天津医药

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B 族维生素对高同型半胱氨酸血症脑梗死患者神经功能的影响

朱炬1,张哲成1,张静1,王素红2,王渝2   

  1. 1. 天津市第三中心医院神经内科
    2. 天津市第三中心医院
  • 收稿日期:2013-01-31 修回日期:2013-05-22 出版日期:2013-08-15 发布日期:2013-08-15
  • 通讯作者: 朱炬

Effect of B-Vitamin Therapy on Neurological Dysfunction of Brain Infarction in Patients with Hyperhomocysteinemia

ZHUJu 1,ZHANG ZHECHENG 1,ZHANG JING 1,WangSu-Hong 1,WangYu 2   

  1. 1. Department of Neurology, Tianjin Third Central Hospital, Tianjin 300170, China
    2. Department of Neurology, Tianjin Third Central Hospital, Tianjin300170, China
  • Received:2013-01-31 Revised:2013-05-22 Published:2013-08-15 Online:2013-08-15
  • Contact: ZHUJu

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摘要： 目的 评价应用复合B族维生素对高同型半胱氨酸血症（Hhcy）脑梗死患者神经功能预后的影响。方法  将1 000例Hhcy脑梗死患者分为干预组与对照组，各500例。干预组在常规二级预防基础上加用复合B族维生素，对照组仅行常规治疗，随访2年。以美国国立卫生研究院卒中量表（NIHSS）评分评价神经功能缺损程度，Barthel Index （BI评分）评价日常生活行为能力。采用高效液相荧光检测法检测血浆tHcy水平。随访24个月时干预组中tHcy下降明显（较入组时下降≥3 μmol/L）者为干预亚组。结果 干预组tHcy明显降低，除入组时2组差异无统计学意义（P>0.05）外，随访3、12、24个月时干预组均低于对照组。随访12、18和24个月时干预组NIHSS评分均低于对照组（P<0.05），其余时点2组间差异无统计学意义（P>0.05）。不同时点2组BI评分差异无统计学意义（P>0.05）。干预亚组NIHSS评分低于对照组，BI评分高于对照组。结论 复合B族维生素干预降低tHcy可能有利于脑梗死1~2年后神经功能缺损的改善，血浆tHcy水平下降明显者可能获益更多。

关键词: 维生素B, 复合, 高同种半胱氨酸血症, 脑梗死, 预后, 总同型半胱氨酸, 神经功能缺损, NIHSS 评分

Abstract: Objective   To investigate whether Vitamin B complex supplements would reduce stroke-related disability in hyperhomocysteinemia patients with recent ischemic stroke. Methods   1000 brain infarction patients with hyperhomocysteinemia were assigned to receive either a daily dose of Vitamin B complex (Treatment group, n=500) or not (Control group, n=500) on the base of conventional secondary prevention medications for a period of 2 years. Neurological dysfunction was assessed by National Institutes of Health Stroke Scale (NIHSS) and stroke disability was evaluated by Barthel Index (BI) score. High performance liquid chromatographic method with fluorescence detection was used for the determination of total plasma homocysteine levels. After 2 years of follow-up, the patients in the treatment group, whose tHcy level was reduced by 3-μmol/L or more, was defined as the treatment subgroup. Results  Homocysteine levels were significantly reduced in the treatment group. A lower NIHSS Scale was obtained at 12m, 18m, 24m in the treatment group compared to that in the control group (P<0.05), there were no statistical significance difference in the two groups at other time points (P>0.05). For the BI score, there were no statistical significance difference in the two groups at any time points (P>0.05). After 2 years of Vitamin B complex supplementation, the treatment subgroup was associated with a lower NIHSS Scale and higher BI Scale compared to that in the control group (P<0.05). Conclusion   Lowering of homocysteine may have bneficial effects on neurological functional outcome at 1-2 year after stroke onset. Who have significant reduction of homocysteine level, may be most likely to benefit from treatment with B vitamins.

Key words: vitamin B complex, hyperhomocysteinemia, brain infarction, prognosis, total homocysteine, neurological deficit, national institutes of health stroke scale score, NIHSS 评分