不同维生素与缺血性卒中相关性的研究进展
Research Progress on the Association between Different Vitamins and Ischemic Stroke
DOI: 10.12677/acm.2026.1631197, PDF,   
作者: 蒋兆雪, 余 震*：重庆医科大学附属第二医院神经内科，重庆
关键词: 维生素；脑梗死；缺血性卒中；Vitamins； Cerebral Infarction； Ischemic Stroke
摘要: 缺血性卒中，即脑梗死，是全球致死、致残的主要疾病之一，占所有脑卒中的80%以上；其病理机制涉及血管损伤、炎症反应、氧化应激等多个环节。传统危险因素如高血压、糖尿病等的相关研究已形成明确共识，而维生素代谢失衡作为脑梗死研究的新兴方向，目前尚未形成统一的结论。本文采用GRADE证据分级工具对现有研究结论进行质量评价，系统梳理维生素A、B族、C、D、E与脑梗死的相关性，重点针对各类维生素的作用机制、研究证据、现存争议，以期为脑梗死的临床防治提供更坚实的科学依据。
Abstract: Ischemic stroke, also known as cerebral infarction, is one of the leading causes of death and disability worldwide, accounting for over 80% of all strokes. Its pathological mechanism involves multiple aspects such as vascular damage, inflammatory response, and oxidative stress. Studies on traditional risk factors such as hypertension and diabetes have reached a clear consensus, while the research on vitamin imbalance as an emerging direction in the study of cerebral infarction has not yet reached a unified conclusion. This article uses the GRADE evidence grading tool to evaluate the quality of existing research conclusions, systematically sorts out the correlations between vitamins A, B complex, C, D, and E and cerebral infarction, and focuses on the mechanism of action, research evidence, and existing controversies of various vitamins, with the aim of providing a more solid scientific basis for the clinical prevention and treatment of cerebral infarction.
文章引用：蒋兆雪, 余震. 不同维生素与缺血性卒中相关性的研究进展[J]. 临床医学进展, 2026, 16(3): 3877-3885. https://doi.org/10.12677/acm.2026.1631197

参考文献

[1] Feigin, V.L., Nichols, E., Alam, T., Bannick, M.S., Beghi, E., Blake, N., et al. (2019) Global, Regional, and National Burden of Neurological Disorders, 1990-2016: A Systematic Analysis for the Global Burden of Disease Study 2016. The Lancet Neurology, 18, 459-480. [Google Scholar] [CrossRef] [PubMed]
[2] Abdelhamid, L., Hussein, H., Ghanem, M. and Eissa, N. (2017) Retinoic Acid-Mediated Anti-Inflammatory Responses in Equine Immune Cells Stimulated by LPS and Allogeneic Mesenchymal Stem Cells. Research in Veterinary Science, 114, 225-232. [Google Scholar] [CrossRef] [PubMed]
[3] Lyu, G., Wei, W., Fan, X., Zhong, D. and Li, G. (2025) The Effect of Vitamin C on the JAK/STAT3 Pathway in Ischemic Stroke: Based on the Molecular Interaction between FOXP3 Protein and Stat3 Protein. International Journal of Biological Macromolecules, 311, Article ID: 144069. [Google Scholar] [CrossRef] [PubMed]
[4] Xie, X., Zhao, S., Fang, R., Chen, H., Zhang, H., Wang, X., et al. (2025) Vitamin E Inhibits Oxidative Stress and Inflammation in Stress‐Induced Gastritis via Modulating Nrf2 and NF-κB Signalling Pathways. Journal of Cellular and Molecular Medicine, 29, e70463. [Google Scholar] [CrossRef] [PubMed]
[5] Murohara, T., Ikeda, H., Otsuka, Y., Aoki, M., Haramaki, N., Katoh, A., et al. (2004) Inhibition of Platelet Adherence to Mononuclear Cells by α-Tocopherol: Role of P-Selectin. Circulation, 110, 141-148. [Google Scholar] [CrossRef] [PubMed]
[6] McNulty, H., Pentieva, K., Hoey, L. and Ward, M. (2008) Homocysteine, B-Vitamins and CVD: Symposium on ‘Diet and CVD’. Proceedings of the Nutrition Society, 67, 232-237. [Google Scholar] [CrossRef] [PubMed]
[7] Zhao, M., Wang, X., He, M., Qin, X., Tang, G., Huo, Y., et al. (2017) Homocysteine and Stroke Risk: Modifying Effect of Methylenetetrahydrofolate Reductase C677T Polymorphism and Folic Acid Intervention. Stroke, 48, 1183-1190. [Google Scholar] [CrossRef] [PubMed]
[8] Li, M., Ren, R., Wang, K., Wang, S., Chow, A., Yang, A.K., et al. (2025) Effects of B Vitamins on Homocysteine Lowering and Thrombotic Risk Reduction—A Review of Randomized Controlled Trials Published since January 1996. Nutrients, 17, Article 1122. [Google Scholar] [CrossRef] [PubMed]
[9] Cui, P., Hou, H., Song, B., Xia, Z. and Xu, Y. (2024) Vitamin D and Ischemic Stroke—Association, Mechanisms, and Therapeutics. Ageing Research Reviews, 96, Article ID: 102244. [Google Scholar] [CrossRef] [PubMed]
[10] Aihara, K., Azuma, H., Akaike, M., Ikeda, Y., Yamashita, M., Sudo, T., et al. (2004) Disruption of Nuclear Vitamin D Receptor Gene Causes Enhanced Thrombogenicity in Mice. Journal of Biological Chemistry, 279, 35798-35802. [Google Scholar] [CrossRef] [PubMed]
[11] Kong, L., Wang, Y., Wang, X., Wang, X., Zhao, Y., Wang, L., et al. (2015) Retinoic Acid Ameliorates Blood-Brain Barrier Disruption Following Ischemic Stroke in Rats. Pharmacological Research, 99, 125-136. [Google Scholar] [CrossRef] [PubMed]
[12] Tang, X., Liu, H., Xiao, Y., Wu, L. and Shu, P. (2022) Vitamin C Intake and Ischemic Stroke. Frontiers in Nutrition, 9, Article 935991. [Google Scholar] [CrossRef] [PubMed]
[13] Saldeen, T., Li, D. and Mehta, J.L. (1999) Differential Effects of α-and γ-Tocopherol on Low-Density Lipoprotein Oxidation, Superoxide Activity, Platelet Aggregation and Arterial Thrombogenesis. Journal of the American College of Cardiology, 34, 1208-1215. [Google Scholar] [CrossRef] [PubMed]
[14] Huo, Y., Li, J., Qin, X., Huang, Y., Wang, X., Gottesman, R.F., et al. (2015) Efficacy of Folic Acid Therapy in Primary Prevention of Stroke among Adults with Hypertension in China: The CSPPT Randomized Clinical Trial. JAMA, 313, 1325-1335. [Google Scholar] [CrossRef] [PubMed]
[15] Dong, H., Pi, F., Ding, Z., Chen, W., Pang, S., Dong, W., et al. (2015) Efficacy of Supplementation with B Vitamins for Stroke Prevention: A Network Meta-Analysis of Randomized Controlled Trials. PLOS ONE, 10, e0137533. [Google Scholar] [CrossRef] [PubMed]
[16] 中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组, 等. 中国脑梗死和短暂性脑缺血发作二级预防指南(2022) [J]. 中华神经科杂志, 2022, 55(10): 1071-1110.
[17] Kataria, N., Yadav, P., Kumar, R., Kumar, N., Singh, M., Kant, R., et al. (2021) Effect of Vitamin B6, B9, and B12 Supplementation on Homocysteine Level and Cardiovascular Outcomes in Stroke Patients: A Meta-Analysis of Randomized Controlled Trials. Cureus, 13, e14958. [Google Scholar] [CrossRef] [PubMed]
[18] The Editors of The Lancet Diabetes & Endocrinology (2024) Retraction and Republication—Estimating Dose-Response Relationships for Vitamin D with Coronary Heart Disease, Stroke, and All-Cause Mortality: Observational and Mendelian Randomisation Analyses. The Lancet Diabetes & Endocrinology, 12, 8. [Google Scholar] [CrossRef] [PubMed]
[19] Xie, Y., Acosta, J.N., Ye, Y., Demarais, Z.S., Conlon, C.J., Chen, M., et al. (2023) Whole-Exome Sequencing Analyses Support a Role of Vitamin D Metabolism in Ischemic Stroke. Stroke, 54, 800-809. [Google Scholar] [CrossRef] [PubMed]
[20] Xu, Y., Zheng, H., Slabu, I., Liehn, E.A. and Rusu, M. (2025) Vitamin C in Cardiovascular Disease: From Molecular Mechanisms to Clinical Evidence and Therapeutic Applications. Antioxidants, 14, Article 506. [Google Scholar] [CrossRef] [PubMed]
[21] Kadri, A., Sjahrir, H., Juwita Sembiring, R. and Ichwan, M. (2020) Combination of Vitamin a and D Supplementation for Ischemic Stroke: Effects on Interleukin-1ß and Clinical Outcome. Medicinski Glasnik, 17, 425-432. [Google Scholar] [CrossRef] [PubMed]
[22] Tripathi, S., Nath, M., Misra, S. and Kumar, P. (2024) From a to E: Uniting Vitamins against Stroke Risk—A Systematic Review and Network Meta‐Analysis. European Journal of Clinical Investigation, 54, e14165. [Google Scholar] [CrossRef] [PubMed]
[23] Keli, S.O., Hertog, M.G.L., Feskens, E.J.M., et al. (1996) Dietary Flavonoids, Antioxidant Vitamins, and Incidence of Stroke. Archives of Internal Medicine, 156, 637-642. [Google Scholar] [CrossRef] [PubMed]
[24] Daviglus, M.L., Orencia, A.J., Dyer, A.R., Liu, K., Morris, D.K., Persky, V., et al. (1997) Dietary Vitamin C, β-Carotene and 30-Year Risk of Stroke: Results from the Western Electric Study. Neuroepidemiology, 16, 69-77. [Google Scholar] [CrossRef] [PubMed]
[25] Maggio, E., Bocchini, V.P., Carnevale, R., Pignatelli, P., Violi, F. and Loffredo, L. (2023) Vitamin E Supplementation (Alone or with Other Antioxidants) and Stroke: A Meta-Analysis. Nutrition Reviews, 82, 1069-1078. [Google Scholar] [CrossRef] [PubMed]
[26] Milman, U., Blum, S., Shapira, C., Aronson, D., Miller-Lotan, R., Anbinder, Y., et al. (2008) Vitamin E Supplementation Reduces Cardiovascular Events in a Subgroup of Middle-Aged Individuals with Both Type 2 Diabetes Mellitus and the Haptoglobin 2-2 Genotype: A Prospective Double-Blinded Clinical Trial. Arteriosclerosis, Thrombosis, and Vascular Biology, 28, 341-347. [Google Scholar] [CrossRef] [PubMed]
[27] Spence, J.D., Howard, V.J., Chambless, L.E., Malinow, M.R., Pettigrew, L.C., Stampfer, M., et al. (2001) Vitamin Intervention for Stroke Prevention (VISP) Trial: Rationale and Design. Neuroepidemiology, 20, 16-25. [Google Scholar] [CrossRef] [PubMed]
[28] Lonn, E., Held, C., Arnold, J.M., et al. (2006) Rationale, Design and Baseline Characteristics of a Large, Simple, Randomized Trial of Combined Folic Acid and Vitamins B6 and B12 in High-Risk Patients: The Heart Outcomes Prevention Evaluation (HOPE)-2 Trial. Canadian Journal of Cardiology, 22, 47-53. [Google Scholar] [CrossRef] [PubMed]
[29] Lonn, E., Yusuf, S., Arnold, J.M., et al. (2006) Homocysteine Lowering with Folic Acid and B Vitamins in Vascular Disease. The New England Journal of Medicine, 354, 1567-1577.
[30] VITATOPS Trial Study Group, Hankey, G.J., Algra, A., et al. (2007) VITATOPS, the Vitamins to Prevent Stroke Trial: Rationale and Design of a Randomised Trial of B-Vitamin Therapy in Patients with Recent Transient Ischaemic Attack or Stroke (NCT00097669) (ISRCTN74743444). International Journal of Stroke, 2, 144-150. [Google Scholar] [CrossRef] [PubMed]
[31] Galan, P., Kesse-Guyot, E., Czernichow, S., Briancon, S., Blacher, J. and Hercberg, S. (2010) Effects of B Vitamins and ω 3 Fatty Acids on Cardiovascular Diseases: A Randomised Placebo Controlled Trial. BMJ, 341, c6273. [Google Scholar] [CrossRef] [PubMed]
[32] Nie, S., Huang, P., Niu, H., Ding, F., Gong, L., Zou, C., et al. (2025) Vitamin D Deficiency Enhances Platelet Activation and Thrombosis by Regulating VDR/Akt Pathway Based on Platelet Proteomics. European Journal of Pharmacology, 999, Article ID: 177684. [Google Scholar] [CrossRef] [PubMed]
[33] Sari, A., Durmus, B., Karaman, C.A., Ogut, E. and Aktas, I. (2018) A Randomized, Double-Blind Study to Assess If Vitamin D Treatment Affects the Outcomes of Rehabilitation and Balance in Hemiplegic Patients. Journal of Physical Therapy Science, 30, 874-878. [Google Scholar] [CrossRef] [PubMed]
[34] Momosaki, R., Abo, M. and Urashima, M. (2019) Vitamin D Supplementation and Post-Stroke Rehabilitation: A Randomized, Double-Blind, Placebo-Controlled Trial. Nutrients, 11, Article 1295. [Google Scholar] [CrossRef] [PubMed]
[35] Torrisi, M., Bonanno, L., Formica, C., Arcadi, F.A., Cardile, D., Cimino, V., et al. (2021) The Role of Rehabilitation and Vitamin D Supplementation on Motor and Psychological Outcomes in Poststroke Patients. Medicine, 100, e27747. [Google Scholar] [CrossRef] [PubMed]
[36] Kangisser, L., Tan, E., Bellomo, R., Deane, A.M. and Plummer, M.P. (2021) Neuroprotective Properties of Vitamin C: A Scoping Review of Pre-Clinical and Clinical Studies. Journal of Neurotrauma, 38, 2194-2205. [Google Scholar] [CrossRef] [PubMed]
[37] Chang, C., Chen, J., Wu, M. and Hu, M. (2020) Therapeutic Treatment with Vitamin C Reduces Focal Cerebral Ischemia-Induced Brain Infarction in Rats by Attenuating Disruptions of Blood Brain Barrier and Cerebral Neuronal Apoptosis. Free Radical Biology and Medicine, 155, 29-36. [Google Scholar] [CrossRef] [PubMed]
[38] Iwata, N., Okazaki, M., Xuan, M., Kamiuchi, S., Matsuzaki, H. and Hibino, Y. (2014) Orally Administrated Ascorbic Acid Suppresses Neuronal Damage and Modifies Expression of SVCT2 and GLUT1 in the Brain of Diabetic Rats with Cerebral Ischemia-Reperfusion. Nutrients, 6, 1554-1577. [Google Scholar] [CrossRef] [PubMed]
[39] Jiang, Q., Im, S., Wagner, J.G., Hernandez, M.L. and Peden, D.B. (2022) γ-Tocopherol, a Major Form of Vitamin E in Diets: Insights into Antioxidant and Anti-Inflammatory Effects, Mechanisms, and Roles in Disease Management. Free Radical Biology and Medicine, 178, 347-359. [Google Scholar] [CrossRef] [PubMed]
[40] Renaud, D., Höller, A. and Michel, M. (2024) Potential Drug-Nutrient Interactions of 45 Vitamins, Minerals, Trace Elements, and Associated Dietary Compounds with Acetylsalicylic Acid and Warfarin—A Review of the Literature. Nutrients, 16, Article 950. [Google Scholar] [CrossRef] [PubMed]
[41] Chiayi Christian Hospital (2025) Prevention and Treatment for Bruises in Patients with Ischemic Stroke. ClinicalTri-als.gov, NCT06823999.
[42] Judd, S.E., Morgan, C.J., Panwar, B., Howard, V.J., Wadley, V.G., Jenny, N.S., et al. (2015) Vitamin D Deficiency and Incident Stroke Risk in Community-Living Black and White Adults. International Journal of Stroke, 11, 93-102. [Google Scholar] [CrossRef] [PubMed]
[43] Sun, Q., Pan, A., Hu, F.B., Manson, J.E. and Rexrode, K.M. (2012) 25-Hydroxyvitamin D Levels and the Risk of Stroke: A Prospective Study and Meta-Analysis. Stroke, 43, 1470-1477. [Google Scholar] [CrossRef] [PubMed]
[44] Hodis, H.N., Mack, W.J., Dustin, L., Mahrer, P.R., Azen, S.P., Detrano, R., et al. (2009) High-Dose B Vitamin Supplementation and Progression of Subclinical Atherosclerosis: A Randomized Controlled Trial. Stroke, 40, 730-736. [Google Scholar] [CrossRef] [PubMed]
[45] Kacerova, T., Yates, A.G., Dai, J., Shepherd, D., Pires, E., de Jel, S., et al. (2025) Role of B Vitamins in Modulating Homocysteine and Metabolic Pathways Linked to Brain Atrophy: Metabolomics Insights from the VITACOG Trial. Alzheimer’s & Dementia, 21, e70521. [Google Scholar] [CrossRef] [PubMed]
[46] Durga, J., Bots, M.L., Schouten, E.G., Grobbee, D.E., Kok, F.J. and Verhoef, P. (2011) Effect of 3 Y of Folic Acid Supplementation on the Progression of Carotid Intima-Media Thickness and Carotid Arterial Stiffness in Older Adults. The American Journal of Clinical Nutrition, 93, 941-949. [Google Scholar] [CrossRef] [PubMed]
[47] Chaudhuri, J.R., Mridula, K.R., Alladi, S., Anamika, A., Umamahesh, M., Balaraju, B., et al. (2014) Serum 25-Hydroxyvitamin D Deficiency in Ischemic Stroke and Subtypes in Indian Patients. Journal of Stroke, 16, 44-50. [Google Scholar] [CrossRef] [PubMed]
[48] Manouchehri, N., Vakil-Asadollahi, M., Zandifar, A., Rasmani, F. and Saadatnia, M. (2017) Vitamin D Status in Small Vessel and Large Vessel Ischemic Stroke Patients: A Case-Control Study. Advanced Biomedical Research, 6, 146. [Google Scholar] [CrossRef] [PubMed]

为你推荐