叶酸和甲钴胺治疗卒中患者髋关节骨折的随机对照试验

作     者：Sato Y. Honda Y. Iwamoto J. 黄卫东 

作者机构：Departmentof Neurology Mitate Hospital 3237 YugetaTagawa 826-0041 Japan Dr. 

出 版 物：《世界核心医学期刊文摘（神经病学分册）》 (Digest of the World Core Medical Journals:Clinical Neurology)

年 卷 期：2005年第1卷第7期

页      面：6-7页

学科分类：1002[医学-临床医学] 100210[医学-外科学(含：普外、骨外、泌尿外、胸心外、神外、整形、烧伤、野战外)] 10[医学] 

主　　题：髋关节骨折 甲钴胺 随机对照试验 骨折发生率 Japanese 缺血性卒中 骨质疏松 placebo 安慰剂 folate 

摘      要：Context: Stroke increases the risk of subsequent hip fracture by 2 to 4 times. Hyperhomocysteinemia is a risk factor for both ischemic stroke and osteoporotic fractures in elderly men and women. Treatment with folate and mecobalamin (vita min B12) may improve ***: To investigate whether trea tment with folate and vitamin B12 reduces the incidence of hip fractures in pati ents with hemiplegia following ***, Setting, and Patients: A double-b lind, randomized controlled study of 628 consecutive patients aged 65 years or o lder with residual hemiplegia at least 1 year following first ischemic stroke, w ho were recruited from a single Japanese hospital from April 1, 2000, to May 31, 2001. Patients were assigned to daily oral treatment with 5 mg of folate and 15 00 μg of mecobalamin,or double placebo; 559 completed the 2-year *** in Outcome Measure: Incidence of hip fractures in the 2 patient groups during th e 2-year follow-up. Results:At baseline, patients in both groups had high leve ls of plasma homocysteine and low levels of serum cobalamin and serum folate. Af ter 2 years, plasma homocysteine levels decreased by 38%in the treatment group and increased by 31%in the placebo group (P .001). The number of hip fracture s per 1000 patient-years was 10 and 43 for the treatment and placebo groups, re spectively(P .001). The adjusted relative risk, absolute risk reduction,and th e number needed to treat for hip fractures in the treatment vs placebo groups we re 0.20 (95%confidence interval [CI], 0.08-0.50), 7.1%(95%CI, 3.6%-10.8%) , and 14 (95%CI, 9-28), respectively. No significant adverse effects were repo rted. Conclusion: In this Japanese population with a high baseline fracture risk , combined treatment with folate and vitamin B12 is safe and effective in reduci ng the risk of a hip fracture in elderly patients following stroke.