叶酸、维生素B12和多奈哌齐治疗高同型半胱氨酸血症阿尔茨海默病患者的对照研究

摘要

目的：探讨叶酸、维生素B12和多奈哌齐联合应用对高同型半胱氨酸血症（ HHcy）阿尔茨海默病（ AD）患者的影响。方法：100例AD患者依就诊顺序随机分为3组：联合治疗组（叶酸、维生素B12和多奈哌齐联合治疗）34例、多奈哌齐治疗组（单用多奈哌齐）33例、对照组（仅常规治疗）33例，观察3个月。分别于治疗前和治疗3个月进行简易精神状态检查表（ MMSE）、日常生活能力量表（ ADL）评分及血清Hcy浓度检测。结果：治疗后，MMSE、ADL评分及血清Hcy浓度组间效应有统计学意义（F＝29•71，F＝6•06，F＝6•62；P均＜0•01）。联合治疗组MMSE评分减分值、ADL评分减分值、血清Hcy浓度减分值均明显高于多奈哌齐治疗组（t＝—3•48，t＝—2•26，t＝2•25；P均＜0•05或P＜0•01）及对照组（t＝—9•14，t＝—5•73，t＝5•01；P均＜0•01）。治疗后Hcy浓度减分值与MMSE评分减分值、ADL评分减分值呈正相关（r＝0•423，P＜0•01；r＝0•240，P＜0•05）。结论：叶酸、维生素B12和多奈哌齐联合治疗可降低血清Hcy浓度，并改善AD患者的认知功能和行为能力。%Objective:To investigate the effects of combination therapy with folic acid,vitamin B12 and donepezil in Alzheimer′s disease( AD)patients with hyperhomocysteinemia( HHch)• Method:One hundred AD patients with HHch were randomly divided into 3 groups:combination treatment group( 34 cases,treated with folic acid,vitamin B12 and donepezil),donepezil group(33 cases,treated with donepezil alone)and the control group(33 cases,conventional treatment without any anti_dementia drug)according to the order of treat_ment for 3 months•All the patients were assessed by scales of Mini mental state examination( MMSE)and ac_tivity of daily living( ADL);and the level of serum homocysteine( Hcy)of them were detected before treatment and 3 months after treatment respectively• Results:After treatment,the group effect in scores of MMSE,ADL and the level of serum Hcy among the groups had statistical significance(F=29•71,F=6•06,F=6•62;all P<0•01)•The decrease value of MMSE and ADL scores,and the level of serum Hcy in combination treatment group were significantly higher than donepezil group(t= —3•48,t= —2•26,t=2•25,all P <0•05 or P<0•01)and the control group(t= —9•14,t= —5•73,t=5•01,all P<0•01)•After treatment,the decrease value of serum Hcy was positively correlated with the decrease value of MMSE and ADL scores( r =0•423,P <0•01;r =0•240,P<0•05)• Conclusion:Conbination therapy of folic acid,vitamin B12 and donepezil can reduce the serum Hcy concentration and improve congnitive function and behavior ability in AD patient with HHch.