Compher C W, Kinosian B P, Evans-Stoner N, Huzinec J, Buzby G P
Clinical Nutrition Support Services, University of Pennsylvania Health System, Philadelphia 19104, USA.
JPEN J Parenter Enteral Nutr. 2001 Jan-Feb;25(1):1-7; discussion 7-8. doi: 10.1177/014860710102500101.
Hyperhomocysteinemia is associated with venous thrombosis and vitamin deficiency. Patients with short bowel syndrome have increased risk of venous thrombosis due to central catheters, and of vitamin deficiency due to malabsorption. The current investigation was designed to evaluate the relationship between history of venous thrombosis and current hyperhomocystinemia and vitamin deficiency in patients with short bowel syndrome.
Plasma total homocysteine (tHcy), serum vitamin B12, folate, B6, and methylmalonic acid (MMA) were measured. Venous thrombosis was documented by venogram or ultrasound.
Ten of 17 patients had venous thromboses, including 17 of 38 observed superior and 12 of 26 inferior veins. Total homocysteine was correlated with number of thromboses. The relative risk of multiple thromboses in the highest tHcy tertile was 3.6-fold that of the lowest tertile. Vitamin B12 and folate levels were within normal limits, but B12 deficiency by MMA or tHcy level was apparent in 7 patients. Vitamin-deficient patients had higher tHcy and MMA than those without deficiency.
Venous thrombosis in patients with short bowel syndrome is related to hyperhomocystinemia, which is also related to vitamin B12 deficiency, not detected by serum vitamin B12 concentration. Whether treatment of vitamin deficiencies and associated reduction in tHcy will reduce recurrent venous thrombosis in these patients is not known.
高同型半胱氨酸血症与静脉血栓形成及维生素缺乏有关。短肠综合征患者因中心静脉导管置入有静脉血栓形成风险增加，且因吸收不良有维生素缺乏风险增加。本研究旨在评估短肠综合征患者静脉血栓形成病史与当前高同型半胱氨酸血症及维生素缺乏之间的关系。
检测血浆总同型半胱氨酸（tHcy）、血清维生素B12、叶酸、B6及甲基丙二酸（MMA）。静脉造影或超声记录静脉血栓形成情况。
17例患者中有10例发生静脉血栓，其中38条观察到的上肢静脉中有17条、26条下肢静脉中有12条发生血栓。总同型半胱氨酸与血栓数量相关。tHcy最高三分位数组发生多发血栓的相对风险是最低三分位数组的3.6倍。维生素B12和叶酸水平在正常范围内，但7例患者根据MMA或tHcy水平显示存在维生素B12缺乏。维生素缺乏患者的tHcy和MMA高于非缺乏患者。
短肠综合征患者的静脉血栓形成与高同型半胱氨酸血症有关，高同型半胱氨酸血症也与血清维生素B12浓度未检测到的维生素B12缺乏有关。维生素缺乏的治疗及相关tHcy降低是否会减少这些患者的复发性静脉血栓形成尚不清楚。
