15±1.95）次/年，t＝2.028，P＝0.047]，MMSE评分明显增高[（26.89±1.94）、（25.75±2.20）分，t＝2.024，P＝0.048]，HDMA评分明显降低[（15.22±7.55）、（17.70±4.90）分�ObjectiveTo investigate the influence of vitamin B supplementation on the plasma total homocysteine （Hcy）, serum folate, serum vitamin B12, serum vitamin B6, and clinical state of senile epilepsy.MethodsA total of 132 senile epilepsy patients with hyperhomocysteinemia, who visited the Second Affiliated Hospital of Soochow University from January 2013 to July 2015, were enrolled into this study. Eighty-three patients who accepted the therapy of vitamin B supplementation （folate 2.5 mg/d, vitamin B6 10.0 mg/d, vitamin B12 1.5 mg/d） were selected as treatment group, and 49 patients with no vitamin B supplementation were selected as control group. All patients were followed-up for one year. The differences of serum Hcy, folate, vitamin B12, vitamin B6 and seizure frequency, MMSE scores, Hamilton Depression Rating Scale （HDMA） scores between the treatment and the control groups were compared. According to the concentration of serum Hcy, 132 patients were divided into two groups： 75 patients （46 patients in the treatment group and 29 patients in the control group） with mild hyperhomocysteinemia （Hcy： 15.0-29.9 μmol/L）, 57 patients （37 patients in the treatment group and 20 patients in the control group） with moderate-severe hyperhomocysteinemia （Hcy≥30.0 μmol/L）. The differences of serum Hcy, folate, vitamin B12, vitamin B6 and seizure frequency, MMSE scores, HDMA scores between the treatment and the control group in the mild hyperhomocysteinemia group and in the moderate-severe hyperhomocysteinemia group were compared. And the influence factors of Hcy were analyzed.ResultsCorrelation analysis revealed that Hcy was positively correlated with age （r=0.269, P=0.002）, and negatively correlated with folate （r=-0.222, P=0.010）. Hcy was associated with smoking （χ2=7.363, P=0.007）, hypertension （χ2=6.187, P=0.013）, and two or more antiepileptic drugs polytherapy （χ2=4.708, P=0.030）. After vitamin B supplementation in the group of moderate-severe hyperhomocysteinemia,

关 键 词：癫痫 半胱氨酸 叶酸 维生素B6 维生素B12 

分 类 号：R742.1[医药卫生—神经病学与精神病学]