本文選題：同型半胱氨酸 + 二級預防��； 參考：《安徽醫(yī)科大學》2017年碩士論文

【摘要】：目的探討補充葉酸、維生素B_(12)治療中青年男性腦梗死伴高同型半胱氨酸(HHcy)血癥患者的臨床療效,同時觀察患者血漿Hcy水平變化。為中青年男性腦梗死的治療及二級預防提供理論依據(jù)及更合理的方案。方法選取我院神經(jīng)內(nèi)科2014年12月-2015年12月住院及門診診治100例首次發(fā)作腦梗死的中青年男性高同型半胱氨酸血癥患者,按就診日期隨機分為試驗組50例(A組)、對照組50例(B組)�；颊呷朐簳r分別評定兩組患者NIHSS評分、Barthel指數(shù)(BI)、m RS評分,并記錄血漿Hcy水平。兩組患者均根據(jù)缺血性卒中診治指南進行抗血小板聚集、腦保護、改善微循環(huán)、調(diào)脂等常規(guī)治療,A組在常規(guī)治療的同時補充葉酸、維生素B_(12)治療,維生素B_(12) 1.5mg,每日一次;葉酸5mg,每日一次;分別于治療后3個月、12個月再次評定兩組患者NIHSS評分、BI、m RS評分,并記錄血漿Hcy水平及1年內(nèi)兩組腦梗死復發(fā)例數(shù)。結果⑴兩組治療前后血漿Hcy濃度比較:兩組治療前血漿Hcy水平A組(22.05±4.44)umol/L、B組(21.27±3.79)umol/L,無顯著差異(P0.05),A組治療3個月后,血漿Hcy水平(13.57±2.57)umol/L,治療12個月后血漿Hcy水平(10.61±3.13)umol/L,B組治療3個月、12個月后血漿Hcy水平分別是(19.62±3.19)umol/L、(18.31±4.45)umol/L,兩組比較,A組血漿Hcy濃度顯著降低,明顯低于B組,差異具有顯著性(均P0.05);⑵兩組治療前后NIHSS評分比較:兩組患者入院時NIHHS評分,A組(9.86±4.59)分,B組(9.53±4.47)分,兩組治療前NIHSS評分無顯著差異(P0.05),A組患者補充葉酸及維生素B_(12)治療3個月后,患者NIHSS評分(4.55±2.33)分,治療12個月后,NIHSS評分為(3.02±1.73)分;B組治療3個月、12個月后NIHSS評分分別是(5.91±2.93)、(4.44±2.27)分,兩組患者經(jīng)治療后NIHSS評分均有不同程度的降低(均P0.05),且A組治療3個月、12個月后NIHSS評分均顯著低于B組,差異有顯著性(均P0.05);⑶兩組治療前后日常生活能力比較:兩組患者治療前,BI評分在60分以上A組7例、B組8例,差異無統(tǒng)計學意義(P0.05),治療3個月后A組BI評分在60分以上有32例,B組有26例,兩組前3個月BI評分無顯著差異(P0.05),12個月后,A組BI評分在60分以上有39例,B組為30例,A組BI評分在60分以上例數(shù)多于B組,且差異有顯著性(P0.05);⑷兩組治療前后m RS評分比較:治療前A組m RS評分0~2分3例,3~5分41例,B組分別為2例、43例,x2分析入院時m RS評分無明顯差異(P0.05);治療3個月后A組m RS評分0~2分26例,3~5分18例,B組分別為17例、28例,經(jīng)卡方檢驗,兩組差異有顯著性(P0.05);治療12個月后A組m RS評分0~2分33例,3~5分11例,B組分別為23例、11例,A組神經(jīng)功能恢復優(yōu)于B組,兩組有顯著性差異(P0.05);⑸兩組腦梗死復發(fā)率比較:對兩組患者隨訪1年,在隨訪期間記錄兩組腦梗死復發(fā)例數(shù),1年內(nèi)A組腦梗死復發(fā)3例,B組復發(fā)10例,腦梗死復發(fā)率A組(6.8%)明顯低于B組(22.2%),差異有統(tǒng)計學意義(P0.05)。A組在口服葉酸及維生素B_(12)過程中均未出現(xiàn)嚴重不良反應。結論葉酸聯(lián)合維生素B_(12)治療中青年男性腦梗死伴高同型半胱氨酸(HHcy)血癥患者,可以顯著降低血漿Hcy水平,有利于促進經(jīng)功能恢復,提高患者生活質量,改善中青年男性HHcy腦梗死患者預后,并有效降低其1年內(nèi)腦梗死復發(fā)率;口服葉酸及維生素B_(12)安全有效可靠,無藥物不良反應。
[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.

【學位授予單位】：安徽醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R743.3

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