目的 評(píng)價(jià)B族維生素對(duì)高同型半胱氨酸血癥（Hhcy）腦梗死患者認(rèn)知功能的影響。方法 采取前瞻、開放、平行對(duì)照研究方法，1 000例Hhcy腦梗死患者分為治療組和對(duì)照組，各500例。對(duì)照組僅采用常規(guī)治療，治療組在常規(guī)治療的基礎(chǔ)上加用多種B族維生素，即每日口服葉酸片2.5 mg、維生素B₁₂片0.5 mg、維生素B₆片25 mg，共治療2年，隨訪觀察2年。記錄治療前、治療后3、12、24個(gè)月的空腹血漿總同型半胱氨酸（tHcy）水平，并記錄治療前、隨訪0.5、3、6、12、18、24個(gè)月MMSE的評(píng)分，觀察兩組MMSE下降≥2分病例發(fā)生的例數(shù)及發(fā)生率。結(jié)果 治療后3、12、24個(gè)月，治療組比對(duì)照組tHcy明顯降低，差異有統(tǒng)計(jì)學(xué)意義（P<0.01）。隨訪0.5、3、6、12、18個(gè)月時(shí)治療組MMSE評(píng)分均高于對(duì)照組，兩組間差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。隨訪24個(gè)月時(shí)，兩組MMSE評(píng)分比較差異無(wú)統(tǒng)計(jì)學(xué)意義。治療組隨訪全程中曾出現(xiàn)過(guò)MMSE較治療前水平下降≥2分的患者，兩組間差異無(wú)統(tǒng)計(jì)學(xué)意義。隨訪24個(gè)月時(shí)，兩組MMSE較治療前水平下降≥2分的患者例數(shù)比較差異無(wú)統(tǒng)計(jì)學(xué)意義。隨訪3個(gè)月時(shí)，兩組新發(fā)生的MMSE較治療前水平下降≥2分的患者例數(shù)比較差異有統(tǒng)計(jì)學(xué)意義（P<0.05）；其他隨訪時(shí)間點(diǎn)兩組新發(fā)生的MMSE較治療前水平下降≥2分的患者例數(shù)差異均無(wú)統(tǒng)計(jì)學(xué)意義。結(jié)論 B族維生素干預(yù)可能有助于減緩患者腦梗死后近期認(rèn)知功能的衰退，但對(duì)遠(yuǎn)期的干預(yù)作用尚需進(jìn)一步觀察。

Objective To assess the effect of B vitamins on cognitive function of cerebral infarction patients with hyperhomocy-steinemia (Hhcy). Methods A prospective, open, case-controlled clinical trial was used. Cerebral infarction patients (1 000 cases) with Hhcy were randomly divided into treatment and control groups (500 cases in each group). The patients in the control group were given conventional therapy. On the basis of conventional therapy, the patients in the treatment group were given a daily dose of B vitamins (folic acid 2.5 mg, B₁₂ 500 μg, and B₆ 25 mg) for two years. The patients were followed up for two years. The total homocysteine (tHcy) level was recorded before treatment, 3, 12, and 24 months after treatment. MMSE scores were recorded before treatment, 0.5, 3, 6, 12, 18, and 24 months after followed up. The number and incidence of patients whose MMSE level reduced ≥ 2 scores were marked. Results After 3, 12, and 24 months of treatment, the tHcy levels in the treatment group reduced significantly compared to those in the control group (P < 0.01). After followed up for 0.5, 3, 6, 12, and 18 months, MMSE scores in the treatment group were higher than those in the control group, and there was significant differences between the two groups (P < 0.05). After followed up for 24 months, there was no significant difference between two groups. During the whole course of followed up, MMSE level in the treatment group ever reduced ≥2 scores, and there was no significant difference between two groups. After followed up for 24 months, there was no significant difference between two groups in the number of patients whose MMSE level reduced ≥ 2 scores. After followed up for 3 months, the number of new patients whose MMSE level reduced ≥ 2 scores was lower than that in the control group, with significant difference (P < 0.05). During the other time of following up, there was no significant difference between two groups. Conclusion B vitamins supplementation is likely to avail to alleviate the recession of recent cognitive function of cerebral infarction patients, while the long term intervention effect is to be further observed.

天津市科技計(jì)劃項(xiàng)目（07ZCGYSF03700）