Sombolos Kostas, Fragia Theodora, Natse Taïsir, Bartholomatos George, Karagianni Anna, Katsaris George, Christidou Fotini, Bamichas Gerasimos, Stangou Maria, Papagalanis Nikos
Renal Unit, G. Papanikolaou General Hospital, Thessaloniki, Greece.
J Nephrol. 2002 Nov-Dec;15(6):671-5.
Many regimens using different doses of folic acid (FA) alone or with supplementation of B-complex vitamins (BCV) have been tested for the reduction of total homocysteine (tHcy) levels in hemodialysis (HD) patients. BCV are usually administered orally and for a short period. In the present study, we assessed the effect of long-term intravenous (IV) BCV on serum tHCy levels in HD patients, and the effect produced by moderate oral supplementation with FA.
In a cohort of 37 patients under chronic HD treatment for a mean of 50.2 +/- 46.7 months, serum concentrations of tHcy, folate and vitamin B12 were determined at the end of four sequential periods: (A) three months without any FA supplementation, (B) three months with oral supplementation of 5 mg of FA three times weekly, (C) six months without FA supplementation, and (D) three months without BVC or FA supplementation. From the start of HD treatment and throughout the study until the beginning of period D, patients received a standard IV dose of BCV (B1 250 mg + B6 250 mg + B12 1.5 mg) three times per week, post-dialysis.
At the end of period B, mean serum tHcy levels were significantly lower than in periods A and C (13.7 +/- 3.6 micromol/L vs 19.6 +/- 10.8 micromol/L and 21.3 +/- 9.4 micromol/L, respectively, p < 0.001) and mean serum folate levels were significantly higher (20.7 +/- 7.4 ng/mL vs 5.0 +/- 2.8 ng/mL and 4.5 +/- 1.4 ng/mL, respectively, p < 0.01). At the end of period D, mean serum tHcy levels were significantly higher than in all the previons periods (29.3 +/- 13.5 micromol/L, p < 0.001). Twenty-six of the 37 patients (70.2%) had normal (< 15 micromol/L) serum tHcy levels at the end of period B and only one (2.7%) had normal tHcy at the end of period D. Mean serum vitamin B12 levels at the end of periods A, B and C were 100 times the usual normal values. At the end of period D, although significantly lowered (p < 0.001), they remained above the normal range.
Long-term high-dose BCV IV three times a week post-dialysis reduced serum tHcy levels only when combined with oral FA supplementation.
许多使用不同剂量叶酸（FA）单独或联合补充复合维生素B（BCV）的方案已被用于检测血液透析（HD）患者总同型半胱氨酸（tHcy）水平的降低情况。BCV通常口服且疗程较短。在本研究中，我们评估了长期静脉注射（IV）BCV对HD患者血清tHcy水平的影响，以及中等剂量口服FA所产生的效果。
在一组37例接受慢性HD治疗平均50.2±46.7个月的患者中，在四个连续阶段结束时测定tHcy、叶酸和维生素B12的血清浓度：（A）三个月不补充任何FA；（B）每周三次口服5mg FA，共三个月；（C）六个月不补充FA；（D）三个月不补充BVC或FA。从HD治疗开始直至整个研究期间，直到阶段D开始，患者在每次透析后接受标准静脉剂量的BCV（维生素B1 250mg + 维生素B6 250mg + 维生素B12 1.5mg），每周三次。
在阶段B结束时，血清tHcy平均水平显著低于阶段A和C（分别为13.7±3.6μmol/L vs 19.6±10.8μmol/L和21.3±9.4μmol/L，p<0.001），血清叶酸平均水平显著更高（分别为20.7±7.4ng/mL vs 5.0±2.8ng/mL和4.5±1.4ng/mL，p<0.01）。在阶段D结束时，血清tHcy平均水平显著高于之前所有阶段（29.3±13.5μmol/L，p<0.001）。37例患者中有26例（70.2%）在阶段B结束时血清tHcy水平正常（<15μmol/L），而在阶段D结束时只有1例（2.7%）tHcy水平正常。在阶段A、B和C结束时血清维生素B12平均水平是正常正常值的100倍。在阶段D结束时，尽管显著降低（p<0.001），但仍高于正常范围。
每周三次透析后长期静脉注射高剂量BCV仅在联合口服FA补充时可降低血清tHcy水平。
