叶酸联合维生素B_6对老年H型高血压患者内皮功能及预后的影响
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摘要
目的观察叶酸联合维生素B6治疗老年H型高血压患者的疗效及对内皮功能和预后的影响。方法选择2012年10月—2013年3月本院接诊的135例符合入组标准的H型老年高血压患者作为研究对象,按随机数字表分为观察组67例和对照组68例,对照组患者给予降压、降脂等基础药物及强调生活方式的改变,观察组患者在对照组的基础上再给予叶酸联合维生素B6治疗,两组均观察12周,治疗前后进行血浆Hcy、NO和内皮素水平检测,采用动脉硬化检测仪测定肱踝脉搏波传导速度(ba PWV),所有患者均随访12个月,记录主要心血管事件发生情况(非致死性心肌梗塞、脑梗塞及心血管疾病死亡)。结果观察组治疗后血浆Hcy、内皮素和ba PWV水平均较治疗前明显降低,P均<0.05,NO较治疗前明显升高,P<0.05,观察组治疗后Hcy、内皮素和ba PWV水平明显低于对照组,P<0.05,NO明显高于对照组。对照组上述指标治疗前后无明显改善,P均>0.05。对照组发生脑卒中10例,心肌梗塞2例,心血管病死亡2例,心血管事件发生率为17.65%,观察组发生脑卒中3例,心肌梗塞1例,心血管事件发生率为5.97%,差异具有统计学意义,χ2=4.405,P<0.05。结论叶酸联合维生素B6干预可明显降低H型老年高血压患者的Hcy水平,改善血管内皮功能,预防或减轻动脉粥样硬化程度,降低心血管病的发生率,值得在临床推广。
OBJECTIVE To observe the effect of Folic acid and vitamin B6 on endothelial function and prognosis in the treatment ofpatients with hyperhomocysteinima-related hypertention. METHODS 135 patients with hyperhomocysteinima-related hypertention metthe inclusion criteria were included research subjects from October 2012- March 2013 in our hospital, all patients were randomly di-vided into 67 cases of observation group and 67 cases of the control group, the control group were treated with antihypertensivedrugs, lipid-lowering drugs and Lifestyle changes. The observation group were given Folic acid and vitamin B6 on the basis of thecontrol group,both groups were observed for 12 weeks, the plasma Hcy, NO, endothelin levels were detected before and after treat-ment, brachial-ankle pulse wave velocity(ba PWV) were measured by Arteriosclerosis detector, all patients had been followed up for12 months, the occurrence of major cardiovascular events(nonfatal myocardial infarction, cerebral infarction and cardiovascular death)were recorded. RESULT The plasma Hcy, endothelin, ba PWV of observation group after treatment were significantly lower than be-fore treatment, P <0.05, NO was significantly higher than before treatment, P <0.05, the plasma Hcy, endothelin, ba PWV of the obser-vation group after treatment were significantly lower than the control group, P <0.05, NO was significantly higher than the controlgroup,the The above-mentioned index of the control group had no significant improvement, P > 0.05. There were 10 cases of stroke,Two cases of myocardial infarction,two cases of cardiovascular death, the rate of cardiovascular events was 17.65%, in the observa-tion group,three were 3 cases of stroke, one cases of myocardial infarction,the rate of cardiovascular events was 5.97 %, the differ-ence was statistically significant, χ2= 4.405, P<0.05. CONCLUSION Folic acid and vitamin B6 could significantly reduce Hcy levelsin patients with hyperhomocysteinima-related hypertention, improve endothelial function and prevent or mitigate mitigate the extent ofatherosclerosis and reduce the incidence of cardiovascular events, worthy of promotion.
OBJECTIVE To observe the effect of Folic acid and vitamin B6 on endothelial function and prognosis in the treatment ofpatients with hyperhomocysteinima-related hypertention. METHODS 135 patients with hyperhomocysteinima-related hypertention metthe inclusion criteria were included research subjects from October 2012- March 2013 in our hospital, all patients were randomly di-vided into 67 cases of observation group and 67 cases of the control group, the control group were treated with antihypertensivedrugs, lipid-lowering drugs and Lifestyle changes. The observation group were given Folic acid and vitamin B6 on the basis of thecontrol group,both groups were observed for 12 weeks, the plasma Hcy, NO, endothelin levels were detected before and after treat-ment, brachial-ankle pulse wave velocity(ba PWV) were measured by Arteriosclerosis detector, all patients had been followed up for12 months, the occurrence of major cardiovascular events(nonfatal myocardial infarction, cerebral infarction and cardiovascular death)were recorded. RESULT The plasma Hcy, endothelin, ba PWV of observation group after treatment were significantly lower than be-fore treatment, P <0.05, NO was significantly higher than before treatment, P <0.05, the plasma Hcy, endothelin, ba PWV of the obser-vation group after treatment were significantly lower than the control group, P <0.05, NO was significantly higher than the controlgroup,the The above-mentioned index of the control group had no significant improvement, P > 0.05. There were 10 cases of stroke,Two cases of myocardial infarction,two cases of cardiovascular death, the rate of cardiovascular events was 17.65%, in the observa-tion group,three were 3 cases of stroke, one cases of myocardial infarction,the rate of cardiovascular events was 5.97 %, the differ-ence was statistically significant, χ2= 4.405, P<0.05. CONCLUSION Folic acid and vitamin B6 could significantly reduce Hcy levelsin patients with hyperhomocysteinima-related hypertention, improve endothelial function and prevent or mitigate mitigate the extent ofatherosclerosis and reduce the incidence of cardiovascular events, worthy of promotion.
引文
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[9]Yamashina A,Tomiyama H.Arteriosclerosis and pulse wave ve-locity[J].Nihon Rinsho,2004,62(1):80-86.
[10]张军齐,晓勇,李英肖,等.叶酸、维生素B2对老年高血压伴高同型半胱氨酸血症患者血清同型半胱氨酸、一氧化氮、血压水平的影响[J].中国老年学,2008,28(1):39-41.
[11]王东霞,吴俊.叶酸对老年H型高血压患者同型半胱氨酸水平和动脉粥样硬化的影响[J].中华老年心脑血管病杂志,2014,16(2):205-206.
[2]Biasioli S,Schiavon R.Homocysteine as a cardiovascular risk fac-tor[J].Blood Pu Iif,2000,18(3):177-82.
[3]陆婷婷,刘莎,谭畅畅,等.血清c Tn T、Hcy、hs-CRP水平与心脑血管事件危险的相关性研究[J].国际检验医学杂志,2013,34(10):1203-1205.
[4]张明玺,罗俊.H型高血压的病因及发病机制[J].心血管病学进展,2012(33):253-256.
[5]Khandanpour N,Loke YK,Meyer FJ,et al.Homocysteine and pe-ripheral arterial disease:systematic review and meta-analysis[J].Eur J Vasc Endovasc Surg,2009(38):316-322.
[6]尤雪梅,刘蔚玲,狄海.叶酸、维生素B6治疗高同型半胱氨酸血症的疗效观察[J].中国医院用药评价与分析,2012,12(11):1018-1019.
[7]王拥军,刘力生,饶克勤,等.我国脑卒中预防策略思考:同时控制高血压和高同型半胱氨酸水平[J].中华医学杂志,2008(88):3316-3318.
[8]程丝,冯娟,王宪.高同型半胱氨酸血症治疗研究进展[J].生理科学进展,2011(42):329-334.
[9]Yamashina A,Tomiyama H.Arteriosclerosis and pulse wave ve-locity[J].Nihon Rinsho,2004,62(1):80-86.
[10]张军齐,晓勇,李英肖,等.叶酸、维生素B2对老年高血压伴高同型半胱氨酸血症患者血清同型半胱氨酸、一氧化氮、血压水平的影响[J].中国老年学,2008,28(1):39-41.
[11]王东霞,吴俊.叶酸对老年H型高血压患者同型半胱氨酸水平和动脉粥样硬化的影响[J].中华老年心脑血管病杂志,2014,16(2):205-206.