Vasilopoulos S, Saiean K, Emmons J, Berger W L, Abu-Hajir M, Seetharam B, Binion D G
Division of Gastroenterology and Hepatology, Department of Medicine, Froedtert Memorial Lutheran Hospital, Digestive Disease Center, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, USA.
J Clin Gastroenterol. 2001 Aug;33(2):132-6. doi: 10.1097/00004836-200108000-00008.
Elevated plasma total homocysteine (tHcy) is associated with a higher risk of thrombosis. Crohn's disease (CD) is associated with hypercoagulability of undefined etiology. We investigated tHcy in patients with CD and its relationship with vitamin status, disease activity, location, duration, and history of terminal ileum (TI) resection.
We examined fasting plasma tHcy, folate, serum vitamin B12 levels, and sedimentation rate in consecutive adult patients with CD. Harvey-Bradshaw index of CD activity and history of TI resection and thromboembolism were recorded.
Median plasma tHcy was 10.2 micromol/L in 125 patients with CD. Men (n = 60) had higher plasma tHcy than women (n = 65) (11.2 vs. 9.1 micromol/L; p = 0.004). Patients with a history of TI resection showed lower serum B12 levels (293 vs. 503 pg/mL; p < 0.001) and higher plasma tHcy levels (11.0 vs. 9.35 micromol/L; p = 0.027) than patients without such history. Multivariate analysis showed history of TI resection, serum B12, and creatinine levels to be significant predictors of elevated plasma tHcy. Fourteen patients with CD with a history of thrombosis had an elevated median plasma tHcy of 11.6 micromol/L.
Terminal ileum resection contributes to elevated plasma tHcy levels in CD cases. We recommend tHcy screening in patients with CD, especially in those with prior history of TI resection, and the initiation of vitamin supplementation when appropriate.
血浆总同型半胱氨酸（tHcy）升高与血栓形成风险增加相关。克罗恩病（CD）与病因不明的高凝状态有关。我们研究了CD患者的tHcy及其与维生素状态、疾病活动度、病变部位、病程以及回肠末端（TI）切除史的关系。
我们检测了连续入选的成年CD患者的空腹血浆tHcy、叶酸、血清维生素B12水平以及血沉。记录CD活动度的Harvey-Bradshaw指数以及TI切除史和血栓栓塞史。
125例CD患者的血浆tHcy中位数为10.2微摩尔/升。男性（n = 60）的血浆tHcy高于女性（n = 65）（11.2对9.1微摩尔/升；p = 0.004）。有TI切除史的患者血清B12水平较低（293对503皮克/毫升；p < 0.001），血浆tHcy水平较高（11.0对9.35微摩尔/升；p = 0.027）。多变量分析显示，TI切除史、血清B12和肌酐水平是血浆tHcy升高的显著预测因素。14例有血栓形成史的CD患者血浆tHcy中位数升高至11.6微摩尔/升。
回肠末端切除导致CD患者血浆tHcy水平升高。我们建议对CD患者进行tHcy筛查，尤其是有TI切除史的患者，并在适当的时候开始补充维生素。
