冠心病心力衰竭伴高同型半胱氨酸血症患者叶酸和B族维生素治疗的临床价值研究  

The clinical signficance of application of folic acid and vitamin B group in patients with coronary heart disease and heart failure associated with homocystinemia

作　　者：蒋庆渊[1] 陆铭[1] 李锦玉[1] 李志强[1] 刘春兰[1] 刘莹莹[1] 

机构地区：[1]上海市浦东医院复旦大学附属浦东医院心内科,上海201399

出　　处：《临床和实验医学杂志》2017年第11期1096-1099,共4页Journal of Clinical and Experimental Medicine

摘　　要：目的探讨冠心病心力衰竭伴高同型半胱氨酸患者中叶酸和B族维生素(Vit B)治疗的临床价值。方法将100例冠心病心力衰竭伴高同型半胱氨酸患者纳入研究,使用双盲法分为对照组(给予β受体阻滞剂、利尿剂、血管紧张素II受体拮抗剂或血管紧张素转换酶抑制剂治疗)和观察组(在对照组基础上加用Vit B6和Vit B12以及叶酸)。以治疗前、治疗4周和8周为观察时间点,检测同型半胱氨酸(HCY)和N末端脑钠肽(NT-pro BNP)水平,行心脏彩超检查。记录两组治疗期间不良反应。结果治疗后4周、8周观察组HCY水平均低于治疗前,且低于对照组,差异均有显著性(P<0.05);治疗4周时对照组HCY与治疗前无显著变化(P>0.05)。治疗4周、8周时观察组HCY显著下降,治疗8周时显著低于对照组,差异均有显著性(P<0.05)。治疗8周时观察组E/A值明显高于治疗前,且高于同期对照组,差异均有显著性(P<0.05)。两组均未发生明显不良反应。结论叶酸和B族维生素用于冠心病心力衰竭伴高同型半胱氨酸患者中具有以下作用:(1)改善患者的NT-pro BNP及HCY水平;(2)改善患者心脏舒缩功能;(3)疗效较常规用药显著且无明显副作用。Objective To evaluate the signtficance of application of folic acid and vitamin B （Vit B） group in patients with heart failure associated with homocysteinemia. Methods A total of 100 patients with coronary heart disease and heart failure associated with homocysteinemia were included in this study. They were divided into control group （treated with p - blocker, diuretics and ARB or ACEI） and observation group （applied with Vit B6 , Vit B12 and folic acid on the basis of treatment in control group）. The detection of levels of homocysteine （ HCY） and nitrogen terminal brain natriuretic peptide （NT-proBNP） and examination of Doppler ultrasonic cardiography were carried out before treatment and in 4 to 8 weeks after treatment. Adverse events in patients of these 2 groups were recorded during the course of treatment. Results The levels of homocysteine in patients of observation group were lower than those of patients in control group in 4 weeks and 8 weeks after treatment, and all of them were lower than those of control group （P 〈 0. 05）. Levels of homocysteine in patients of observation group were significantly decreased in 4 weeks and 8 weeks after treatment, and they were significantly lower than those of control group in 8 weeks after treatment （ P〈0.05） . The E/A value of patients in observation group after treatment for 8 weeks was obviously higher than that before treatment, in comparison with that of control group, the difference was significant （ P 〈 0. 0 5） . There was no significant adverse events occurred in patients of both groups. Conclusion The application of folic acid, vitamin B6 and vitamin B12 in patients with coronary heart disease and heart failure associated with homocysteinemia has following effects ： ① increase in levels of NT - proBNP and homocysteine; ② improvement of systolic and diastolic heart function in these patients; ③its efficacy is more signficant than that of conventional medication, without obvious side effect, hence it is worthy to be

关 键 词：冠心病心力衰竭 高同型半胱氨酸 叶酸 B族维生素 心脏功能 

分 类 号：R541[医药卫生—心血管疾病]