叶酸、维生素B_(12)对高血压合并急性脑梗死病人血管内皮功能及同型半胱氨酸水平的变化研究  

The Influence of Folic Acid and Vitamin B_(12) on Vascular Endothelial Function and Homocysteine Levels in Patients with Essential Hypertension Complicated with Acute Cerebral Infarction

作　　者：黎铮[1] 李国辉[1] 陈绚[1] 李春明[1] 梁丽芸[1] 黄宇[1] 韦维[1] 赵海林[1] 王晓婷[1] Li Zheng;Li Guohui;Chen Xuan;Li Chunming;Liang Liyun;Huang Yu;Wei Wei;Zhao Hailin;Wang Xiaoting(Wuzhou Red Cross Hospital ,Wuzhou 543002,Guangxi,China)

机构地区：[1]梧州市红十字会医院,广西梧州543002

出　　处：《中西医结合心脑血管病杂志》2018年第23期3520-3523,共4页Chinese Journal of Integrative Medicine on Cardio-Cerebrovascular Disease

基　　金：2015年梧州市科学研究与技术开发计划项目(No.201502037)

摘　　要：目的探讨高血压合并急性脑梗死病人应用叶酸、维生素B_(12)治疗后血管内皮功能及同型半胱氨酸水平的变化。方法选取我院2015年4月—2016年8月治疗的80例高血压合并急性脑梗死病人。按随机数字表分配法分为两组,联合治疗组40例在常规脑梗死治疗基础上,加用叶酸、维生素B_(12)治疗;常规组40例采用营养脑神经,控制基础血压,降低颅内压力,改善脑血管循环的常规治疗方式。选取同期在我院体检的40名健康人作为健康对照组。检测各组病人在治疗前后的血管内皮功能、同型半胱氨酸、颈动脉内-中膜厚度、一氧化氮(NO)及内皮型NO合成酶(eNOS)等临床指标的变化,并与健康对照组对比。观察对比治疗后高血压合并急性脑梗死病人美国国立卫生研究院卒中量表(NIHSS)评分、Barthel指数(Bl)评分的变化。结果两组高血压合并脑梗死病人的血清同型半胱氨酸随治疗时间的延长显著下降,NO及内皮型NO合成酶水平随治疗时间的延长显著升高,差异有统计学意义(P<0.05)。两组病人血管内皮功能在治疗后2周与6个月时相比,差异无统计学意义(P>0.05)。两组高血压合并脑梗死病人在治疗前NIHSS评分及BI评分对比,差异无统计学意义(P>0.05)。治疗后2周及6个月,联合治疗组NIHSS评分及BI评分均随时间延长显著升高,与常规组对比差异有统计学意义(P <0.05)。结论高血压合并急性脑梗死病人发病后同型半胱氨酸水平显著升高,颈动脉内-中膜厚度、一氧化氮及内皮型NO合成酶含量降低,血流黏稠度增加,红细胞沉降率增加,采用叶酸、维生素B_(12)治疗后可显著降低同型半胱氨酸水平,改善病人血管内皮功能。Objective To investigate the changes of vascular endothelial function and homocysteine levels in patients with essential hypertension and acute cerebral infarction treated with folic acid and vitamin B12.Methods Eighty hypertensive patients with acute cerebral infarction in our hospital from April 2015 to August 2016 were randomly divided into two groups:conventional group(n=40) treated with routine treatment,and treatment group(n=40) treated with folic acid and vitamin B12in the basis of routine treatment.Forty healthy individuals were as control group.The changes of vascular endothelial function,homocysteine,carotid intima-media thickness (IMT),nitric oxide (NO) and endothelial NO synthase were detected before and after treatment in each group,and compared with healthy controls.Stroke Scale(NIHSS) and Barthel index (BI) scores were compared in patients with hypertension and acute cerebral infarction after treatment.Results Serum homocysteine level decreased significantly while the levels of NO and endothelial NO synthase increased significantly with the prolongation of treatment time in two groups with hypertension and acute cerebral infarction (P<0.05).There was no significant difference in vascular endothelial function between the two groups after 2 weeks and6months of treatment(P>0.05).There was no significant difference in the scores of NIHSS and BI between the two groups of patients with hypertension and cerebral infarction(P>0.05).After 2 weeks and 6 months of treatment,the scores of NIHSS and BI in treatment group increased significantly with time,which were higher than that in conventional group(P<0.05).Conclusion The level of homocysteine increased significantly,carotid intima-media thickness,nitric oxide and endothelial NO synthase content decreased,blood flow viscosity increased,and erythrocyte sedimentation rate increased in patients with hypertension complicated with acute cerebral infarction.After treatment with folic acid and vitamin B12,it can significantly reduce the level of homocysteine and i

关 键 词：高血压 急性脑梗死 叶酸 维生素B12 血管内皮 同型半胱氨酸 

分 类 号：R544.1[医药卫生—心血管疾病] R255.3[医药卫生—内科学]