Tungkasereerak Pakorn, Ong-ajyooth Leena, Chaiyasoot Walailak, Ong-ajyooth Sompong, Leowattana Wattana, Vasuvattakul Somkiat, Vareesangthip Kriengsak, Shayakul Chairat, Chanchairujira Thawee, Sritippayawan Suchai
Renal Division, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
J Med Assoc Thai. 2006 Aug;89(8):1187-93.
Hyperhomocysteinemia is an independent risk factor for atherosclerotic vascular disease in chronic hemodialysis patients. This stratified randomized controlled trial was designed to measure the effect of high dose oral vitamin B6, vitamin B12, and folic acid on homocysteine levels, and to evaluate the effect on atherosclerosis as measured by Intima-Media Thickness (IMT) of carotid arteries.
Fifty-four chronic hemodialysis patients with hyperhomocysteinemia were randomized to receive oral 15 mg folic acid, 50 mg vitamin B6, and 1 mg vitamin B12 daily (treatment group) or oral 5 mg folic acid alone (control group) for 6 months. Homocysteine level and IMT were measured in both groups.
At 6 months, homocysteine levels in the treatment group were significantly reduced from 27.94 +/- 8.54 to 22.71 +/- 3.68 mmol/l (p = 0.009) and were not significantly increased from 26.81 +/- 7.10 to 30.82 +/- 8.76 mmol/l in control group (p = 0.08). Mean difference between both groups was statistically significant (p = 0.002). There was no significant difference of IMT of carotid arteries, however, a tendency that the treatment group would have less thickness was observed (0.69 +/- 0.29 mm and 0.62 +/- 0.16 mm, p = 0.99).
Treatment of hyperhomocysteinemia in chronic hemodialysis patients with daily oral 15 mg folic acid, 50 mg vitamin B6, and 1 mg vitamin B12 for 6 months decreases homocysteine levels and tends to reduce IMT of carotid arteries. A long term study for the prevention of atherosclerosis is warranted.
高同型半胱氨酸血症是慢性血液透析患者动脉粥样硬化性血管疾病的独立危险因素。本分层随机对照试验旨在测定高剂量口服维生素B6、维生素B12和叶酸对同型半胱氨酸水平的影响，并通过颈动脉内膜中层厚度（IMT）评估其对动脉粥样硬化的影响。
54例患有高同型半胱氨酸血症的慢性血液透析患者被随机分为两组，一组每天口服15毫克叶酸、50毫克维生素B6和1毫克维生素B12（治疗组），另一组仅口服5毫克叶酸（对照组），为期6个月。两组均测量同型半胱氨酸水平和IMT。
6个月时，治疗组的同型半胱氨酸水平从27.94±8.54显著降至22.71±3.68毫摩尔/升（p = 0.009），而对照组从26.81±7.10毫摩尔/升显著升至30.82±8.76毫摩尔/升（p = 0.08）。两组间的平均差异具有统计学意义（p = 0.002）。颈动脉IMT无显著差异，然而，观察到治疗组有厚度减小的趋势（分别为0.69±0.29毫米和0.62±0.16毫米，p = 0.99）。
慢性血液透析患者每日口服15毫克叶酸、50毫克维生素B6和1毫克维生素B12治疗高同型半胱氨酸血症6个月可降低同型半胱氨酸水平，并倾向于降低颈动脉IMT。有必要进行一项预防动脉粥样硬化的长期研究。
