N5,N10-亚甲基四氢叶酸还原酶基因多态性指导个体化叶酸用药对慢性肾衰竭血液透析患者同型半胱氨酸的影响
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摘要
目的观察慢性肾衰竭维持性血液透析(MHD)患者在N5,N10-亚甲基四氢叶酸还原酶(MTHFR)基因多态性指导下的个体化服用叶酸治疗纠正高同型半胱氨酸血症的效果。方法研究纳入93例一般状况稳定的MHD患者,分为普通治疗组和个体化治疗组。两组患者均行低通量透析,并在研究期间透析器和血流量保持前后稳定。在透析治疗基础上,普通治疗组患者均口服叶酸15 mg/d,个体化治疗组依据患者MTHFR基因型决定叶酸用量,纯合子突变型(TT)、杂合子突变型(CT)和野生型(CC)患者分别口服叶酸剂量为30 mg/d、15 mg/d和10 mg/d。两组均治疗3个月,且所有患者均不使用维生素B_(12)。观察两组治疗前后血清同型半胱氨酸(Hcy)水平。结果给予叶酸普通治疗能有效降低慢性肾衰MHD患者血清Hcy水平,而依据MTHFR基因型个体化给予叶酸治疗的患者血清Hcy水平改善情况更佳,两组比较差异有统计学意义(P<0.05)。结论 MTHFR基因多态性指导个体化叶酸用药联合低通量透析能有效纠正慢性肾衰竭MHD患者高同型半胱氨酸血症。
引文
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[4] 田军,胡大勇,陆石,等.慢性肾衰竭血液透析患者血浆同型半胱氨酸的测定及其临床意义[J].中华内科杂志,2002,41(4):263-264.
[5] Liu Y,Liu YQ,Morita T,et al.Effect of dietary supplementation with folate on choline deficiency-induced hyperhomocysteinemia in rats[J].J Nutr Sci Vitaminol (Tokyo),2012,58(1):20-28.
[6] 施翎,聂振禹,冯微微,等.亚甲基四氢叶酸还原酶基因C677T、A1298C和G1793A多态性与血液透析患者血浆Hcy水平的关系[J].中国老年学杂志,2018,38(7):1659-1661.
[7] 刘琦,张一帆,邵国建,等.不同剂量叶酸联合B族维生素治疗维持性血液透析患者高同型半胱氨酸血症的效果观察[J].温州医科大学学报,2015,45(7):530-533.
[8] Soohoo M,Ahmadi SF,Qader H,et al.Association of serum vitamin B12 and folate with mortality in incident hemodialysis patients[J].Nephrol Dial Transplant,2016,32(6):1024-1032.
[9] Achour O,Elmtaoua S,Zellama D,et al.The C677T MTHFR genotypes influence the efficacy of B9 and B12 vitamins supplementation to lowering plasma total homocysteine in hemodialysis [J].J Nephrol,2016,29(5):691-698.
[10] Yamamoto K,Isa Y,Nakagawa T,et al.Folic acid fortification ameliorates hyperhomocysteinemia caused by a vitamin B6-deficient diet supplemented with l-methionine[J].Biosci Biotechnol Biochem,2012,76(10):1861-1865.