叶酸联合维生素B_6及甲钴胺治疗老年冠状动脉介入术后患者高同型半胱氨酸血症的临床观察
摘要
目的观察叶酸联合维生素B_6、甲钴胺治疗老年PCI术后患者高同型半胱氨酸(homocysteine,Hcy)血症的有效性和安全性。方法选择2017年6月～2018年1月在许昌市中心医院心血管内科就诊的老年PCI术后合并高Hcy血症患者287例,依据降低血清Hcy治疗方案不同,分为观察组(145例)和对照组(142例)。观察组采用叶酸联合维生素B_6、甲钴胺降低血清Hcy治疗,对照组单用叶酸降低血清Hcy治疗。记录2组治疗前、治疗2、4个月血清Hcy水平,计算2组患者治疗4个月时,血清Hcy的下降幅度和治疗有效率。观察2组药物不良反应的发生。结果观察组治疗2、4个月血清Hcy明显低于对照组,差异有统计学意义[(23.24±5.13)μmol/L vs (26.47±6.12)μmol/L,P=0.009;(13.32±4.26)μmol/Lvs(16.25±3.98)μmol/L,P=0.000];治疗4个月,2组血清Hcy较治疗前均有明显降低,差异有统计学意义(P<0.05);观察组血清Hcy的下降幅度和治疗有效率明显高于对照组,差异有统计学意义[(54.82±11.12)%vs (45.31±10.87)%,P=0.000;81.38%vs 64.08%,P=0.030]。2组药物不良反应均轻微,2组腹胀、恶心、腹泻及尿液变黄发生率比较,差异无统计学意义(P>0.05)。结论叶酸联合维生素B_6、甲钴胺治疗老年PCI术后患者高Hcy血症疗效确切,安全性好,值得临床推广应用。
引文
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[16]杜梦琳.不同剂量叶酸片降同型半胱氨酸疗效观察[J].中西医结合心脑血管病杂志,2016,14(6):664-665.DOI:10.3969/j.issn.1672-1349.2016.06.038.
[17]宋文娟,吴俊.不同剂量叶酸对老年脑梗死患者同型半胱氨酸水平和认知功能的影响[J].实用老年医学,2013,27(11):920-923.DOI:10.3969/j.issn.1003-9198.2013.11.013.
[18]王冬,于旭红,沙杭.叶酸的临床应用现状[J].中国临床药理学杂志,2016,32(19):1813-1816.DOI:10.13699/j.cnki.1001-6821.2016.19.023.
[19]Kuwahara K,Nanri A,Pham NM,et al.Serum vitamin B6,folate,and homocysteine concentrations and oxidative DNAdamage in Japanese men and women[J].Nutrition,2013,29(10):1219-1223.DOI:10.1016/j.nut.2013.03.014.
[20]Ni J,Zhang L,Zhou T,et al.Association between the MTH-FR C677Tpolymorphism,blood folate and vitamin B12deficiency,and elevated serum total homocysteine in healthy individuals in Yunnan Province,China[J].J Chin Med Assoc,2017,80(3):147-153.DOI:10.1016/j.jcma.2016.07.005.
[21]Kang SS,Rosenson RS.Analytic approaches for the treatment of hyperhomocysteinemia and its impact on vascular disease[J].Cardiovasc Drugs Ther,2018,32(2):233-240.DOI:10.1007/s10557-018-6790-1.
[2]Zhang HP,Ai H,Zhao Y,et al.Effect of chronic total occlusion percutaneous coronary intervention on clinical outcomes in elderly patients[J].Am J Med Sci,2018,355(2):174-182.DOI:10.1016/j.amjms.2017.09.007.
[3]陈德友,刘霖,邹晓,等.老年心血管病合并高同型半胱氨酸血症患者阿司匹林抵抗发生率及危险因素调查[J].中华老年心脑血管病杂志,2015,17(11):1140-1143.DOI:10.3969/j.issn.1009-0126.2015.11.006.
[4]Xiao Y,Su X,Huang W,et al.Role of S-adenosylhomocysteine in cardiovascular disease and its potential epigenetic mechanism[J].Int J Biochem Cell Biol,2015,67:158-166.DOI:10.1016/j.biocel.2015.06.015.
[5]Shah H,Jan MU,Altaf A,et al.Correlation of hyperhomocysteinemia with coronary artery disease in absence of conventional risk factors among young adults[J].J Saudi Heart Assoc,2018,30(4):305-310.DOI:10.1016/j.jsha.2018.04.002.
[6]Hassan A,Dohi T,Miyauchi K,et al.Prognostic impact of homocysteine levels and homocysteine thiolactonase activity on long-term clinical outcomes in patients undergoing percutaneous coronary intervention[J].J Cardiol,2017,69(6):830-835.DOI:10.1016/j.jjcc.2016.08.013.
[7]中华医学会心血管病学分会介入心脏病学组,中国医师协会心血管内科医师分会血栓防治专业委员会,中华心血管病杂志编辑委员会.中国经皮冠状动脉介入治疗指南(2016)[J].中华心血管病杂志,2016,44(5):382-400.DOI:10.3760/cma.j.issn.0253-3758.2016.05.006.
[8]邹蓉,赵合庆,徐兴顺.伴有同型半胱氨酸增高的老年癫痫患者维生素B补充治疗的临床价值[J].中华神经科杂志,2017,50(4):250-254.DOI:10.3760/cma.j.issn.1006-7876.2017.04.004.
[9]芦燕玲,潘伟琦,宋晓华,等.老年非高血压人群同型半胱氨酸升高与新发心脑血管事件的关系[J].中华老年心脑血管病杂志,2018,20(6):607-609.DOI:10.3969/j.issn.1009-0126.2018.06.013.
[10]Santilli F,DavìG,Patrono C.Homocysteine,methylenetetrahydrofolate reductase,folate status and atherothrombosis:a mechanistic and clinical perspective[J].Vascul Pharmacol,2016,78:1-9.DOI:10.1016/j.vph.2015.06.009.
[11]Kaur G,Gaur R,Yadav S,et al.Association of vitamin B12mediated hyperhomocysteinemia and methylenetetrafolate reductase(C677T)gene polymorphism with cognitive impairment:apopulation based study from North India[J].Psychiatry Res,2018,270:123-125.DOI:10.1016/j.psychres.2018.08.103.
[12]Yeh EL,Huang YC,Tsai SF,et al.Relationship between plasma levels of homocysteine and the related B vitamins in patients with hemodialysis adequacy or inadequacy[J].Nutrition,2018,53:103-108.DOI:10.1016/j.nut.2018.02.004.
[13]Xu HX,Liu M,Chen PS,et al.GW25-e1134clinical significance of serum homocysteine detection in patients with coronary heart disease[J].J Am Coll Cardiol,2014,64(16):c237-c238.DOI:10.1016/j.jacc.2014.06.1104.
[14]Qin XH,Fan FF,Cui YM,et al.Folic acid supplementation with and without vitamin B6and revascularization risk:a meta-analysis of randomized controlled trials[J].Clin Nutr,2014,33(4):603-612.DOI:10.1016/j.clnu.2014.01.006.
[15]Mishchenko O,Iakovlieva L,Kyrychenko O,et al.Pharmacoeconomic analysis of the combined homocysteine-lowering and standard therapy versus standard therapy of patients with Chd,postpercutaneous coronary intervention(PCI)and B12deficiency[J].Value Health,2015,18(7):A404.DOI:10.1016/j.jval.2015.09.942.
[16]杜梦琳.不同剂量叶酸片降同型半胱氨酸疗效观察[J].中西医结合心脑血管病杂志,2016,14(6):664-665.DOI:10.3969/j.issn.1672-1349.2016.06.038.
[17]宋文娟,吴俊.不同剂量叶酸对老年脑梗死患者同型半胱氨酸水平和认知功能的影响[J].实用老年医学,2013,27(11):920-923.DOI:10.3969/j.issn.1003-9198.2013.11.013.
[18]王冬,于旭红,沙杭.叶酸的临床应用现状[J].中国临床药理学杂志,2016,32(19):1813-1816.DOI:10.13699/j.cnki.1001-6821.2016.19.023.
[19]Kuwahara K,Nanri A,Pham NM,et al.Serum vitamin B6,folate,and homocysteine concentrations and oxidative DNAdamage in Japanese men and women[J].Nutrition,2013,29(10):1219-1223.DOI:10.1016/j.nut.2013.03.014.
[20]Ni J,Zhang L,Zhou T,et al.Association between the MTH-FR C677Tpolymorphism,blood folate and vitamin B12deficiency,and elevated serum total homocysteine in healthy individuals in Yunnan Province,China[J].J Chin Med Assoc,2017,80(3):147-153.DOI:10.1016/j.jcma.2016.07.005.
[21]Kang SS,Rosenson RS.Analytic approaches for the treatment of hyperhomocysteinemia and its impact on vascular disease[J].Cardiovasc Drugs Ther,2018,32(2):233-240.DOI:10.1007/s10557-018-6790-1.