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目的探讨长期干预高同型半胱氨酸血症(Hhcy)与颈内动脉系统短暂性脑缺血发作(TIA)预后与转归的相关性,为TIA的治疗与预防提供参考。方法收集伴有Hhcy的颈内动脉系统TIA患者,随机分为治疗组105例和对照组78例,对照组给予常规治疗;治疗组在常规治疗基础上加用叶酸片及维生素B6、维生素B12片(甲钴胺),随访2年后缺血性脑血管事件发生情况;比较治疗前后Hcy水平,评价TIA患者的再发性脑血管事件发生率及药物不良反应发生率。结果 2年后对照组空腹Hcy水平与常规治疗前相比无显著差异,治疗组空腹血浆Hcy水平降低,与治疗前比较有显著差异,治疗组的缺血性脑血管事件复发率与对照组相比无显著差异。结论口服叶酸加维生素B6、B12可降低高同型半胱氨酸血症,且干预Hhcy有减少TIA后再发缺血性脑血管事件的趋势。
Objective To investigate the relationship between the long-term intervention of hyperhomocysteinemia (Hhcy) and the prognosis and prognosis of transient ischemic attack (TIA) in the internal carotid artery system, and to provide a reference for the treatment and prevention of TIA. Methods TIA patients with internal carotid artery system accompanied with Hhcy were randomly divided into treatment group (n = 105) and control group (n = 78). The control group was given routine treatment. The treatment group received folic acid tablets and vitamin B6 and vitamin B12 tablets (Mecobalamin) were included in this study. The incidence of ischemic cerebrovascular events was followed up for 2 years. The levels of Hcy before and after treatment were compared to evaluate the incidence of recurrent cerebral vascular events and the incidence of adverse drug reactions in patients with TIA. Results After two years, the fasting Hcy level in the control group had no significant difference compared with that before the routine treatment. The fasting plasma Hcy level in the treatment group decreased significantly compared with that before treatment. The relapse rate of ischemic cerebrovascular events in the treatment group was significantly lower than that in the control group No significant difference. Conclusions Oral folic acid plus vitamin B6 and B12 can reduce hyperhomocysteinemia, and the intervention of Hhcy has the tendency to reduce ischemic cerebrovascular events after TIA.