本文選題：同型半胱氨酸 + 葉酸�。� 參考：《天津醫(yī)科大學(xué)》2012年碩士論文

【摘要】：目的 通過補充葉酸和復(fù)合VitB,觀察腦卒中患者血漿Hcy水平及愈后復(fù)發(fā)情況,揭示血漿Hcy對腦卒中發(fā)病的影響,明確葉酸和復(fù)合VitB對腦卒中復(fù)發(fā)預(yù)防的作用。通過觀察葉酸和復(fù)合VitB對D-二聚體、纖維蛋白原、血脂水平和凝血四項時間變化的影響,初步探討補充葉酸和復(fù)合VitB對腦卒中患者血漿Hcy水平影響和預(yù)防腦卒中復(fù)發(fā)的機制。 方法 研究選取天津中醫(yī)藥大學(xué)第一附屬醫(yī)院針灸科2009年6月～2010年4月期間診斷為腦卒中的住院患者134例,男性98例,女性36例,年齡41～73歲,平均(58.62±7.11)歲。將患者隨機分為葉酸和復(fù)合VitB預(yù)和常規(guī)治療對照2組,每組各67例。腦卒中患者入院后空腹12h,于次日清晨取肘正中靜脈血8ml,采用酶聯(lián)免疫法和比濁法分別檢測患者入院時和出院時血漿Hcy、D-二聚體、纖維蛋白原、血脂水平和凝血四項時間。依據(jù)腦卒中的基本體征、癥狀對出院患者或其家屬進行隨訪,每間隔90d電話隨訪1次,隨訪持續(xù)12個月。同時運用腦卒中殘損評定法對出院的腦卒中患者進行愈后效果評價。 結(jié)果 1.干預(yù)后干預(yù)組血漿Hcy水平平均下降3.25μmol/L,對照組Hcy水平平均下降1.52μmol/L,干預(yù)組優(yōu)于對照組,治療效果差異具有統(tǒng)計學(xué)意義(P0.05)。 2.干預(yù)組和對照組血脂水平比較,腦卒中患者的血脂水平(D-D、TC、TG、LDL-C和FIB)明顯下降(P0.05)。 3.干預(yù)組和對照組凝血四項比較,腦卒中患者凝血四項(PT、INR、APTT和TT)水平?jīng)]有明顯變化,差異無統(tǒng)計學(xué)意義(均P0.05)。 4.干預(yù)組腦卒中患者復(fù)發(fā)率明顯低于對照組,差異有統(tǒng)計學(xué)意義(P0.05)。 5.兩組患者平均SIAS評分雖均10分,干預(yù)組為(20.72±2.33)分,高于對照組(12.70±1.77)分,差異具有統(tǒng)計學(xué)意義(P0.01)。 結(jié)論 高同型半胱氨酸血癥是腦卒中發(fā)病獨立危險因素之一。補充葉酸和復(fù)合VitB后,腦卒中患者血漿Hcy水平明顯降低。補充葉酸和復(fù)合VitB可明顯減少腦卒中患者愈后復(fù)發(fā),使腦卒中患者愈后生命質(zhì)量明顯提高。其機制可能與D-D、FIB、TC、TG和LDL-C水平有關(guān)。
[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 鹵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 鹵2.33 in the intervention group, which was higher than that in the control group (12.70 鹵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.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R151

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