叶酸联合维生素B12治疗中青年男性脑梗死伴高同型半胱氨酸血症的临床研究

发布时间：2018-04-27 03:39

本文选题：同型半胱氨酸 + 二级预防　；参考：《安徽医科大学》2017年硕士论文

【摘要】：目的探讨补充叶酸、维生素B_(12)治疗中青年男性脑梗死伴高同型半胱氨酸(HHcy)血症患者的临床疗效,同时观察患者血浆Hcy水平变化。为中青年男性脑梗死的治疗及二级预防提供理论依据及更合理的方案。方法选取我院神经内科2014年12月-2015年12月住院及门诊诊治100例首次发作脑梗死的中青年男性高同型半胱氨酸血症患者,按就诊日期随机分为试验组50例(A组)、对照组50例(B组)。患者入院时分别评定两组患者NIHSS评分、Barthel指数(BI)、m RS评分,并记录血浆Hcy水平。两组患者均根据缺血性卒中诊治指南进行抗血小板聚集、脑保护、改善微循环、调脂等常规治疗,A组在常规治疗的同时补充叶酸、维生素B_(12)治疗,维生素B_(12) 1.5mg,每日一次;叶酸5mg,每日一次;分别于治疗后3个月、12个月再次评定两组患者NIHSS评分、BI、m RS评分,并记录血浆Hcy水平及1年内两组脑梗死复发例数。结果⑴两组治疗前后血浆Hcy浓度比较:两组治疗前血浆Hcy水平A组(22.05±4.44)umol/L、B组(21.27±3.79)umol/L,无显著差异(P0.05),A组治疗3个月后,血浆Hcy水平(13.57±2.57)umol/L,治疗12个月后血浆Hcy水平(10.61±3.13)umol/L,B组治疗3个月、12个月后血浆Hcy水平分别是(19.62±3.19)umol/L、(18.31±4.45)umol/L,两组比较,A组血浆Hcy浓度显著降低,明显低于B组,差异具有显著性(均P0.05);⑵两组治疗前后NIHSS评分比较:两组患者入院时NIHHS评分,A组(9.86±4.59)分,B组(9.53±4.47)分,两组治疗前NIHSS评分无显著差异(P0.05),A组患者补充叶酸及维生素B_(12)治疗3个月后,患者NIHSS评分(4.55±2.33)分,治疗12个月后,NIHSS评分为(3.02±1.73)分;B组治疗3个月、12个月后NIHSS评分分别是(5.91±2.93)、(4.44±2.27)分,两组患者经治疗后NIHSS评分均有不同程度的降低(均P0.05),且A组治疗3个月、12个月后NIHSS评分均显著低于B组,差异有显著性(均P0.05);⑶两组治疗前后日常生活能力比较:两组患者治疗前,BI评分在60分以上A组7例、B组8例,差异无统计学意义(P0.05),治疗3个月后A组BI评分在60分以上有32例,B组有26例,两组前3个月BI评分无显著差异(P0.05),12个月后,A组BI评分在60分以上有39例,B组为30例,A组BI评分在60分以上例数多于B组,且差异有显著性(P0.05);⑷两组治疗前后m RS评分比较:治疗前A组m RS评分0~2分3例,3~5分41例,B组分别为2例、43例,x2分析入院时m RS评分无明显差异(P0.05);治疗3个月后A组m RS评分0~2分26例,3~5分18例,B组分别为17例、28例,经卡方检验,两组差异有显著性(P0.05);治疗12个月后A组m RS评分0~2分33例,3~5分11例,B组分别为23例、11例,A组神经功能恢复优于B组,两组有显著性差异(P0.05);⑸两组脑梗死复发率比较:对两组患者随访1年,在随访期间记录两组脑梗死复发例数,1年内A组脑梗死复发3例,B组复发10例,脑梗死复发率A组(6.8%)明显低于B组(22.2%),差异有统计学意义(P0.05)。A组在口服叶酸及维生素B_(12)过程中均未出现严重不良反应。结论叶酸联合维生素B_(12)治疗中青年男性脑梗死伴高同型半胱氨酸(HHcy)血症患者,可以显著降低血浆Hcy水平,有利于促进经功能恢复,提高患者生活质量,改善中青年男性HHcy脑梗死患者预后,并有效降低其1年内脑梗死复发率;口服叶酸及维生素B_(12)安全有效可靠,无药物不良反应。
[Abstract]:Objective to investigate the clinical efficacy of folic acid and vitamin B_ (12) in the treatment of young and middle-aged men with cerebral infarction and homocysteine (HHcy), and to observe the changes in plasma Hcy levels in the patients and to provide theoretical basis and more reasonable plan for the treatment and two prevention of cerebral infarction in young and middle-aged men. Methods in 2014, 12 of the Department of Neurology in our hospital were selected. 100 cases of middle and young male hyperhomocysteinemia in the hospitalized and outpatient clinic in December, -2015, were randomly divided into 50 cases (group A) and 50 cases (group B) in the control group according to the date of hospitalization. The patients were admitted to two groups of patients' NIHSS score, Barthel index (BI), m RS score, and the level of plasma Hcy. Two groups were affected. All patients were treated with antiplatelet aggregation, brain protection, microcirculation and lipid regulation, supplemented with folic acid, vitamin B_ (12) (12), vitamin B_ (12) 1.5mg, once a day, 5mg of folic acid, once a day, and 3 months after treatment and 12 months respectively in two groups of patients with NIHSS evaluation. Score, BI, m RS score, and record the plasma Hcy level and the number of recurrent cases of cerebral infarction in 1 years. Results (1) the plasma Hcy concentration in the two groups before and after treatment: two groups before treatment, Hcy level A group (22.05 + 4.44) umol/L, B group (21.27 + 3.79) umol/L, no significant difference (P0.05), A group after 3 months, plasma levels (13.57 + 2.57), treat 12 The plasma level of Hcy was (10.61 + 3.13) umol/L, group B was treated for 3 months, and the plasma Hcy level was (19.62 + 3.19) umol/L and (18.31 + 4.45) umol/L after 12 months. The plasma Hcy concentration in group A was significantly lower than that in group B, significantly lower than that in group B (all P0.05). (2) the NIHSS score before and after treatment in group two: NIHHS scores in group two at admission In group A (9.86 + 4.59) and group B (9.53 + 4.47), there was no significant difference between the two groups before treatment (P0.05). The patients in group A supplemented folic acid and vitamin B_ (12) were treated for 3 months with NIHSS score (4.55 + 2.33), and after 12 months of treatment, NIHSS score was (3.02 + 1.73) scores; B group was treated for 3 months and NIHSS scores were respectively. 27) scores, two groups of patients after the treatment of NIHSS scores were reduced in varying degrees (P0.05), and the A group was treated for 3 months, 12 months after the NIHSS score was significantly lower than the B group, the difference was significant (all P0.05); (3) the two groups before and after treatment of daily living ability: two groups of patients before treatment, BI score in 60 or more A group 7 cases, B Group 8 cases, the difference was not statistically significant Meaning (P0.05), after 3 months of treatment, there were 32 cases of BI score in group A, 26 in group B and no significant difference in BI score in the first 3 months (P0.05). 12 months later, BI score in A group was 39 in 60, and 30 in B, and BI score in A group was more than B group, and the difference was significant before and after treatment. 4 Before treatment, the m RS score of A group was 3 cases, 3~5 score was 41 cases, B group was 2 cases, 43 cases, m RS score was no significant difference (P0.05). 3 months after treatment, A group M score score 26 cases, 18 cases, 28 cases respectively, 28 cases, two groups of significant differences, two cases, 11 cases, 12 months after treatment. Group B were 23 cases, 11 cases were better than group B and two groups had significant difference (P0.05). The recurrence rate of cerebral infarction in two groups was compared: two groups of patients were followed up for 1 years. During the follow-up period, the recurrent cases were recorded in two groups of cerebral infarction, 3 in group A in 1 years, 10 in group B, and in group A (6.8%) of cerebral infarction recurrence rate (6.8%) significantly lower than that of B group (22.2%). The difference was statistically significant (P0.05) group.A did not have serious adverse reactions in the course of oral folic acid and vitamin B_ (12). Conclusion folic acid combined with vitamin B_ (12) treatment of young male cerebral infarction with Hyperhomocysteine (HHcy) patients can significantly reduce the level of blood plasma Hcy, which is beneficial to the promotion of functional recovery and the improvement of patient's life. Quality, improve the prognosis of HHcy cerebral infarction in young and middle-aged men, and effectively reduce the recurrence rate of cerebral infarction within 1 years; oral folic acid and vitamin B_ (12) are safe, effective and reliable, without adverse drug reactions.

【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3

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