叶酸联合维生素b12治疗老年冠心病慢性心力衰竭伴高同型半胱氨酸血症疗效观察

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1、授予单位代码10089学号或申请号13105K妗逭科大§HebeiMedicalUniversity硕士学位论文在职科学学位叶酸联合维生素B12治疗老年冠心病慢性心力衰竭伴高同型半胱氨酸血症疗效观察学位申请人：边树伟导师：李星涛教授专业：内科学二级学院：第四医院2015年3月河北医科大学学位论文使用授权及知识产权归属承诺本学位论文在导师(或指导小组)的指导下，由本人独立完成。本学位论文研究所获得的研究成果，其知识产权归河北医科大学所有。河北医科大学有权对本学位论文进行交流、公开和使用。凡发表与学位论文主要内容相关的论文，第一

2、署名为单位河北医科大学，试验材料、原始数据、申报的专利等知识产权均归河北医科大学所有。否则,承担相应法律责任。研究生签名：导师签章二级学院领导盖章：o年j•月w日河北医科大学研究生学位论文独创性声明本论文是在导师指导下进行的研究工作及取得的研究成果，除了文中特别加以标注和致谢等内容外,文中不包含其他人已经发表或撰写的研究成果,指导教师对此进行了审定。本论文由本人独立撰写,文责自负。研究生签名：导师签章-目录中文摘要························································

3、·····················1英文摘要·············································································3研究论文叶酸联合维生素B12治疗老年冠心病慢性心力衰竭伴高同型半胱氨酸血症疗效观察前言·············································································6材料与方法···································

4、·································7结果·············································································10附表·············································································12讨论···································································

5、··········14结论·············································································18参考文献·······································································18综述血浆同型半胱氨酸血症与冠心病心力衰竭的研究进展···········23致谢·······················································

6、····························37个人简历·············································································38中文摘要叶酸联合维生素B12治疗老年冠心病慢性心力衰竭伴高同型半胱氨酸血症疗效观察摘要目的：探讨叶酸联合维生素B12治疗老年冠心病心力衰竭患者的心功能影响、氮末端脑钠肽（NT-proBNP）及心室结构变化，明确疗效。方法：选择2013-10～2014-11在承德市中心医院老年病科住院的老年冠心病所致慢性

7、心衰合并高同型半胱氨酸血症（HHCY）患者，随机分为对照组和实验组。对照组给予常规药物（ACEI-依那普利或ARB-厄贝沙坦、β受体阻滞剂-比索洛尔、利尿剂-氢氯噻嗪）。实验组在应用常规药物基础上加用叶酸和维生素B12。治疗后第4周后、第8周后检查：血常规、血糖、血脂及肝肾功能，NT-proBNP，心脏彩超等指标。比较治疗前后两组各项指标的变化。结果：1治疗前，实验组与对照组同型半胱氨酸（HCY）水平差异无统计学意义，经过治疗第4周后，对照组HCY水平有所降低，但与治疗前相比无统计学意义；实验组HCY水平下降明显，与治疗前相

8、比均有统计学意义，P<0.05。与对照组相比，实验组的HCY水平明显下降，有统计学意义，P<0.05。治疗第8周后，对照组HCY水平有所降低，但与治疗前相比无统计学意义；实验组HCY水平进一步下降，与治疗前及与治疗第4周后相比均有统计学意义，P<0.05。与对照组相比，实验组的HCY水平明