同型半胱氨酸、维生素与冠状动脉疾病。文献综述
Homocysteine, vitamins, and coronary artery disease. Comprehensive review of the literature.
作者信息
Taylor B V, Oudit G Y, Evans M
机构信息
Department of Family and Community Medicine, University of Toronto in Ontario.
出版信息
Can Fam Physician. 2000 Nov;46:2236-45.
OBJECTIVE
To summarize results of clinical trials investigating the role of homocysteine (tHcy) as a risk factor for coronary artery disease (CAD) and the role of vitamin therapy (folic acid and vitamins B6 and B12) in primary and secondary prevention of CAD.
QUALITY OF EVIDENCE
MEDLINE was searched from January 1976 to January 1999 to locate cross-sectional, retrospective and prospective cohort studies and meta-analyses on CAD using the MeSH words homocysteine, folic acid, vitamins B6 and B12, and coronary artery or heart disease.
MAIN MESSAGE
Elevated tHcy levels are prevalent; most retrospective and cross-sectional studies show an association with increased risk of CAD. Results from recent prospective studies are less consistent. Folic acid, alone or with vitamins B6 and B12, reduces tHcy concentrations in the blood. Results from ongoing randomized controlled trials could determine the effect of vitamins B6 and B12 and folic acid supplementation on CAD-related morbidity and mortality and could indicate whether routine supplementation with these vitamins should be advocated. Before mass screening for tHcy can be done, the tHcy assay must be standardized.
CONCLUSION
The role of homocysteine and vitamins B6 and B12 in managing CAD is unclear. Routine screening is not recommended.
目的
总结关于同型半胱氨酸（总同型半胱氨酸，tHcy）作为冠状动脉疾病（CAD）危险因素的作用以及维生素疗法（叶酸、维生素B6和维生素B12）在CAD一级和二级预防中的作用的临床试验结果。
证据质量
检索1976年1月至1999年1月期间的MEDLINE，以查找使用主题词同型半胱氨酸、叶酸、维生素B6和维生素B12以及冠状动脉或心脏病对CAD进行的横断面、回顾性和前瞻性队列研究及荟萃分析。
主要信息
tHcy水平升高很普遍；大多数回顾性和横断面研究表明其与CAD风险增加有关。近期前瞻性研究的结果不太一致。单独使用叶酸或与维生素B6和维生素B12联合使用可降低血液中的tHcy浓度。正在进行的随机对照试验的结果可能会确定维生素B6、维生素B12和叶酸补充剂对CAD相关发病率和死亡率的影响，并可能表明是否应提倡常规补充这些维生素。在能够进行tHcy大规模筛查之前，必须对tHcy检测进行标准化。
结论
同型半胱氨酸以及维生素B6和维生素B12在CAD管理中的作用尚不清楚。不建议进行常规筛查。
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