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目的探讨不同剂量B族维生素对高同型半胱氨酸血症(hyperho mocysteinemia,Hhcy)脑梗死患者二级预防的作用。方法采用随机对照法,将900例Hhcy脑梗死患者分为大剂量B族维生素干预组300例(口服叶酸25 mg,甲钴胺500μg,维生素B630 mg,均为2次/d),小剂量B族维生素干预组300例(口服叶酸2.5 mg,甲钴胺500μg,维生素B630 mg,均为1次/d)和对照组300例,随访1年,观察不同剂量B族维生素联合应用对脑梗死症状性复发与影像学再发的二级预防作用,记录试验期间血浆总同型半胱氨酸(total homocysteine,tHcy)水平。结果B族维生素干预可显著降低患者血浆tHcy水平,且大剂量B族维生素干预组比小剂量B族维生素干预组更明显,但对脑梗死症状性复发和影像学再发大剂量B族维生素干预组和小剂量B族维生素干预组均无明显降低。结论 B族维生素可降低Hhcy脑梗死患者的血浆tHcy水平,但未能证实B族维生素干预对Hhcy脑梗死患者二级预防有益。
Objective To investigate the effect of different doses of B vitamins on secondary prevention in patients with hyperhomocysteinemia (Hhcy) cerebral infarction. Methods 900 patients with Hhcy cerebral infarction were divided into high dose B vitamins treatment group (oral folic acid 25 mg, methylcobalamin 500 μg, vitamin B630 mg twice a day), low dose B 300 vitamins intervention group (oral folic acid 2.5 mg, mecobalamin 500μg, vitamin B630 mg, were 1 / d) and control group of 300 patients were followed up for 1 year to observe the different doses of B vitamins on the symptoms of cerebral infarction Secondary recurrence and recurrent secondary prevention, recording the plasma total homocysteine (total homocysteine, tHcy) levels during the trial. Results The intervention of B vitamins could significantly reduce the level of plasma tHcy in patients, and the high-dose B vitamins intervention group was more obvious than the low-dose B vitamins intervention group. However, the relapse of symptomatic cerebral infarction and high dose B vitamins Group and low-dose B vitamins intervention group were no significant reduction. Conclusions B vitamins can reduce the level of plasma tHcy in patients with Hhcy cerebral infarction, but failed to confirm the benefit of B vitamins in secondary prevention of Hhcy cerebral infarction.