叶酸和复合维生素B对脑卒中复发预防作用的研究

发布时间：2018-05-16 23:17

本文选题：同型半胱氨酸 + 叶酸　；参考：《天津医科大学》2012年硕士论文

【摘要】：目的通过补充叶酸和复合VitB,观察脑卒中患者血浆Hcy水平及愈后复发情况,揭示血浆Hcy对脑卒中发病的影响,明确叶酸和复合VitB对脑卒中复发预防的作用。通过观察叶酸和复合VitB对D-二聚体、纤维蛋白原、血脂水平和凝血四项时间变化的影响,初步探讨补充叶酸和复合VitB对脑卒中患者血浆Hcy水平影响和预防脑卒中复发的机制。方法研究选取天津中医药大学第一附属医院针灸科2009年6月～2010年4月期间诊断为脑卒中的住院患者134例,男性98例,女性36例,年龄41～73岁,平均(58.62±7.11)岁。将患者随机分为叶酸和复合VitB预和常规治疗对照2组,每组各67例。脑卒中患者入院后空腹12h,于次日清晨取肘正中静脉血8ml,采用酶联免疫法和比浊法分别检测患者入院时和出院时血浆Hcy、D-二聚体、纤维蛋白原、血脂水平和凝血四项时间。依据脑卒中的基本体征、症状对出院患者或其家属进行随访,每间隔90d电话随访1次,随访持续12个月。同时运用脑卒中残损评定法对出院的脑卒中患者进行愈后效果评价。结果 1.干预后干预组血浆Hcy水平平均下降3.25μmol/L,对照组Hcy水平平均下降1.52μmol/L,干预组优于对照组,治疗效果差异具有统计学意义(P0.05)。 2.干预组和对照组血脂水平比较,脑卒中患者的血脂水平(D-D、TC、TG、LDL-C和FIB)明显下降(P0.05)。 3.干预组和对照组凝血四项比较,脑卒中患者凝血四项(PT、INR、APTT和TT)水平没有明显变化,差异无统计学意义(均P0.05)。 4.干预组脑卒中患者复发率明显低于对照组,差异有统计学意义(P0.05)。 5.两组患者平均SIAS评分虽均10分,干预组为(20.72±2.33)分,高于对照组(12.70±1.77)分,差异具有统计学意义(P0.01)。结论高同型半胱氨酸血症是脑卒中发病独立危险因素之一。补充叶酸和复合VitB后,脑卒中患者血浆Hcy水平明显降低。补充叶酸和复合VitB可明显减少脑卒中患者愈后复发,使脑卒中患者愈后生命质量明显提高。其机制可能与D-D、FIB、TC、TG和LDL-C水平有关。
[Abstract]:Purpose The level of plasma Hcy and recurrence of stroke patients were observed by supplementation of folic acid and complex Vit B to reveal the effect of plasma Hcy on the pathogenesis of stroke and to clarify the role of folic acid and compound VitB in preventing stroke recurrence. By observing the effects of folic acid and compound VitB on the changes of D-dimer, fibrinogen, blood lipids and coagulation, the effects of folic acid supplementation and compound VitB on the plasma Hcy level in stroke patients and the mechanism of preventing the recurrence of stroke were discussed. Method 134 inpatients with stroke were selected from Department of Acupuncture and moxibustion of the first affiliated Hospital of Tianjin University of traditional Chinese Medicine from June 2009 to April 2010, 98 males and 36 females, aged 41 to 73 years, with an average age of 58.62 卤7.11 years. Patients were randomly divided into folic acid and combined with VitB pretreatment and routine control group, 67 cases in each group. On an empty stomach 12 hours after admission, 8 ml of median elbow vein blood was taken from stroke patients the next morning. The plasma levels of Hcyn D- dimer, fibrinogen, blood lipids and coagulation were measured by enzyme linked immunosorbent assay (Elisa) and turbidimetry respectively at admission and discharge. According to the basic signs of stroke, the patients or their families were followed up by telephone every 90 days for 12 months. At the same time, the post-recovery effect of discharged stroke patients was evaluated by the method of stroke disability assessment. Result 1. After intervention, the plasma Hcy level in the intervention group decreased by 3.25 渭 mol / L on average, and the Hcy level in the control group decreased by 1.52 渭 mol / L on average. The intervention group was superior to the control group, and the difference in treatment effect was statistically significant (P 0.05). 2. Compared with the control group, the blood lipid levels of the intervention group and the control group were significantly lower than that of the patients with stroke, and the levels of LDL-C and FIBs of the patients with stroke were significantly lower than those of the control group (P 0.05). 3. In the intervention group and the control group, there were no significant changes in the levels of PTT INRN APTT and TTT in the patients with stroke, but there was no significant difference between the two groups (all P 0.05). 4. The recurrence rate of stroke patients in the intervention group was significantly lower than that in the control group (P 0.05). 5. The average SIAS score of the two groups was 10 points, which was 20.72 卤2.33 in the intervention group, which was higher than that in the control group (12.70 卤1.77). The difference was statistically significant (P 0.01). Conclusion Hyperhomocysteinemia is one of the independent risk factors for stroke. The level of plasma Hcy in stroke patients decreased significantly after folic acid supplementation and combined VitB. Supplementation of folic acid and VitB could significantly reduce the recurrence of stroke patients and improve the quality of life of stroke patients. The mechanism may be related to the levels of TG and LDL-C.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R151

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