以重叠病例研究方式,探讨饮食与血浆中叶酸与中风及不同形式中风

1、以重疊病例研究方式，探討飲食與血漿中葉酸與中風及不同形式中風間的相關性翁履珍IntroductionStroke(World Health Organization)vA focal ( or at times global) neurological impairment sudden onset, and lasting more than 24 hrs (or leading to death) and of presumed vascular origin.v5.5 million deaths that occur every year world wide is due to st

2、roke. vStroke is the second leading cause of death after ischemic heart disease.AgePrevalence(人/100000人)USA3720 1760UK65y以上7000 5000JAPAN20y以上 2880中風的型式vIschemic stroke Caused by a blood clot that blocks a blood vessel or artery in the brain vHemorrhagic stroke A blood vessel in the brain ruptures a

3、nd spills blood into the surrounding tissue (National Institute of Neurological disorder and stroke, /index.htm)Treatable Risk Factors vHigh blood pressurevHeart diseasevCigarette smokingvDiabetesvWarning signs or history of stroke TIAs( Transient ischemic attacks ) (National

4、Institute of Neurological disorder and stroke, /index.htm)中風的飲食保護因子vDifference of stroke mortality in Japanese emigration (SYME , 1975)v-3 fatty acid ( Iso et al.2001 )vAntioxidants Vitamin C ( Vok et al.2003) Vitamin E (Yochum et al.2000) Carotenoids (Hirvonen et al.2000) Fla

5、vonoids (Keli et al.1996)vMinerals Potassium Magnesium (Ascherio et al.1998)vOthers Cereal fiber(Ascherio et al.1998) Folate (He et al.2004) Vitamin B6 (Kelly et al.2003) Vitamin B12 (He et al.2004)Folate (Folic acid)vWater Soluble vFunctions i. Red blood cell formation ii. New cell division iii. Pr

6、otein metabolism vDeficiencies Anemia, diarrhea, depression, heartburn vToxicity Insomnia, irritability, diarrhea, may mask B12 deficiency vRecommended Intakes (RDA): 400 g/day for adults vFood Sources Green leafy vegetables, liver, legumes, seeds, and enriched breads, cereals, rice, and pasta. http

7、:/ metabolismHomocysteinevHomocysteine & CVDvHomocysteine level CVD (Bautista et al.2002)vHomocysteine level stroke (Brattstrom, et al.1992)vElevated homocysteine levelv Genetic defects MTHFR(677C-T) (Brattstrom, et al.1998) v Low intake Folate, vitamin B6 vitamin B12 (Verhoef, et al.1996)vFolat

8、e and CVDvFolate and stroke Serum folate stroke (Wayne H. et al) 9.2mmol/L vs. 9.2mmol/L RBC folate stroke ( Killian Robinson ) Folate intake & stroke Inverse correlation NHEFS (Lydia A. Bazzano et al.) Ischemic stroke in men(Ka He ,et al.) No significant association women (QAael K, et al.)Folat

9、eFolatev葉酸缺乏狀況(93-96國民營養調查)v2003十大死因排名(衛生署)缺乏(13項為空白之受試者，予以排除 Biochemistry analysis 以加入heparin之採血管採血 離心15min後（3000rpm;4000rpm） 取上清液（血漿） 置入-70冰箱保存vPlasma Folate ImmunoassayvPlasma vitamin B6 HPLCvPlasma vitamin B12 ImmunoassayRisk factorvAgevSexv居住地 (竹東，朴子)vSmoking (never，past smoker，current smoker1-10,10-20,20支煙/天)vHypertension (yes, no)vBMI (25, 25)vAlcohol intake (yes, no)vPhysical activity vEducation ( 12年，12年)vTotal energy vHypercholesterolemia (240mg/dl, 240mg/dl)vPlasma vitamin B6vPlasma vitamin B12StatisticsvMean SDvt-test Difference of varia