叶酸干预治疗同型半胱氨酸增高型急性脑梗死的临床应用研究
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摘要
目的:探讨叶酸干预在同型半胱氨酸(Hcy)增高型急性脑梗死患者中的临床效果。方法:选择2017年1-12月治疗的Hcy增高型急性脑梗死患者100例作为研究对象,将其按随机数字表法分为对照组(n=50)和观察组(n=50)。对照组给予经典标准方案进行治疗,观察组在对照组基础上联合叶酸干预治疗。比较两组神经缺损、运动功能、炎症因子、Hcy水平、死亡率及再住院率。结果:观察组治疗2个疗程后NIHSS评分低于对照组,而FMA、BI评分均高于对照组(P<0.05);观察组治疗2个疗程后IL-1β、IL-6及IL-17水平均低于对照组(P<0.05);两组入院第3、7、14天Hcy水平均低于入院第1天,且观察组均低于对照组(P<0.05);观察组治疗后6、12个月死亡率及再住院率均低于对照组(P<0.05)。结论:将叶酸干预用于Hcy增高型急性脑梗死患者中能改善患者神经缺损及运动功能,有助于降低炎症因子、Hcy水平,能降低患者死亡率、再住院率,值得推广应用。
Objective:To investigate the clinical effect of Folic acid intervention in patients with acute cerebral infarction with elevated homocysteine(Hcy).Method:A total of 100 patients with Hcy-enhanced acute cerebral infarction treated from January to December 2017 were selected as the research objects.The patients were divided into control group(n=50) and observation group(n=50) by random number table method.The control group was treated with the classic standard regimen.The observation group was treated with Folic acid intervention on the basis of the control group.The neurological deficits,motor function,inflammatory factors,Hcy levels,mortality,and rehospitalization rates were compared between the two groups.Result:The NIHSS score of the observation group was lower than that of the control group after two courses of treatment,while the FMA and BI scores were higher than those of the control group(P<0.05).The levels of IL-1β,IL-6 and IL-17 in the observation group were lower than those in the control group after two courses of treatment(P<0.05).The levels of Hcy on the 3 rd,7 th and 14 th day after admission were lower than the first day of admission,and the level of the observation group was lower than that of the control group(P<0.05).The mortality and rehospitalization rate of the observation group at 6 months and 12 months after treatment were lower than those of the control group(P<0.05).Conclusion:Folic acid intervention in patients with acute cerebral infarction with Hcy can improve neurological deficit and motor function,help reduce inflammatory factors and Hcy levels,and reduce mortality and rehospitalization rate.It is worthy of popularization and application.
Objective:To investigate the clinical effect of Folic acid intervention in patients with acute cerebral infarction with elevated homocysteine(Hcy).Method:A total of 100 patients with Hcy-enhanced acute cerebral infarction treated from January to December 2017 were selected as the research objects.The patients were divided into control group(n=50) and observation group(n=50) by random number table method.The control group was treated with the classic standard regimen.The observation group was treated with Folic acid intervention on the basis of the control group.The neurological deficits,motor function,inflammatory factors,Hcy levels,mortality,and rehospitalization rates were compared between the two groups.Result:The NIHSS score of the observation group was lower than that of the control group after two courses of treatment,while the FMA and BI scores were higher than those of the control group(P<0.05).The levels of IL-1β,IL-6 and IL-17 in the observation group were lower than those in the control group after two courses of treatment(P<0.05).The levels of Hcy on the 3 rd,7 th and 14 th day after admission were lower than the first day of admission,and the level of the observation group was lower than that of the control group(P<0.05).The mortality and rehospitalization rate of the observation group at 6 months and 12 months after treatment were lower than those of the control group(P<0.05).Conclusion:Folic acid intervention in patients with acute cerebral infarction with Hcy can improve neurological deficit and motor function,help reduce inflammatory factors and Hcy levels,and reduce mortality and rehospitalization rate.It is worthy of popularization and application.
引文
[1]刘沙沙,田祥,李放,等.叶酸干预伴高同型半胱氨酸血症的冠心病心力衰竭患者的疗效观察[J].中国循环杂志,2016,31(7):649-653.
[2] Wu W,Guan Y,Xu K,et al.Plasma Homocysteine Levels Predict the Risk of Acute Cerebral Infarction in Patients with Carotid Artery Lesions[J].Molecular Neurobiology,2016,53(4):2510-2517.
[3]瞿国英,陈一可.老年高血压患者血清同型半胱氨酸水平的变化及叶酸治疗的作用[J].中国医院药学杂志,2018,38(5):520-522.
[4]田丹丹,张程达,王连珂,等.亚甲基四氢叶酸还原酶基因及甲硫氨酸合成酶基因多态性与口服叶酸治疗高同型半胱氨酸血症疗效的关系研究[J].中国全科医学,2016,19(12):1396-1400.
[5]殷文明,姚义琴,邹荣成.同型半胱氨酸测定在急性脑梗塞合并颈动脉病变的临床应用价值分析[J].中国临床解剖学杂志,2017,35(6):695-699.
[6]杨莉萍,蔡木发.心血管疾病患者联合检测同型半胱氨酸及叶酸的临床意义[J].广东医学,2017,38(15):2361-2362.
[7] Fan H,Yang S,Li Y,et al.Assessment of Homocysteine as a Diagnostic and Early Prognostic Biomarker for Patients with Acute Lacunar Infarction[J].European Neurology,2017,79(1-2):54-62.
[8]李莹鸿,靳利利,黄培红,等.复方芪麻胶囊干预治疗对H型高血压患者同型半胱氨酸、瘦素水平的影响[J].中国中西医结合杂志,2017,37(6):676-679.
[9]薛焱,刘海润,杨子聪,等.血浆同型半胱氨酸与急性心肌梗死患者预后的相关性研究[J].重庆医学,2017,46(31):28-30,33.
[10]王雁,任爱华,翁秀妹,等.运动干预对实验性高同型半胱氨酸血症大鼠过氧化及血管内皮功能的影响[J].中国康复医学杂志,2016,31(11):1208-1212.
[11] Zhong C,Xu T,Xu T,et al.Plasma Homocysteine and Prognosis of Acute Ischemic Stroke:a Gender-Specific Analysis From CATIS Randomized Clinical Trial[J].Molecular Neurobiology,2016,54(3):1-9.
[12]岳伟,吴昊,石志鸿,等.血浆同型半胱氨酸水平与急性缺血性脑卒中患者的卒中复发及死亡关系的研究[J].中华神经医学杂志,2016,15(7):654-659.
[13]李莉.NT-proBNP联合血清HCY检测在心力衰竭患者治疗及预后评估中的应用[J].临床心血管病杂志,2018,34(4):334-337.
[14] Pang X,Si J,Xu S,et al.Simvastatin inhibits homocysteine-induced CRP generation via interfering with the ROS-p38/ERK1/2 signal pathway in rat vascular smooth muscle cells[J].Vascular Pharmacology,2016,88(12):42-47.
[15]梁海峰,杨明,刘瑜,等.血浆同型半胱氨酸水平对非ST段抬高急性冠脉综合征患者围术期心肌梗死及预后的影响研究[J].中国全科医学,2017,20(7):823-827.
[16]祁景,刘小军,王艮卫,等.急性脑梗死患者血浆同型半胱氨酸水平与颈动脉内膜中层厚度的相关性研究[J].中华实验外科杂志,2016,33(5):1201-1203.
[2] Wu W,Guan Y,Xu K,et al.Plasma Homocysteine Levels Predict the Risk of Acute Cerebral Infarction in Patients with Carotid Artery Lesions[J].Molecular Neurobiology,2016,53(4):2510-2517.
[3]瞿国英,陈一可.老年高血压患者血清同型半胱氨酸水平的变化及叶酸治疗的作用[J].中国医院药学杂志,2018,38(5):520-522.
[4]田丹丹,张程达,王连珂,等.亚甲基四氢叶酸还原酶基因及甲硫氨酸合成酶基因多态性与口服叶酸治疗高同型半胱氨酸血症疗效的关系研究[J].中国全科医学,2016,19(12):1396-1400.
[5]殷文明,姚义琴,邹荣成.同型半胱氨酸测定在急性脑梗塞合并颈动脉病变的临床应用价值分析[J].中国临床解剖学杂志,2017,35(6):695-699.
[6]杨莉萍,蔡木发.心血管疾病患者联合检测同型半胱氨酸及叶酸的临床意义[J].广东医学,2017,38(15):2361-2362.
[7] Fan H,Yang S,Li Y,et al.Assessment of Homocysteine as a Diagnostic and Early Prognostic Biomarker for Patients with Acute Lacunar Infarction[J].European Neurology,2017,79(1-2):54-62.
[8]李莹鸿,靳利利,黄培红,等.复方芪麻胶囊干预治疗对H型高血压患者同型半胱氨酸、瘦素水平的影响[J].中国中西医结合杂志,2017,37(6):676-679.
[9]薛焱,刘海润,杨子聪,等.血浆同型半胱氨酸与急性心肌梗死患者预后的相关性研究[J].重庆医学,2017,46(31):28-30,33.
[10]王雁,任爱华,翁秀妹,等.运动干预对实验性高同型半胱氨酸血症大鼠过氧化及血管内皮功能的影响[J].中国康复医学杂志,2016,31(11):1208-1212.
[11] Zhong C,Xu T,Xu T,et al.Plasma Homocysteine and Prognosis of Acute Ischemic Stroke:a Gender-Specific Analysis From CATIS Randomized Clinical Trial[J].Molecular Neurobiology,2016,54(3):1-9.
[12]岳伟,吴昊,石志鸿,等.血浆同型半胱氨酸水平与急性缺血性脑卒中患者的卒中复发及死亡关系的研究[J].中华神经医学杂志,2016,15(7):654-659.
[13]李莉.NT-proBNP联合血清HCY检测在心力衰竭患者治疗及预后评估中的应用[J].临床心血管病杂志,2018,34(4):334-337.
[14] Pang X,Si J,Xu S,et al.Simvastatin inhibits homocysteine-induced CRP generation via interfering with the ROS-p38/ERK1/2 signal pathway in rat vascular smooth muscle cells[J].Vascular Pharmacology,2016,88(12):42-47.
[15]梁海峰,杨明,刘瑜,等.血浆同型半胱氨酸水平对非ST段抬高急性冠脉综合征患者围术期心肌梗死及预后的影响研究[J].中国全科医学,2017,20(7):823-827.
[16]祁景,刘小军,王艮卫,等.急性脑梗死患者血浆同型半胱氨酸水平与颈动脉内膜中层厚度的相关性研究[J].中华实验外科杂志,2016,33(5):1201-1203.