CAJ | 학술논문

目的通过比较维持性血液透析(maintenance hemodialysis,MHD)患者叶酸干预治疗前后的同型半胱氨酸(homocysteine,Hcy)及颈动脉动脉内膜-中层厚度(intima-media thickness, IMT)改变情况,旨在探讨叶酸对动脉粥样硬化的保护作用。方法选择 MHD治疗时间超过3个月患者60例,分为对照组和叶酸组,每组各30例。所有患者均进行普通低通量透析器透析,每周3次,每次4 h,常规降压、纠正贫血、纠正酸碱失衡及电解质紊乱等处理,以及口服维生素 B121 mg/d,叶酸组口服叶酸15 mg/d,疗程为6个月,所有患者进入观察前及干预治疗半年后于透析前10 min,抽取空腹血10ml,比较治疗前后2组间Hcy值,并超声测量IMT的变化。结果①治疗半年后叶酸组 Hcy水平下降(P<0.01),对照组治疗前后 Hcy 水平变化不明显(P>0.7)；且2组治疗半年后Hcy比较。②叶酸组治疗半年后颈动脉IMT值差异不明显(P>0.05),而对照组半年后IMT值明显升高(P<0.05),且半年后2组 IMT值之间比较差异有统计学意义(P<0.05)。结论叶酸组经干预治疗后 Hcy水平明显下降,而颈动脉 IMT值变化不明显；对照组 Hcy变化不明显,而颈动脉 IMT明显升高,提示 Hcy可能参与了动脉粥样硬化的发生和发展。推测叶酸可能通过下调 Hcy水平,起到延缓动脉粥样硬化病情发展的作用。
목적통과비교유지성혈액투석(maintenance hemodialysis,MHD)환자협산간예치료전후적동형반광안산(homocysteine,Hcy)급경동맥동맥내막-중층후도(intima-media thickness, IMT)개변정황,지재탐토협산대동맥죽양경화적보호작용。방법선택 MHD치료시간초과3개월환자60례,분위대조조화협산조,매조각30례。소유환자균진행보통저통량투석기투석,매주3차,매차4 h,상규강압、규정빈혈、규정산감실형급전해질문란등처리,이급구복유생소 B121 mg/d,협산조구복협산15 mg/d,료정위6개월,소유환자진입관찰전급간예치료반년후우투석전10 min,추취공복혈10ml,비교치료전후2조간Hcy치,병초성측량IMT적변화。결과①치료반년후협산조 Hcy수평하강(P<0.01),대조조치료전후 Hcy 수평변화불명현(P>0.7)；차2조치료반년후Hcy비교。②협산조치료반년후경동맥IMT치차이불명현(P>0.05),이대조조반년후IMT치명현승고(P<0.05),차반년후2조 IMT치지간비교차이유통계학의의(P<0.05)。결론협산조경간예치료후 Hcy수평명현하강,이경동맥 IMT치변화불명현；대조조 Hcy변화불명현,이경동맥 IMT명현승고,제시 Hcy가능삼여료동맥죽양경화적발생화발전。추측협산가능통과하조 Hcy수평,기도연완동맥죽양경화병정발전적작용。
Objective Bycomparisinghomocysteine(Hcy)andintima-mediathichness(IMT) in maintenance hemodyalysis (MHD)patients who treated with folic acid,to investigate the protective effectoffolicacidonatherosclerosis.Methods SixtypatientsreceivingMHDmorethan3months were divided into two groups:control group and folic acid group.The folic acid group was orally ad-ministrated folic acid 15 mg every day for six months.Hcy level and carotid IMT change were com-paredbetweentwogroups.Results (1)Hcylevelsinfolicacidgroupwasreducedatsixthmonthaf-ter treatment (P=0.01).There was no significant difference in control group before and after treat-ment (P>0.05).There was significant difference in Hcy levels between two groups after six months (P=0.03).(2)In folic acid group,carotid IMT values showed no obvious difference at 6th month af-ter treatment (P>0.05),and those in control group were significantly increased (P<0.05).There was significant difference in IMT values between two groups after six months (P < 0.05 ). Conclusions Afterfolicacidintervention,theHcylevelsaresignificantlydecreasedandcarotidIMT values have no obvious changes,and in control group,the Hcy levels have no change significantly,but thecarotid IMT values are significantly increased,suggesting that Hcy may contribute to the develop-ment of atherosclerosis.Folic acid has a protective effect of delaying atherosclerotic disease progres-sion by reducing the Hcy levels.