B族維生素干預血漿同型半胱氨酸水平防治心腦血管疾病作用的Meta分析_《中國循證醫學雜志》

作者：

張琛 ^1,2 ,  朱惠蓮 ¹

1. 中山大學公共衛生學院營養學系（廣州 510080）；2. 廣州醫學院圖書館（廣州 510182）;

關鍵詞：

B 族維生素同型半胱氨酸心腦血管疾病 Meta 分析

DOI：

10.7507/1672-2531.20090013

視頻：

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摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

目的　評價通過補充B 族維生素降低血漿同型半胱氨酸（Hcy）水平對心腦血管疾病的防治作用。
方法　以“homocysteine”、“cardiovascular disease”、“cerebrovascular disease”、“B vitamins”、“randomized controlledtrial”等為檢索詞，檢索PubMed、Ovid、Springer 等電子數據庫；并同時運用手工檢索和文獻追溯手段，收集國外1998 ～ 2008 年6 月公開發表的關于補充B 族維生素干預血漿同型半胱氨酸水平的隨機對照試驗。兩名評價者獨立依據納入和排除標準篩選文獻，提取資料并進行方法學質量評估。統計學分析采用RevMan 4.2 軟件。
結果　共納入16 個隨機對照試驗（共27 043 例）。Meta 分析結果表明，干預組與對照組之間心血管事件（CVE）、冠心病（CHD）、腦卒中和總病死率的差異均無統計學意義，其RR（95%CI）分別為0.98（0.94，1.03）、0.99（0.92，1.07）、0.90（0.80，1.02）、0.98（0.92，1.05）。剔除評分較低的研究后做敏感性分析，結果不變。
結論　 ① 目前的研究尚未能證實同型半胱氨酸和心腦血管疾病之間存在因果關系，尚需大量大規模的前瞻性隨機對照試驗來驗證。② 目前還沒有足夠證據說明補充B 族維生素會減少心血管事件發生的危險，故不推薦把補充B 族維生素作為心腦血管疾病的二級預防措施。

引用本文： 張琛,朱惠蓮. B族維生素干預血漿同型半胱氨酸水平防治心腦血管疾病作用的Meta分析. 中國循證醫學雜志, 2009, 09(1): 55-62. doi: 10.7507/1672-2531.20090013 復制

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3.	The Homocysteine Studies Collaboration. Homocysteine and risk of ischemic heart disease and stroke. JAMA, 2002, 16: 2015-2022.
4.	Sackett DL, Clarke M, Oxman AD, et al. Cochrane Reviewers, Handbook 4.2,In Review Manager.Versions 4.2.Oxford, England: The cochrane collaboration, 2002, 13-36.
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7.	Righetti M, Ferrario GM, Milani S, et al. Effects of folic acid treatment on homocysteine levels and vascular disease in hemodialysis patients. Med Sci Monit, 2003, 9: P119-P124.
8.	Lange H, Suryapranata H, De Luca G, et al. Folate therapy and instent restenosis after coronary stenting. N Engl J Med, 2004, 350: 2673-2681.
9.	Toole JF, Mal inow MR, Chambles s LE, e t al . Lower ing homocysteine in patients with ischemic stroke to prevent recurrent stroke,myocardial infarction,and death: the Vitamin Intervention for Stroke Prevention (VISP) randomized controlled trial. JAMA, 2004, 291: 565-575.
10.	Wrone EM, Hornberger JM, Zehnder JL, et al. Randomized trial of folic acid for prevention of cardiovascular events in end-stage renal disease. J Am Soc Nephrol, 2004, 15: 420-426.
11.	Liem A, Reynierse-Buitenwerf GH, Zwinderman AH, et al. Secondary prevention with folic acid: results of the Goes extension study. Heart, 2005, 91: 1213-1214.
12.	Bonaa KH, Njolstad I, Ueland PM, et al. Homocysteine lowering and cardiovascular events after acute myocardial infarction. N Engl J Med, 2006, 354: 1578-1588.
13.	Lonn E, Yusuf S, Arnold MJ, et al. Homocysteine lowering with folic acid and B vitamins in vascular disease. N Engl J Med, 2006, 354: 1567-1577.
14.	Righetti M, Serbelloni P, Johansson I, et al. Homocysteine-lowering vitamin B treatment decreases cardiovascular events in hemodialysis patients. Blood Purif, 2006, 24: 379-386.
15.	Zoungas S, McGrath BP, Branley P, et al. Cardiovascular morbidity and mortality in the Atherosclerosis and Folic Acid Supplementation Trial (ASFAST) in chronic renal failure: a multicenter, randomized, controlled trial. J Am Coll Cardiol, 2006, 47: 1108-1116.
16.	Haijer M, Willems HP, Blom HJ, et al. Homocysteine lowering by B vitamins and the secondary prevention of deep vein thrombosis and pulmonary embolism:a randomized, placebo-controlled, doubleblind trial. Blood, 2007, 109: 139-144.
17.	Jamison RL, Hartigan P, Kaufman JS, et al. Effect of homocysteine lowering on mortality and vascular disease in advanced chronic kidney disease and end-stage renal disease: a randomized controlled trial. JAMA, 2007, 298(10): 1163-1170.
18.	Ebbing Marta. the European Society of Cardiology Congress 2007.
19.	Albert CM, Cook NR, Gaziano JM, et al. Effect of folic acid and B vitamins on risk of cardiovascular events and total mortality among women at high risk for cardiovascular disease: a randomized trial. JAMA, 2008, 299(17): 2027-2036.
20.	Mann JF, Sheridan P, McQueen MJ, et al. Homocysteine lowering with folic acid and B vitamins in people with chronic kidney disease- -results of the renal Hope-2 study. Nephrol Dial Transplant, 2008, 23(2): 645-653.
21.	Wald NJ. Folic acid and the prevention of neural-tube defects. N Engl J Med, 2004, 350: 101-103．.
22.	Bor MV, Refsum H, Bisp MR, et al. Plasma vitamin B6 vitamers before and after oral vitamin B6 treatment:a randomized placebocontrolled study. Clin Chem, 2003, 49: 155-161.
23.	Matsubara K, Mori M, Matsuura Y, et al. Pyridoxal 5-phosphate and pyridoxal inhibit angiogenesis in serum-free rat aortic ring assay. Int J Mol Med, 2001, 8: 505-508.
24.	Ulrich CM, Potter JD. Folate and cancer--timing is everything. JAMA, 2007, 297(21): 2408-2409.
25.	Moat SJ, Doshi SN, Lang D, et al. Treatment of coronary heart disease with folic acid: Is there a future? Am J Physiol Heart Circ Physiol, 2004, 287: H1-H7.
26.	Kothekar MA. Homocysteine in cardiovascular disease: A culprit or an innocent bystander? Indian J Med Sci, 2007, 61(6): 361-371.
27.	Bostom AG, Carpenter MA, Kusek Jw, et al. Rationale and design of the Folic Acid for Vascular Outcome Reduction In Transplantation(FAVORIT) trial. Am Heart J, 2006, 152: 448.e1-7.
28.	SEARCH Study Collaborative Group. Study of the effectiveness of additional reductions in cholesterol and homocysteine (SEARCH): characteristics of a randomized trial among 12064 myocardial infarction survivors. Am Heart J, 2007, 154: 815-823.
29.	VITATOPS Trial Study Group. VITATOPS, the vitamins to prevent stroke trial: rationale and design of a randomised trial of B-vitamin therapy in patients with recent transient ischaemic attack or stroke. Int J Stroke, 2007, 2(2): 144-150.

1. 孔靈芝, 胡盛壽. 中國心血管病報告. 北京: 中國大百科全書出版社. 2008, 4.
2. Boushey CJ, Beresford SA, Omenn GS, et al. A quantitative assessment of plasma homocysteine as a risk factor for vascular disease: probable benefits of increasing folic acid intakes. JAMA, 1995, 274: 1049-1057.
3. The Homocysteine Studies Collaboration. Homocysteine and risk of ischemic heart disease and stroke. JAMA, 2002, 16: 2015-2022.
4. Sackett DL, Clarke M, Oxman AD, et al. Cochrane Reviewers, Handbook 4.2,In Review Manager.Versions 4.2.Oxford, England: The cochrane collaboration, 2002, 13-36.
5. Baker F, Picton D, Blackwood S, et al. Blinded comparison of folic acid and placebo in patients with ischemic heart disease: an outcome trial [abstract]. Circulation, 2002, 106(suppl 2): 741S.
6. Schnyder G, Roffi M, Flammer Y, et al. Effect of homocysteinelowering therapy with folic acid, vitamin B12, and vitamin B6 on clinical outcome after percutaneous coronary intervention:the Swiss Heart Study: a randomized controlled trial. JAMA, 2002, 288: 973-979.
7. Righetti M, Ferrario GM, Milani S, et al. Effects of folic acid treatment on homocysteine levels and vascular disease in hemodialysis patients. Med Sci Monit, 2003, 9: P119-P124.
8. Lange H, Suryapranata H, De Luca G, et al. Folate therapy and instent restenosis after coronary stenting. N Engl J Med, 2004, 350: 2673-2681.
9. Toole JF, Mal inow MR, Chambles s LE, e t al . Lower ing homocysteine in patients with ischemic stroke to prevent recurrent stroke,myocardial infarction,and death: the Vitamin Intervention for Stroke Prevention (VISP) randomized controlled trial. JAMA, 2004, 291: 565-575.
10. Wrone EM, Hornberger JM, Zehnder JL, et al. Randomized trial of folic acid for prevention of cardiovascular events in end-stage renal disease. J Am Soc Nephrol, 2004, 15: 420-426.
11. Liem A, Reynierse-Buitenwerf GH, Zwinderman AH, et al. Secondary prevention with folic acid: results of the Goes extension study. Heart, 2005, 91: 1213-1214.
12. Bonaa KH, Njolstad I, Ueland PM, et al. Homocysteine lowering and cardiovascular events after acute myocardial infarction. N Engl J Med, 2006, 354: 1578-1588.
13. Lonn E, Yusuf S, Arnold MJ, et al. Homocysteine lowering with folic acid and B vitamins in vascular disease. N Engl J Med, 2006, 354: 1567-1577.
14. Righetti M, Serbelloni P, Johansson I, et al. Homocysteine-lowering vitamin B treatment decreases cardiovascular events in hemodialysis patients. Blood Purif, 2006, 24: 379-386.
15. Zoungas S, McGrath BP, Branley P, et al. Cardiovascular morbidity and mortality in the Atherosclerosis and Folic Acid Supplementation Trial (ASFAST) in chronic renal failure: a multicenter, randomized, controlled trial. J Am Coll Cardiol, 2006, 47: 1108-1116.
16. Haijer M, Willems HP, Blom HJ, et al. Homocysteine lowering by B vitamins and the secondary prevention of deep vein thrombosis and pulmonary embolism:a randomized, placebo-controlled, doubleblind trial. Blood, 2007, 109: 139-144.
17. Jamison RL, Hartigan P, Kaufman JS, et al. Effect of homocysteine lowering on mortality and vascular disease in advanced chronic kidney disease and end-stage renal disease: a randomized controlled trial. JAMA, 2007, 298(10): 1163-1170.
18. Ebbing Marta. the European Society of Cardiology Congress 2007.
19. Albert CM, Cook NR, Gaziano JM, et al. Effect of folic acid and B vitamins on risk of cardiovascular events and total mortality among women at high risk for cardiovascular disease: a randomized trial. JAMA, 2008, 299(17): 2027-2036.
20. Mann JF, Sheridan P, McQueen MJ, et al. Homocysteine lowering with folic acid and B vitamins in people with chronic kidney disease- -results of the renal Hope-2 study. Nephrol Dial Transplant, 2008, 23(2): 645-653.
21. Wald NJ. Folic acid and the prevention of neural-tube defects. N Engl J Med, 2004, 350: 101-103．.
22. Bor MV, Refsum H, Bisp MR, et al. Plasma vitamin B6 vitamers before and after oral vitamin B6 treatment:a randomized placebocontrolled study. Clin Chem, 2003, 49: 155-161.
23. Matsubara K, Mori M, Matsuura Y, et al. Pyridoxal 5-phosphate and pyridoxal inhibit angiogenesis in serum-free rat aortic ring assay. Int J Mol Med, 2001, 8: 505-508.
24. Ulrich CM, Potter JD. Folate and cancer--timing is everything. JAMA, 2007, 297(21): 2408-2409.
25. Moat SJ, Doshi SN, Lang D, et al. Treatment of coronary heart disease with folic acid: Is there a future? Am J Physiol Heart Circ Physiol, 2004, 287: H1-H7.
26. Kothekar MA. Homocysteine in cardiovascular disease: A culprit or an innocent bystander? Indian J Med Sci, 2007, 61(6): 361-371.
27. Bostom AG, Carpenter MA, Kusek Jw, et al. Rationale and design of the Folic Acid for Vascular Outcome Reduction In Transplantation(FAVORIT) trial. Am Heart J, 2006, 152: 448.e1-7.
28. SEARCH Study Collaborative Group. Study of the effectiveness of additional reductions in cholesterol and homocysteine (SEARCH): characteristics of a randomized trial among 12064 myocardial infarction survivors. Am Heart J, 2007, 154: 815-823.
29. VITATOPS Trial Study Group. VITATOPS, the vitamins to prevent stroke trial: rationale and design of a randomised trial of B-vitamin therapy in patients with recent transient ischaemic attack or stroke. Int J Stroke, 2007, 2(2): 144-150.

《中國循證醫學雜志》

B族維生素干預血漿同型半胱氨酸水平防治心腦血管疾病作用的Meta分析

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《中國循證醫學雜志》

B族維生素干預血漿同型半胱氨酸水平防治心腦血管疾病作用的Meta分析

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