Márk L, Erdei F, Márki-Zay J, Nagy E, Kondacs A, Katona A
Békés Megyei Képviselótestület Pándy Kálmán Kórháza, Gyula, II. Belgyógyászat-Kardiológia.
Orv Hetil. 2001 Jul 29;142(30):1611-5.
In the latest years it became clear that beside traditional cardiovascular risk factors the high plasma homocysteine level increases the risk of atherosclerotic diseases too. Metaanalysis of 27 papers found that 10% of population's coronary risk is attributable to homocysteine and a 5 mumol/l increase in its plasma level elevates the coronary risk by as much as 0.5 mumol/l cholesterol increase. Recent studies have shown an inverse relation between the levels of plasma homocysteine and that of folic acid, vitamin B6, vitamin B12. The latters are cofactors and substrates of the homocysteine and methionin metabolism. The plasma total cholesterol, HDL-cholesterol, triglyceride, lipoprotein(a), Apo A1, Apo B and homocysteine concentrations were examined in 39 patients suffering from coronary artery disease treated in the Cardiac Rehabilitation Department of our hospital. Twenty of them were treated by folic acid and vitamin B6 for a three week period. The mean (+/- SD) plasma homocysteine concentration was 15.60 +/- 6.14 mumol/l. In the treated subgroup the mean (+/- SD) plasma homocysteine concentration was 17.3 +/- 7.00 mumol/l, the mean (+/- SD) plasma folic acid level was 8.58 +/- 4.6 mumol/l. After the three week treatment period (folic acid and vitamin B6) the plasma homocysteine level decreased by 26.5% (p = 0.012), that of folic acid increased by 68.7% (p = 0.002). From the plasma lipids the level of total- and LDL-cholesterol decreased significantly (6.7% and 10.4%, P < 0.05), caused by the strict diet during hospital treatment. As for the genetic polymorphism of the V677 gen of the metylenetetrahydrofolate-reductase (MTHFR) enzyme there was a significant correlation with homocysteine level (r = 0.436, p = 0.010), and a negative, but not significant correlation with the folic acid level (r = -0.354).
近年来，人们清楚地认识到，除了传统的心血管危险因素外，高血浆同型半胱氨酸水平也会增加动脉粥样硬化疾病的风险。对27篇论文的荟萃分析发现，人群中10%的冠心病风险可归因于同型半胱氨酸，其血浆水平每升高5μmol/L，冠心病风险就会升高，幅度相当于胆固醇升高0.5μmol/L。最近的研究表明，血浆同型半胱氨酸水平与叶酸、维生素B6、维生素B12水平呈负相关。后三者是同型半胱氨酸和蛋氨酸代谢的辅助因子和底物。我们医院心脏康复科对39例冠心病患者的血浆总胆固醇、高密度脂蛋白胆固醇、甘油三酯、脂蛋白(a)、载脂蛋白A1、载脂蛋白B和同型半胱氨酸浓度进行了检测。其中20例患者接受了为期三周的叶酸和维生素B6治疗。血浆同型半胱氨酸平均(±标准差)浓度为15.60±6.14μmol/L。在治疗亚组中，血浆同型半胱氨酸平均(±标准差)浓度为17.3±7.00μmol/L，血浆叶酸平均(±标准差)水平为8.58±4.6μmol/L。经过为期三周的治疗期(叶酸和维生素B6)后，血浆同型半胱氨酸水平下降了26.5%(p = 0.012)，叶酸水平升高了68.7%(p = 0.002)。在血脂方面，由于住院期间严格的饮食控制，总胆固醇和低密度脂蛋白胆固醇水平显著下降(分别下降6.7%和10.4%，P < 0.05)。至于亚甲基四氢叶酸还原酶(MTHFR)酶V677基因的基因多态性，其与同型半胱氨酸水平存在显著相关性(r = 0.436，p = 0.010)，与叶酸水平呈负相关，但不显著(r = -0.354)。
