CAJ | 학술논문

目的：探讨叶酸联合B族维生素降低血清同型半胱氨酸（Hcy）及改善心脏结构的最适剂量。方法：将本院血液透析中心120例血液透析（HD）患者作为研究对象，分为4组，每组30例，A组（叶酸片0 mg/d+维生素B6片60 mg/d+维生素B12片0.5 mg/d），B组（叶酸片5 mg/d+维生素B6片60 mg/d+维生素B12片0.5 mg/d），C组（叶酸片15 mg/d+维生素B6片60 mg/d+维生素B12片0.5 mg/d），D组（叶酸片30 mg/d+维生素B6片60 mg/d+维生素B12片0.5 mg/d）。采集第1次HD前、后血样、实验半年时HD前血样及实验结束时患者最后一次HD前血样进行Hcy检测。同时在第1次HD、治疗半年及结束时检测血浆叶酸、维生素B12、血胆固醇、高密度脂蛋白、低密度脂蛋白、甘油三脂、颈动脉B超、心超，以上指标均在HD前进行。观察时间为1年。选取30名健康体检者作为对照组，在实验开始时测定一次Hcy浓度。结果：HD患者Hcy明显高于健康对照组。HD患者服用叶酸联合B族维生素后血浆叶酸水平升高显著，Hcy浓度下降，尤其是B组和C组。D组服用叶酸剂量虽增加但叶酸水平未见相应增加，反而有下降趋势，且Hcy亦未进一步下降。同时发现血浆叶酸浓度与Hcy呈非线性负相关。左心室舒张末期内径（LVDd）、左心室重量指数（LVMI）在服用叶酸组有下降，尤其是B组和C组，D组未见进一步下降。结论：服用叶酸剂量在5～15 mg/d之间可最有效改善心脏结构，降低Hcy，因此可作为叶酸服用的最适剂量。
목적：탐토협산연합B족유생소강저혈청동형반광안산（Hcy）급개선심장결구적최괄제량。방법：장본원혈액투석중심120례혈액투석（HD）환자작위연구대상，분위4조，매조30례，A조（협산편0 mg/d+유생소B6편60 mg/d+유생소B12편0.5 mg/d），B조（협산편5 mg/d+유생소B6편60 mg/d+유생소B12편0.5 mg/d），C조（협산편15 mg/d+유생소B6편60 mg/d+유생소B12편0.5 mg/d），D조（협산편30 mg/d+유생소B6편60 mg/d+유생소B12편0.5 mg/d）。채집제1차HD전、후혈양、실험반년시HD전혈양급실험결속시환자최후일차HD전혈양진행Hcy검측。동시재제1차HD、치료반년급결속시검측혈장협산、유생소B12、혈담고순、고밀도지단백、저밀도지단백、감유삼지、경동맥B초、심초，이상지표균재HD전진행。관찰시간위1년。선취30명건강체검자작위대조조，재실험개시시측정일차Hcy농도。결과：HD환자Hcy명현고우건강대조조。HD환자복용협산연합B족유생소후혈장협산수평승고현저，Hcy농도하강，우기시B조화C조。D조복용협산제량수증가단협산수평미견상응증가，반이유하강추세，차Hcy역미진일보하강。동시발현혈장협산농도여Hcy정비선성부상관。좌심실서장말기내경（LVDd）、좌심실중량지수（LVMI）재복용협산조유하강，우기시B조화C조，D조미견진일보하강。결론：복용협산제량재5～15 mg/d지간가최유효개선심장결구，강저Hcy，인차가작위협산복용적최괄제량。
Objective: To study the the optimum dose of folic acid combined vitamin B to reduce the serum Hcy and improve cardiac structure.Methods: One hundred and twenty HD patients in our hemodialysis center were divided into 4 groups (each 30 patients). Group A (folic acid 0 mg/d+vitamin B6 60 mg/d+vitamin B12 0.5 mg/d), Group B (folic acid 5 mg/d+vitamin B6 60 mg/d+vitamin B12 0.5 mg/d), Group C (folic acid 15 mg/d+vitamin B6 60 mg/d+vitamin B12 0.5 mg/d), Group D (folic acid 30 mg/d+vitamin B6 60 mg/d+vitamin B12 0.5 mg/d). To tset Hcy before and after the ifrst HD, at the middle and the end of the experiment in HD patients. The plasma folate concentration, vitamin B12, blood cholesterol, high-density lipoprotein cholesterol, low density lipoprotein cholesterol, triglycerides, carotid ultrasound, cardiac ultrasound, were tested before hemodialysis at the begin, middle and end of the experiment. The study time was one year. Thirty healthy physical examinations were selected as the control group.Results: Hcy in HD patients was signiifcantly higher than that of controls. After taking folic acid combined B vitamins in HD patients, plasma folate concentration signiifcantly rised, and the Hcy concentration decreased, especially in group B and group C. Folic acid dosage was increased in group D but plasma folate concentration did not rise, and Hcy also did not decline further. The plasma folate concentra-tion was negatively related to the Hcy. Left ventricular end-diastolic diameterand and left ventricular mass index declined in groups of taking folic acid, especially in group B and group C, but did not decline further in group D. Conclusion: Taking folic acid dosage between 5-15 mg/d can be most effectively improved cardiac structure, reduced Hcy, therefore it can be used as taking the optimal dose of folic acid.