RESUMEN
BACKGROUND: Musculoskeletal disorders are an important cause of work absence. Clinical practice guidelines recommend nonsteroidal anti-inflammatory drugs (NSAIDs) for grade I-II cervical sprains. The combination of thiamine + pyridoxine + cyanocobalamin vitamins has been used, alone and in combination with NSAIDs, for pain and inflammation in musculoskeletal disorders. OBJECTIVE: The objective of this study was to demonstrate the analgesic synergy of dexketoprofen, and the combination of vitamins thiamine + pyridoxine + cyanocobalamin in a fixed-dose combination (FDC) for the treatment of acute pain caused by grade I-II cervical sprains. METHODS: We conducted a multicentre, prospective, randomized, double-blind, phase IIIb clinical study comparing two treatment groups: (1) dexketoprofen 25 mg/vitamin B (thiamine 100 mg, pyridoxine 50 mg and cyanocobalamin 0.50 mg) in an FDC (two or more active ingredients combined in a single dosage form) versus (2) dexketoprofen 25 mg monotherapy (single drug to treat a particular disease), one capsule or tablet orally, every 8 h for 7 days. Final mean, average change, and percentage change in pain perception (measured using a visual analogue scale [VAS]) were compared with baseline between groups. A p value < 0.05 was considered statistically significant. Analyses were conducted using SPSS software, v.29.0. RESULTS: A statistically significant reduction in pain intensity was observed from the third day of treatment with the FDC compared with monotherapy (- 3.1 ± - 1.5 and - 2.6 ± - 1.1 cm, respectively) measured using the VAS (p = 0.011). Regarding the degree of disability, using the Northwick Park Neck Pain Questionnaire (NPQ), statistical difference was observed for the final measurement (7.5%, interquartile range [IQR] 2.5, 10.5; vs. 7.9%, IQR 5.0, 13.8; p = 0.028). A lower proportion of adverse events was reported when using the FDC. CONCLUSIONS: The FDC of dexketoprofen/thiamine + pyridoxine + cyanocobalamin vitamins demonstrated superior efficacy and a better safety profile compared with dexketoprofen monotherapy for pain treatment in patients with grade I-II cervical sprains. CLINICAL TRIALS REGISTRATION: NCT05001555, registered 29 July 2021 ( https://clinicaltrials.gov/study/NCT05001555 ).
Asunto(s)
Antiinflamatorios no Esteroideos , Combinación de Medicamentos , Cetoprofeno , Piridoxina , Tiamina , Trometamina , Vitamina B 12 , Humanos , Método Doble Ciego , Tiamina/administración & dosificación , Tiamina/análogos & derivados , Tiamina/uso terapéutico , Cetoprofeno/administración & dosificación , Cetoprofeno/análogos & derivados , Femenino , Adulto , Piridoxina/administración & dosificación , Piridoxina/uso terapéutico , Masculino , Antiinflamatorios no Esteroideos/administración & dosificación , Vitamina B 12/análogos & derivados , Vitamina B 12/administración & dosificación , Vitamina B 12/uso terapéutico , Persona de Mediana Edad , Trometamina/administración & dosificación , Estudios Prospectivos , Complejo Vitamínico B/administración & dosificación , Complejo Vitamínico B/uso terapéutico , Dimensión del Dolor/métodos , Adulto JovenRESUMEN
Abstract Background: In most countries, contrary to some disadvantages, such as pain, relatively higher cost, and poor adherence to treatment, intramuscular (IM) route is still the primary treatment method for Vitamin B12 (VB12) deficiency. In recent years, because of these difficulties, new treatment methods are being sought for VB12 deficiency. Objectives: We aimed to compare sublingual (SL) and IM routes of VB12 administration in children with VB12 deficiency and to compare the efficacy of methylcobalamin and cyanocobalamin therapy in these children. Methods: This retrospective study comprised 129 patients with VB12 deficiency (serum Vitamin 12 level ≤ 200 pg/mL) aged 5-18 years. Based on the formulations of Vitamin 12, we divided the patients into three treatment groups as IM cyanocobalamin, SL cyanocobalamin, and SL methylcobalamin. Results: After Vitamin 12 therapy, serum Vitamin 12 levels increased significantly in all patients, and there was a statistically significant difference between the treatment groups (p < 0.05). Conclusions: SL cyanocobalamin and methylcobalamin were found as effective as IM cyanocobalamin for children with Vitamin 12 deficiency in correcting serum Vitamin 12 level and hematologic abnormalities.
Asunto(s)
Humanos , Masculino , Femenino , Preescolar , Niño , Adolescente , Vitamina B 12/administración & dosificación , Vitamina B 12/análogos & derivados , Complejo Vitamínico B/administración & dosificación , Deficiencia de Vitamina B 12/tratamiento farmacológico , Vitamina B 12/uso terapéutico , Complejo Vitamínico B/uso terapéutico , Administración Sublingual , Estudios Retrospectivos , Inyecciones IntramuscularesRESUMEN
BACKGROUND: In most countries, contrary to some disadvantages, such as pain, relatively higher cost, and poor adherence to treatment, intramuscular (IM) route is still the primary treatment method for Vitamin B12 (VB12) deficiency. In recent years, because of these difficulties, new treatment methods are being sought for VB12 deficiency. OBJECTIVES: We aimed to compare sublingual (SL) and IM routes of VB12 administration in children with VB12 deficiency and to compare the efficacy of methylcobalamin and cyanocobalamin therapy in these children. METHODS: This retrospective study comprised 129 patients with VB12 deficiency (serum Vitamin 12 level ≤ 200 pg/mL) aged 5-18 years. Based on the formulations of Vitamin 12, we divided the patients into three treatment groups as IM cyanocobalamin, SL cyanocobalamin, and SL methylcobalamin. RESULTS: After Vitamin 12 therapy, serum Vitamin 12 levels increased significantly in all patients, and there was a statistically significant difference between the treatment groups (p < 0.05). CONCLUSIONS: SL cyanocobalamin and methylcobalamin were found as effective as IM cyanocobalamin for children with Vitamin 12 deficiency in correcting serum Vitamin 12 level and hematologic abnormalities.
Asunto(s)
Deficiencia de Vitamina B 12/tratamiento farmacológico , Vitamina B 12/análogos & derivados , Vitamina B 12/administración & dosificación , Complejo Vitamínico B/administración & dosificación , Administración Sublingual , Adolescente , Niño , Preescolar , Femenino , Humanos , Inyecciones Intramusculares , Masculino , Estudios Retrospectivos , Vitamina B 12/uso terapéutico , Complejo Vitamínico B/uso terapéuticoRESUMEN
Lactobacillus coryniformis CRL 1001 and L. reuteri CRL 1098 have the complete genes necessary to synthesize pseudo-cobalamin as final product in a vitamin B12 free commercial medium. Unlike vitaminB12 (the most biologically active form), the pseudo-cobalamin contains adenine instead of 5,6-dimethlbenzimidazole (DMB) in the Coα-ligand. Considering the vitamin B12-gene clusters of these bacteria, the aim of this work was to analyze the production of corrinoids with DMB (vitamin B12) instead of adenine (pseudo-B12) as lower ligand base in a vitamin B12 free chemically defined medium (CDM) without purines. Genome-wide screening of genes related to purine metabolism showed that both strains possess all pur genes necessary for the synthesis of inositol monophosphate, the main precursor for purine biosynthesis. Accordingly, both strains were able to grow in B12 free CDM without purines, with the supplementation of different synthetic intermediaries. Isolated compounds with positive vitamin B12 activity were quantified and characterized by LC/MS-MS. Total corrinoids values were higher for both strains in comparison to those obtained in vitaminB12 free commercial medium. Interestingly, CRL 1001 strain synthesized cobalamin, suggesting that this strain is able to activate DMB as nitrogenous base instead adenine when it is in excess in a purine-free medium. The present paper represents the first demonstration of a partial metabolic shift to produce vitamin B12 in a Lactobacillus strain.
Asunto(s)
Lactobacillus/metabolismo , Limosilactobacillus reuteri/metabolismo , Purinas/metabolismo , Vitamina B 12/análogos & derivados , Vitamina B 12/metabolismo , Medios de Cultivo/metabolismo , Redes y Vías MetabólicasRESUMEN
To examine the growth of Candida norvegensis (strain Levazoot 15), four experiments were conducted with different sources of energy, nitrogen, vitamins, and microminerals. Optical density was used as an indirect measure of strain growth in a fully randomized factorial design, in which principal factor A was the source of energy, nitrogen, vitamins, or microminerals and principal factor B was the measurement time point (0, 20, or 40 h). The results showed that the yeast strain used glucose (primarily sucrose and lactose) as the energy source and tryptone as the nitrogen source. The addition of B-complex vitamins or microminerals was not necessary for strain growth. It is concluded that the strain Levazoot 15 preferentially utilizes glucose as a source of energy, tryptone as a source of nitrogen and manganese as a mineral source, and that no vitamin source was necessary for growth.
Asunto(s)
Candida/crecimiento & desarrollo , Candida/metabolismo , Glucosa/metabolismo , Manganeso/metabolismo , Peptonas/metabolismo , Metabolismo Energético/fisiología , Minerales/metabolismo , Nitrógeno/metabolismo , Vitamina B 12/análogos & derivados , Vitamina B 12/metabolismo , Vitaminas/metabolismoRESUMEN
OBJECTIVE: To analyze the effect of mecobalamin on the early-functional outcomes of patients with ischemic stroke and H-type hypertension. METHODS: From October of 2014 to October of 2016, 224 cases of ischemic stroke and H-type hypertension were selected. The patients were randomly divided into treatment control groups, with 112 patients in each group. The control group was treated with the conventional therapy. The observation group was treated with 500 µg of mecobalamin three times a day in addition to the conventional therapy. We compared serum homocysteine (Hcy), hs-CRP levels, carotid plaques, and NIHSS scores between the two groups on the 2nd day and at 4 weeks, 8 weeks, 3 months, and 6 months. RESULTS: After 4 weeks, 8 weeks, 3 months and 6 months, the difference of serum Hcy level between the two groups was statistically significant (t = 4.049, 3.896, 6.052, 6.159, respectively. All P <0.05). After the treatment, at 4 weeks, 8 weeks, 3 months and 6 months, the levels of hs-CRP in the treatment group were significantly lower than those in the control group (t = 37.249, 28.376, 26.454, 20.522, respectively. All P <0.01). After 3 months and 6 months, the carotid artery plaques were significantly reduced in the treatment group compared to those in the control group (t = 2.309 and 2.434. All P <0.05). After 3 months and 6 months, the NIHSS score was significantly higher in the treatment group compared to those in the control group (t = 2.455 and 2.193. All P <0.05). CONCLUSION: Mecobalamin can reduce the level of plasma homocysteine, then lead to reductions of levels of plasma inflammatory factors and volume of carotid artery plaques, resulting in more significant functional recovery.
Asunto(s)
Homocisteína/sangre , Hipertensión/sangre , Hipertensión/tratamiento farmacológico , Accidente Cerebrovascular/tratamiento farmacológico , Vitamina B 12/análogos & derivados , Anciano , Anciano de 80 o más Años , Isquemia Encefálica/sangre , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Accidente Cerebrovascular/sangre , Resultado del Tratamiento , Vitamina B 12/uso terapéuticoRESUMEN
SUMMARY OBJECTIVE To analyze the effect of mecobalamin on the early-functional outcomes of patients with ischemic stroke and H-type hypertension. METHODS From October of 2014 to October of 2016, 224 cases of ischemic stroke and H-type hypertension were selected. The patients were randomly divided into treatment control groups, with 112 patients in each group. The control group was treated with the conventional therapy. The observation group was treated with 500 µg of mecobalamin three times a day in addition to the conventional therapy. We compared serum homocysteine (Hcy), hs-CRP levels, carotid plaques, and NIHSS scores between the two groups on the 2nd day and at 4 weeks, 8 weeks, 3 months, and 6 months. RESULTS After 4 weeks, 8 weeks, 3 months and 6 months, the difference of serum Hcy level between the two groups was statistically significant (t = 4.049, 3.896, 6.052, 6.159, respectively. All P <0.05). After the treatment, at 4 weeks, 8 weeks, 3 months and 6 months, the levels of hs-CRP in the treatment group were significantly lower than those in the control group (t = 37.249, 28.376, 26.454, 20.522, respectively. All P <0.01). After 3 months and 6 months, the carotid artery plaques were significantly reduced in the treatment group compared to those in the control group (t = 2.309 and 2.434. All P <0.05). After 3 months and 6 months, the NIHSS score was significantly higher in the treatment group compared to those in the control group (t = 2.455 and 2.193. All P <0.05). CONCLUSION Mecobalamin can reduce the level of plasma homocysteine, then lead to reductions of levels of plasma inflammatory factors and volume of carotid artery plaques, resulting in more significant functional recovery.
RESUMO OBJETIVO Analisar o efeito de mecobalamin sobre os primeiros resultados funcionais de pacientes com AVC isquêmico e hipertensão H-type. MÉTODOS De outubro de 2014 a outubro de 2016, 224 casos de AVC isquêmico e hipertensão H-type foram selecionadas. Os pacientes foram divididos aleatoriamente em grupo de tratamento e grupo controle, com 112 doentes em cada grupo. O grupo controle foi tratado com a terapia de rotina. O grupo de observação foi tratado com 500 µg de mecobalamin três vezes por dia, além da rotina de tratamento. No segundo dia, 4 semanas, 8 semanas, 3 meses e 6 meses, comparamos níveis séricos da homocisteína (Hcy) e de hs-CRP, placas da carótida e pontuações NIHSS entre os dois grupos. RESULTADOS Após 4 semanas, 8 semanas, 3 meses e 6 meses, a diferença dos níveis séricos de Hcy entre os dois grupos foi estatisticamente significativa (t= 4,049, 3,896, 6,052, 6,159, respectivamente. Todos os P<0,05). Após o tratamento de 4 semanas, 8 semanas, 3 meses e 6 meses, os níveis de hs-CRP no grupo de tratamento foram significativamente inferiores aos do grupo controle (t=37,249, 28,376, 26,454, 20,522, respectivamente. Todos os P<0,01). Depois de 3 meses e 6 meses, as placas da artéria carótida foram significativamente reduzidas no tratamento, em comparação com os do grupo controle (t=2,309 e 2,434. Todos os P<0,05). Depois de 3 meses e 6 meses, as pontuações NIHSS foram significativamente mais elevadas no tratamento em comparação com as do grupo controle (t=2,455 e 2,193. Todos os P<0,05). CONCLUSÃO Mecobalamin pode reduzir o nível de homocisteína plasmática, o que conduz à redução dos níveis de plasma inflamatórios e do volume das placas na artéria carótida, resultando em maior recuperação funcional.
Asunto(s)
Humanos , Masculino , Femenino , Anciano , Anciano de 80 o más Años , Vitamina B 12/análogos & derivados , Accidente Cerebrovascular/tratamiento farmacológico , Homocisteína/sangre , Hipertensión/tratamiento farmacológico , Hipertensión/sangre , Pronóstico , Vitamina B 12/uso terapéutico , Isquemia Encefálica/sangre , Resultado del Tratamiento , Accidente Cerebrovascular/sangre , Persona de Mediana EdadRESUMEN
Homocysteine is an independent risk factor for cardiovascular disease in the general population. In addition, it plays a main role in the development of atherogenesis and thrombosis, particularly in end-stage renal disease patients. Therefore, hemodialysis patients are under the burden of homocysteine toxic effects, present in nearly 90% of dialysis patients. Our group found that folic acid is an efficient therapeutic approach to decrease homocysteine levels, and the addition of intravenous methylcobalamin potentiates this effect; however, methylcobalamin alone was unsuccessful to normalize homocysteine levels. With time a group of patients required a higher dose of folic acid to reduce hyperhomocysteinemia. Patients homozygous and, to a lesser extent heterozygous, to the C677T thermolabile variant of methylenetetrahydrofolate reductase (MTHFR) presented a reduced catalytic activity and required a higher folic acid dose. Vascular-access thrombotic events were similar in all patients according to the variants of the enzyme, suggesting that treating hyperhomocysteinemia was the key to lower the risk of thromboses. Noteworthy, hypohomocysteinemia, generally acompanying malnourishment, is associated to higher mortality. Albeit hyper-homocysteinemia is considered a vascular risk factor in renal failure patients, it has not yet been established in this population if its correction is associated with a decrease in the rate of vascular disease and thrombosis. However, given the mentioned evidence about the low risk and good tolerance of vitamin therapy, we believe it useful to know folate, cobalamin and homocysteine blood levels in chronic renal patients and start a prompt treatment, which may proof adequate to maintain homocysteine levels of 10 +/- 5 micromol/l.
Asunto(s)
Aterosclerosis/etiología , Ácido Fólico/uso terapéutico , Hiperhomocisteinemia/complicaciones , Diálisis Renal/efectos adversos , Trombosis/etiología , Complejo Vitamínico B/uso terapéutico , Aterosclerosis/metabolismo , Ácido Fólico/metabolismo , Homocisteína/sangre , Homocisteína/efectos de los fármacos , Humanos , Hiperhomocisteinemia/tratamiento farmacológico , Hiperhomocisteinemia/metabolismo , Fallo Renal Crónico/tratamiento farmacológico , Fallo Renal Crónico/metabolismo , Metilenotetrahidrofolato Reductasa (NADPH2)/metabolismo , Metilenotetrahidrofolato Reductasa (NADPH2)/uso terapéutico , Factores de Riesgo , Trombosis/metabolismo , Vitamina B 12/análogos & derivados , Vitamina B 12/metabolismo , Vitamina B 12/uso terapéutico , Complejo Vitamínico B/metabolismoRESUMEN
La homocisteína es un factor de riesgo independiente de enfermedad cardiovascular en la población general, y juega un rol protagónico en el desarrollo de la aterogénesis y las trombosis vasculares, sobre todo en pacientes con insuficiencia renal. Así pues, los pacientes en hemodiálisis están bajo los efectos tóxicos de la hiperhomocisteinemia, presente en cerca del 90% de estos pacientes. En nuestra experiencia hemos encontrado que el ácido fólico es un tratamiento eficaz para disminuir los niveles de homocisteína, y el agregado de metilcobalamina intravenosa potencia este efecto; sin embargo, la metilcobalamina por sí sola fue insuficiente para normalizar la homocisteinemia. A lo largo del tiempo, un grupo de pacientes requirió dosis más elevadas de ácido fólico para corregir la hiperhomocisteinemia. Los pacientes homocigotas y, en menor medida hete-rocigotas para la variante termolábil C677T de la enzima metilentetrahidrofolato reductasa (MTHFR), presentaron una actividad catalítica reducida reflejada en la necesidad de una mayor dosis de ácido fólico para normalizar los niveles de homocisteína. Los efectos trombóticos vasculares fueron similares en todos los pacientes respecto a las variantes genéticas de la enzima metilentetrahidrofolato reductasa, sugiriendo que el tratamiento de la hiperhomocisteinemia es importante para disminuir el riesgo de trombosis. Sin embargo, también la hipoho-mocisteinemia, asociada generalmente a estados de desnutrición, se asocia a mayor mortalidad. Si bien se considera a la hiperhomocisteinemia como un factor de riesgo vascular en los pacientes con insuficiencia renal, aún no se determinó en esta población si su corrección se asocia a una disminución de la tasa de enfermedad vascular y de trombosis. No obstante...(AU)
Homocysteine is an independent risk factor for cardiovascular disease in the general population. In addition, it plays a main role in the development of atherogenesis and thrombosis, particularly in end-stage renal disease patients. Therefore, hemodialysis patients are under the burden of homocysteine toxic effects, present in nearly 90% of dialysis patients. Our group found that folic acid is an efficient therapeutic approach to decrease homocysteine levels, and the addition of intravenous methylcobalamin potentiates this effect; however, methylcobalamin alone was unsuccessful to normalize homocysteine levels. With time a group of patients required a higher dose of folic acid to reduce hyperhomocysteinemia. Patients homozygous and, to a lesser extent heterozygous, to the C677T thermolabile variant of methylenetetrahydrofolate reductase (MTHFR) presented a reduced catalytic activity and required a higher folic acid dose. Vascular-access thrombotic events were similar in all patients according to the variants of the enzyme, suggesting that treating hyperhomocysteinemia was the key to lower the risk of thromboses. Noteworthy, hypohomocysteinemia, generally acompanying malnourishment, is associated to higher mortality. Albeit hyper-homocysteinemia is considered a vascular risk factor in renal failure patients, it has not yet been established in this population if its correction is associated with a decrease in the rate of vascular disease and thrombosis. However, given the mentioned evidence about the low risk and good tolerance of vitamin therapy, we believe it useful to know folate, cobalamin and homocysteine blood levels in chronic renal patients and start a prompt treatment, which may proof adequate to maintain homocysteine levels of 10 +/- 5 micromol/l.(AU)
Asunto(s)
Humanos , Aterosclerosis/etiología , Ácido Fólico/uso terapéutico , Hiperhomocisteinemia/complicaciones , Diálisis Renal/efectos adversos , Trombosis/etiología , Complejo Vitamínico B/uso terapéutico , Aterosclerosis/metabolismo , Ácido Fólico/metabolismo , Homocisteína/sangre , Homocisteína/efectos de los fármacos , Hiperhomocisteinemia/tratamiento farmacológico , Hiperhomocisteinemia/metabolismo , Fallo Renal Crónico/tratamiento farmacológico , Fallo Renal Crónico/metabolismo , Metilenotetrahidrofolato Reductasa (NADPH2)/metabolismo , Metilenotetrahidrofolato Reductasa (NADPH2)/uso terapéutico , Factores de Riesgo , Trombosis/metabolismo , Vitamina B 12/análogos & derivados , Vitamina B 12/metabolismo , Vitamina B 12/uso terapéutico , Complejo Vitamínico B/metabolismoRESUMEN
Homocysteine is a risk factor for cardiovascular disease. Mutations in a key enzyme in homocysteine metabolism, methylenetetrahydrofolate reductase, may contribute to hyperhomocysteinemia and alter folate and cobalamin levels. After starting hemodialysis, 10 mg oral folate daily and 500 micrograms intravenous methylcobalamin once weekly were prescribed to 27 hemodialysis patients (time on hemodialysis > or = 12 months) and two groups were defined: Group A normal; Group B heterozygous. Initial, third and twelfth month measurements of homocysteine, serum folate and vitamin B12 levels were collected and analyzed. Heterozygous state of methylenetetrahydrofolate reductase prevalence was 48% and homozygozity 4%. Hyperhomocysteinemia was present in both groups. Cobalamin final levels were significantly lower in Group B compared to Group A. Homocysteine, serum folate and cobalamin levels at third and twelfth month were significantly different from baseline levels but non-different between them in both groups. In Group B, vitamin B12 at third month was significantly higher than initial, but final measurements were not different from baseline determinations. In conclusion, the heterozygous prevalence of the enzyme in hemodialysis patients is similar to that reported in the general population; hyperhomocysteinemia is frequent in hemodialysis patients and final levels in heterozygous patients are significantly higher than in normal patients. Cobalamin levels are lower in the heterozygous group. After one year of treatment, homocysteine tends to increase, suggesting a secondary resistance phenomenon to vitamin supplementation in heterozygous patients.
Asunto(s)
Ácido Fólico/sangre , Homocisteína/sangre , Fallo Renal Crónico/enzimología , Oxidorreductasas actuantes sobre Donantes de Grupo CH-NH/genética , Vitamina B 12/análogos & derivados , Vitamina B 12/sangre , Adulto , Distribución de Chi-Cuadrado , Femenino , Ácido Fólico/uso terapéutico , Heterocigoto , Homocisteína/genética , Humanos , Hiperhomocisteinemia/prevención & control , Fallo Renal Crónico/sangre , Fallo Renal Crónico/terapia , Masculino , Metilenotetrahidrofolato Reductasa (NADPH2) , Persona de Mediana Edad , Mutación Puntual/genética , Diálisis Renal , Estadísticas no Paramétricas , Vitamina B 12/uso terapéuticoRESUMEN
BACKGROUND: There are no data available on the effects of intravenous (i.v.) methylcobalamin (Me-Cbl), the coenzymatically active form of vitamin B12 that acts as a cofactor for methionine synthase in the conversion of total homocysteine (tHcy) to methionine, with or without oral folic acid (FA) supplementation, on fasting tHcy levels in hemodialysis (HD) patients. METHODS: We performed a prospective randomized trial in which 62 chronic HD patients without previous vitamin supplementation were divided into four groups. Group A received Me-Cbl 500 microg twice/week plus FA 10 mg/day; group B received FA 10 mg/day alone; group C received no vitamin supplementation, and group D was on Me-Cbl 500 microg twice/week alone. Fasting tHcy, vitamin B12, serum (s) FA and erythrocytic (e) FA were measured predialysis before and after 4 months of therapy. RESULTS: Final tHcy levels were significantly lower in group A (10.2 +/- 3.1 micromol/l) compared to groups C (27.3 +/- 9.7 micromol/l, p < 0.001) and group D (24.3 +/- 11.8 micromol/l, p < 0.001) and similar to group B (11.2 +/- 1.9 micromol/l, p = n.s.). Mean tHcy levels showed a significant decrease in group A from 22.5 +/- 15.6 to 10.2 +/- 3.1 micromol/l (p = 0.003) and in group B from 19.9 +/- 4.0 to 11.2 +/- 1.9 micromol/l (p = 0.012), while no significant changes were observed in groups C (25.9 +/- 9.3 vs. 27.3 +/- 9.7 micromol/l, p = n.s.) and D (26.6 +/- 14.3 vs. 24.3 +/- 11.8 micromol/l, p = n.s.). CONCLUSION: Oral FA (10 mg/day) supplementation appears to be an effective approach to normalize plasma tHcy in chronic HD patients; the addition of i.v. Me-Cbl (500 microg twice/week) to this regimen showed no benefit. Separately, FA corrected hyperhomocysteinemia (HtHcy), while Me-Cbl showed no change.
Asunto(s)
Ácido Fólico/farmacología , Homocisteína/sangre , Diálisis Renal , Vitamina B 12/análogos & derivados , Vitamina B 12/farmacología , Adulto , Anciano , Anciano de 80 o más Años , Método Doble Ciego , Femenino , Ácido Fólico/sangre , Humanos , Masculino , Metilación , Persona de Mediana Edad , Estudios Prospectivos , Vitamina B 12/sangre , Vitamina B 12/metabolismoRESUMEN
Homocysteine is a risk factor for cardiovascular disease. Mutations in a key enzyme in homocysteine metabolism, methylenetetrahydrofolate reductase, may contribute to hyperhomocysteinemia and alter folate and cobalamin levels. After starting hemodialysis, 10 mg oral folate daily and 500 micrograms intravenous methylcobalamin once weekly were prescribed to 27 hemodialysis patients (time on hemodialysis > or = 12 months) and two groups were defined: Group A normal; Group B heterozygous. Initial, third and twelfth month measurements of homocysteine, serum folate and vitamin B12 levels were collected and analyzed. Heterozygous state of methylenetetrahydrofolate reductase prevalence was 48
. Hyperhomocysteinemia was present in both groups. Cobalamin final levels were significantly lower in Group B compared to Group A. Homocysteine, serum folate and cobalamin levels at third and twelfth month were significantly different from baseline levels but non-different between them in both groups. In Group B, vitamin B12 at third month was significantly higher than initial, but final measurements were not different from baseline determinations. In conclusion, the heterozygous prevalence of the enzyme in hemodialysis patients is similar to that reported in the general population; hyperhomocysteinemia is frequent in hemodialysis patients and final levels in heterozygous patients are significantly higher than in normal patients. Cobalamin levels are lower in the heterozygous group. After one year of treatment, homocysteine tends to increase, suggesting a secondary resistance phenomenon to vitamin supplementation in heterozygous patients.