目的 探讨通脉颗粒联合甲钴胺和叶酸治疗高同型半胱氨酸血症（HHcy）的临床疗效。方法 选取唐山市第九医院2015年3月-2016年3月收治的HHcy患者86例，根据治疗方案的差别分为对照组和治疗组，每组各43例。对照组患者口服甲钴胺片，1片/次，3次/d；同时口服叶酸片，1片/次，1次/d。治疗组在对照组的基础上口服通脉颗粒，1袋/次，3次/d。两组患者均连续治疗6周。观察两组患者的临床疗效，同时比较两组治疗前后同型半胱氨酸（Hcy）、三酰甘油（TG）、总胆固醇（TC）、低密度脂蛋白（LDL-C）、高密度脂蛋白（HDL-C）、血清NO、内皮素-1（ET-1）、超氧化物歧化酶（SOD）和丙二醛（MDA）的变化情况。结果 治疗后，对照组和治疗组的总有效率分别为76.74%、93.02%，两组比较差异有统计学意义（P<0.05）。治疗后，两组TC、TG、LDL-C、Hcy水平均显著降低，HDL-C水平则升高，同组治疗前后比较差异具有统计学意义（P<0.05）；且治疗后治疗组这些观察指标显著优于对照组，两组比较差异具有统计学意义（P<0.05）。治疗后，两组ET-1、MDA、SOD、NO水平均较治疗前明显改善，同组治疗前后比较差异具有统计学意义（P<0.05）；且治疗组这些观察指标显著优于对照组，两组比较差异具有统计学意义（P<0.05）。结论 通脉颗粒联合甲钴胺和叶酸治疗HHcy具有显著的临床疗效，可明显降低血脂和机体氧化应激水平，具有一定的临床推广应用价值。

Objective To explore the clinical curative effect of Tongmai Granules combined with mecobalamin and folic acid in treatment of HHcy. Methods Patients (86 cases) with HHcy in the Ninth Hospital of Tangshan from March 2015 to March 2016 were divided into control and treatment groups based on different treatment methods, and each group had 43 cases. Patients in the control group were po administered with Mecobalamin Tablets, 1 tablet/time, three times daily. And they were also po administered with Folic Acid Tablets, 1 tablet/time, once daily. The patients in the treatment group were po administered with Tongmai Granules on the basis of the control group, 1 bag/time, three times daily. The patients in two groups were treated for 6 weeks. After treatment, the efficacy was evaluated, and the changes of Hcy, TG, TC, LDL-C, HDL-C, NO, ET-1, SOD, and MDA in two groups before and after treatment were compared. Results After treatment, the clinical efficacies in the control and treatment groups were 76.74% and 93.02%, respectively, and there were differences between two groups (P<0.05). After treatment, the levels of TC, TG, LDL-C, and Hcy in two groups were significantly decreased, HDL-C level was increased, and the difference was statistically significant in the same group (P<0.05). And the observational indexes in the treatment group were better than those in the control group, with significant difference between two groups (P<0.05). After treatment, the levels of ET-1, MDA, SOD, and NO were significantly improved, and the difference was statistically significant in the same group (P<0.05). And the observational indexes in the treatment group were better than those in the control group, with significant difference between two groups (P<0.05). Conclusion Tongmai Granules Combined with mecobalamin and folic acid has a good clinical curative effect in treatment of HHcy, can obviously reduce the levels of blood lipid and oxidative stress, which has a certain clinical application value.

河北省科学技术厅资助项目（20140673）