叶酸改善高同型半胱氨酸血症患者内皮功能疗效的Meta 分析

摘要

Objective To system evaluate the effect of folic acid supplementation to decrease the higher serum homo -cysteine in patients with homocysteine and improve endothelial function effect .Methods Search the Cochrane library , PUBMED, Web of Science , Wanfang database , China academic journals network ( CNKI) , Chinese biomedical literature da-tabase ( CBM) from the database establish to 2014 January, clinical randomized controlled trials ( RCT) about folic acid treat-ment of hyperhomocysteinemia were included , and Meta-analysis were performed with the software of RevMan 5.Results 12 RCT of 926 cases were included , 449 cases were taken folic acid , placebo in 477 cases.Meta-analysis showed that:folic acid can significantly reduce the plasma level of homocysteine (WMD=-2.82, 95%CI -3.61 to -2.04, P <0.01), while fo-lic acid can effectively improve the endothelial dependent diastolic function (FMD) (WMD=2.00, 95%CI 0.99 to 3.00, P=0.000 1), of which 3 studies compared the intima media thickness (IMT), the results showed that folic acid treatment did not improve the carotid artery IMT (WMD=-0.05, 95%CI -0.10 to 0.00, P =0.06).Conclusion Folic acid can effectively reduce the serum homocysteine level , and can improve the endothelial function , but not clear about the effect on the vascular IMT.%目的：系统评价补充叶酸降低高同型半胱氨酸血症患者血清同型半胱氨酸水平及改善内皮功能的效果。方法计算机检索Cochrane图书馆、PUBMED、Web of Science、万方数据库、中国学术期刊网（ CNKI）、中国生物医学文献数据库（CBM）从建库至2014年1月收录补充叶酸治疗高同型半胱氨酸血症患者临床随机对照试验（RCT），并对纳入的文献采用RevMan 5]．0软件进行Meta分析。结果共纳入RCT 12篇、患者926例，其中服用叶酸449例，服用安慰剂477例。 Meta分析结果表明：叶酸可以明显降低患者血浆中的同型半胱氨酸水平（ WMD＝-2．82，95％CI-3．61～-2．04， P ＜0．01），同时补充叶酸后可有效改善内皮依赖性舒张功能（FMD）（WMD＝2．00，95％CI 0．99～3．00， P ＝0．0001），其中3篇文献比较了血管内膜中层厚度（IMT），结果表明补充叶酸治疗后不能有效改善颈动脉血管IMT（WMD＝-0．05，95％CI -0．10～0．00， P ＝0．06）。结论补充叶酸可有效降低高同型半胱氨酸血症患者血清同型半胱氨酸水平，同时也可改善患者内皮舒张功能，但不能明确对血管IMT的疗效。