Okada E, Oida K, Tada H, Asazuma K, Eguchi K, Tohda G, Kosaka S, Takahashi S, Miyamori I
Third Department of Internal Medicine, Fukui Medical University, Japan.
Diabetes Care. 1999 Mar;22(3):484-90. doi: 10.2337/diacare.22.3.484.
An increased plasma homocysteine level is an important risk factor for vascular disease, including coronary atherosclerosis, in the general population. However, the role of hyperhomocysteinemia in the development of coronary artery disease (CAD) in patients with type 2 diabetes is unknown. Therefore, we have endeavored to determine the relationship between plasma homocysteine levels and the presence of coronary arteriosclerosis in patients with type 2 diabetes.
The study group consisted of 145 Japanese patients (95 men and 50 women) who underwent routine coronary angiography to assess chest pain or suspected CAD. Plasma total homocysteine level, lipid level, and parameters of fibrinolytic activity were measured. All patients were identified as diabetic or nondiabetic by the new American Diabetes Association (ADA) criteria. The diagnoses of all patients studied were confirmed by coronary angiography. The severity of coronary artery stenosis was quantified using CAD scoring on the basis of prior reports, and subjects were graded as nonstenotic, stenotic single-vessel, stenotic two-vessel, or stenotic three-vessel based on the number of stenotic coronary arteries. Patients were classified into two groups: those with stenotic vessels and those without stenotic vessels.
The plasma homocysteine level was significantly higher in patients with than in patients without stenotic vessels (13.8 +/- 3.9 vs. 11.7 +/- 3.9 mumol/l, respectively; P = 0.0009). The number of stenotic coronary arteries, which was used to grade each case as nonstenotic, stenotic single-vessel, stenotic two-vessel, or stenotic three-vessel, was related only to the total homocysteine level in the diabetic (diabetes mellitus [DM]) group, but it was associated with lipoprotein(a) in the nondiabetic (non-diabetes mellitus [non-DM]) group. Spearman's rank correlation test demonstrated that the plasma homocysteine level was strongly correlated with CAD score, both in the entire study group and in the DM group (P = 0.003 for the entire group and P = 0.011 for the DM group). Hyperhomocysteinemia, which was defined as total homocysteine level > 14.0 mumol/l, was seen in 57 (39.3%) of the patients. The CAD score was highest in diabetic patients with hyperhomocysteinemia (P < 0.05).
There seems to be a clear relationship between hyperhomocysteinemia and an increased risk of coronary arteriosclerosis in Japanese patients with type 2 diabetes.
在普通人群中，血浆同型半胱氨酸水平升高是包括冠状动脉粥样硬化在内的血管疾病的重要危险因素。然而，高同型半胱氨酸血症在2型糖尿病患者冠状动脉疾病（CAD）发生发展中的作用尚不清楚。因此，我们致力于确定2型糖尿病患者血浆同型半胱氨酸水平与冠状动脉粥样硬化之间的关系。
研究组由145名日本患者（95名男性和50名女性）组成，他们接受了常规冠状动脉造影以评估胸痛或疑似CAD。测量了血浆总同型半胱氨酸水平、血脂水平和纤溶活性参数。所有患者均根据美国糖尿病协会（ADA）新标准被确定为糖尿病患者或非糖尿病患者。所有研究患者的诊断均通过冠状动脉造影得到证实。根据先前报告，采用CAD评分对冠状动脉狭窄程度进行量化，并根据狭窄冠状动脉的数量将受试者分为无狭窄、单支血管狭窄、两支血管狭窄或三支血管狭窄。患者分为两组：有狭窄血管的患者和无狭窄血管的患者。
有狭窄血管的患者血浆同型半胱氨酸水平显著高于无狭窄血管的患者（分别为13.8±3.9与11.7±3.9μmol/L；P = 0.0009）。用于将每个病例分为无狭窄、单支血管狭窄、两支血管狭窄或三支血管狭窄的狭窄冠状动脉数量仅与糖尿病（DM）组的总同型半胱氨酸水平相关，但在非糖尿病（非DM）组中与脂蛋白（a）相关。Spearman等级相关检验表明，在整个研究组和DM组中，血浆同型半胱氨酸水平与CAD评分均密切相关（整个组P = 0.003，DM组P = 0.011）。57名（39.3%）患者存在高同型半胱氨酸血症，定义为总同型半胱氨酸水平>14.0μmol/L。高同型半胱氨酸血症的糖尿病患者CAD评分最高（P < 0.05）。
在日本2型糖尿病患者中，高同型半胱氨酸血症与冠状动脉粥样硬化风险增加之间似乎存在明确的关系。
