CAJ | 학술논문

目的了解正常人颈动脉硬化患者及脑梗死患者血清同型半胱氨酸 (serum total nomocysteine,tHcy)水平及给予叶酸和维生素 B12治疗后血 tHcy含量的变化.方法脑梗死组 80例,男 71例,女 9例,年龄 63～ 80岁,平均 74岁,符合脑梗死的诊断标准,均在发病后 2周内测定 tHcy含量;颈动脉硬化组 80例,男 71例,女 9例,年龄 62～ 79岁,平均 72岁.双侧颈动脉 B超检查均存在颈动脉硬化及 (或 )粥样斑块.以上两组均除外甲状腺功能减退及肾功能减退.入选者在测定血清叶酸、维生素 B12、肌酐、血糖、血脂水平及血压和体重指数后,各组均随机分为两组,即干预治疗组及非干预治疗组,每组 40例.干预治疗组患者给予叶酸 1.25 mg,隔日 1次,维生素 B12 8 μ g, 1次 /d,口服 10个月后复查上述各项指标.结果治疗前 3组血 tHcy水平各不相同,脑梗死组为 (16± 5) μ mol/L,颈动脉硬化组为 (14± 5) μ mol/L,正常老年人组为 (12± 3) μ mol/L, 3组比较差异有显著意义.血 tHcy含量增高,叶酸水平越低.相关分析发现,血 tHcy水平与叶酸、维生素 B12呈负相关.干预治疗后,治疗组患者的血 tHcy含量均有所下降.结论不同程度的脑缺血性疾病与血 tHcy水平有一定的关系,补充营养元素有助于降低血 tHcy水平,以减少高 tHcy对血管的素性作用.
목적료해정상인경동맥경화환자급뇌경사환자혈청동형반광안산 (serum total nomocysteine,tHcy)수평급급여협산화유생소 B12치료후혈 tHcy함량적변화.방법뇌경사조 80례,남 71례,녀 9례,년령 63～ 80세,평균 74세,부합뇌경사적진단표준,균재발병후 2주내측정 tHcy함량;경동맥경화조 80례,남 71례,녀 9례,년령 62～ 79세,평균 72세.쌍측경동맥 B초검사균존재경동맥경화급 (혹 )죽양반괴.이상량조균제외갑상선공능감퇴급신공능감퇴.입선자재측정혈청협산、유생소 B12、기항、혈당、혈지수평급혈압화체중지수후,각조균수궤분위량조,즉간예치료조급비간예치료조,매조 40례.간예치료조환자급여협산 1.25 mg,격일 1차,유생소 B12 8 μ g, 1차 /d,구복 10개월후복사상술각항지표.결과치료전 3조혈 tHcy수평각불상동,뇌경사조위 (16± 5) μ mol/L,경동맥경화조위 (14± 5) μ mol/L,정상노년인조위 (12± 3) μ mol/L, 3조비교차이유현저의의.혈 tHcy함량증고,협산수평월저.상관분석발현,혈 tHcy수평여협산、유생소 B12정부상관.간예치료후,치료조환자적혈 tHcy함량균유소하강.결론불동정도적뇌결혈성질병여혈 tHcy수평유일정적관계,보충영양원소유조우강저혈 tHcy수평,이감소고 tHcy대혈관적소성작용.
Aim To investigate total homocysteine(tHcy) concentration in ischemic stroke patients and in carotid atherosclerosis patients in comparison with normal control elders and to evaluate whether providing foliate and vitamin B12 could decrease serum homocysteine concentration.Methods The sample in this study was obtained from the inpatients and outpatients of geriatric department, HuaShan hospital.160 patients were recruited and were divided into two groups with smoking controlled.Thyroid gland abnormality and renal failure were excluded.One group consisted of 71 male and 9 female ischemic stroke patients aged 73 years on average.There were 71 males,9 females carotid atherosclerosis disease patients,aged 72 years on average in the second group.Hypertension and mellitus diabetes were controlled to avoid the influence of the conditions on these patients.The third group consisted of 72 males and 8 females normal control elders,aged 71 years on average.Besides fast serum total homocysteine,every patient took laboratory and physical examinations,including plasma folate, vitamin B12,free plasma glucose,creatinine,cholesterol,triglyceride,blood pressure and blood mass index.Each group was randomly divided further into two subgroups in which one subgroup was provided with folic acid 1.25 mg once every other day and vitamin B12 8 μ g once per day while the other was not.These patients were reexamined after 10 months.Results The serum tHcy concentration was (16± 5) μ mol/L in ischemic stroke group and (14± 5) μ mol/L in carotid atherosclerosis group compared with (12± 3) μ mol/L in normal control elders(P=0.0001).The plasma folate level was lower in ischemic stroke and carotid atherosclerosis patients,and there were no significant differences in other laboratory examination results.Correlation analysis showed that tHcy was negatively correlated with folate and vitamin B12 level,r=- 0.392, - 0.36 respectively in ischemic stroke group, r=- 0.287, - 0.339 respectively in carotid atherosclerosis group, and r=- 0.338, - 0.227 in normal control group.The tHcy concentration was lower in the groups provided with folate and vitamin B12 than that in the groups without folate and vitamin B12 (P=0.0001),even in the normal elders.Conclusion The tHcy concentration is higher in the patients with ischemic stroke and carotid atherosclerosis.Folate supplement could moderately lower serum tHcy level.