| Objective: This study was to explore whether daily folic acid and B-vitamin intervention would reduce homocysteine(HCY)level in ischemic stroke in-hospital-patients with high HCY level.Methods: From January 1,2013 to May 31,2016,a total of 462 ischemic stroke patients from Traditional Chinese Medicine Hospital of Kunshan and the First People's Hospital of Kunshan.All participants were collected age,gender,smoking,drinking,chronic disease history(including diabetes mellitus,hypertension,coronary heart disease,other heart disease)and hospital days,and were measured systolic blood pressure(SBP),diastolic blood pressure(DBP),pulse,height,weight;Laboratory indicators at admission and after 1month treatment were detected,including homocysteine(HCY),white blood cell(WBC),red blood cell(RBC),hemoglobin(HGB),blood platelet(PLT),total protein(TP),albumin(ALB),blood glucose(GLU),blood urea nitrogen(BUN),blood creatinine(CREA),uric acid(UA),triglyceride(TG),total cholesterol(TCHOL),high density lipoprotein(HDL-C),low-density lipoprotein(LDL-C);National institute of health stroke scale(NHISS)scores at admission and discharge and Modified Rankin scale(mRS)score at discharge were also collected.The subjects were divided into the conventional treatment group and intervention group(including vitamin B12 intervention group,vitamin B12 combing folic acid intervention group)according to whether or not to receive vitamin B12 or vitamin B12 combing folic acid to reduce HCY.The difference of HCY reduction after treatment was compared between the conventional treatment group and the intervention group,as well as the difference in neurological function scores between the two groups.Quantile regression was used to analyze the relationship between HCY change and medication patterns and other variables at admission.Results:The mean age of the participants was 70.3±12.8 years,with 291(63%)males and 171(37%)females.All participants were divided into the conventional treatment group(n=253)and the intervention group(n=209).The intervention group received conventional treatment,combing additional treatment including vitamin B12 treatment(n=142)or vitamin B12 plus folic acid treatment(n=67).1.The reduction of HCY in the intervention group were significantly higher than the conventional treatment group(4.5?mol/L versus 0.87?mol/L,P<0.001).2.The reduction of HCY in the vitamin B12 plus folic acid treatment group were significantly higher than the vitamin B12 treatment group(10.50?mol/L versus 3.24?mol/L,P<0.001).3.The comparison of NHISS score and mRS between the conventional treatment group and the intervention group,the vitamin B12 treatment group and the vitamin B12 plus folic acid treatment group were not significant(P>0.05).4.The reduction of HCY was associated with the intervention.After controlling for age,gender,smoking,drinking,coronary heart disease,diabetes,hypertension and laboratory indicates,the multivariate median-regression found that the decreased concentration of HCY in the vitamin B12 treatment group was 2.366(95%CI=1.211-3.520)?mol/L more than the conventional group,and the decreased value in the vitamin B12 plus folic acid treatment group was 8.650(95%CI=6.128-11.172)?mol/L more than the conventional group.5.The reduction of HCY was associated with some laboratory indicates change.After controlling for age,gender,BMI and vitamin B12 intervention,the multivariate median-regression found that the reduced value of HCY was 1.226?mol/L in the TP-decreased group more than the increased/unchanged group,and the decreased value of HCY in the CREA-decreased group was 1.712?mol/L more than the increased/unchanged group.Conclusion:1.After one month treatment with vitamin B12 or vitamin B12 plus folic acid,the HCY level was reduced significantly,which means supplementation with vitamin B12 or vitamin B12 plus folic acid could effectively decrease the HCY level in ischemic stroke patients.2.With 1 months of treatment,the reduced level of HCY was higher in the folic acid plus vitamin B12 treatment patients than that of the single vitamin B12 treatment group,suggesting that folic acid combining vitamin B12 treatment can effectively reduce the level of plasma HCY than the pure vitamin B12 treatment.3.Intervention with folic acid and vitamin B12 had no effect on the neurological function scores at discharge in ischemic stroke patents. |
PDF Full Text Request