Gao W, Jiang N, Meng Z, Tang J
Department of Cardiology, First Teaching Hospital of Beijing Medical University, Beijing 100034, China.
Chin Med J (Engl). 1999 Jul;112(7):586-9.
To examine the relationship between coronary heart disease (CHD) and serum lipid, plasma homocysteine (HCY) as well as the factors related to HCY metabolisms.
The mutation of the 677C-->T transition of 5, 10-methylenetetrahydrofolate reductase (MTHFR) was determined by PCR-based assay. Whole-blood and plasma folate and plasma vitamin B12, as cofactors of MTHFR, were determined by radio-immunologic assay. Plasma HCY was determined by HPLC.
Patients with CHD had elevated plasma HCY concentrations (17.38 +/- 1.94 mumol/L vs 10.25 +/- 1.57 mumol/L, P < 0.01). In patients with myocardial infarction (MI) and family history (FH) of CHD, plasma HCY were elevated even higher (P < 0.05). Plasma HCY concentrations had significant non-linear inverse correlation with plasma folate and B12 concentrations, i.e. the lower the serum folate or B12 concentrations, the higher the plasma HCY concentrations (P < 0.01). Patients with homozygous mutants had higher plasma HCY concentrations. Patients with CHD had increased serum Chol and LDL-C and Apo-B levels (P < 0.01, P < 0.05 and P < 0.05 respectively). But plasma HCY concentrations had no correlation with serum lipid levels. 24.1% of the patients had high lipid and high HCY level, 25.9% had high lipid level and normal HCY level, 20.4% had normal lipid and high HCY level, and 29.6% had normal lipid and HCY level.
HCY may have strong association with the genesis of CHD. Low plasma folate and B12 concentrations may induce Hyperhomocysteinemia [HH(e)]. Plasma HCY concentrations have no correlation with serum lipid levels, so HCY may be an independent risk factor. CHD may be induced by different mechanisms and can be classified into hyperlipidemia, HH (e) and normolipidemia, and normohomocysteinemia.
探讨冠心病（CHD）与血脂、血浆同型半胱氨酸（HCY）以及与HCY代谢相关因素之间的关系。
采用基于聚合酶链反应（PCR）的检测方法测定5,10 - 亚甲基四氢叶酸还原酶（MTHFR）677C→T突变。采用放射免疫分析法测定作为MTHFR辅助因子的全血和血浆叶酸以及血浆维生素B12。采用高效液相色谱法（HPLC）测定血浆HCY。
冠心病患者血浆HCY浓度升高（17.38±1.94μmol/L对10.25±1.57μmol/L，P<0.01）。在有心肌梗死（MI）和冠心病家族史（FH）的患者中，血浆HCY升高更明显（P<0.05）。血浆HCY浓度与血浆叶酸和维生素B12浓度呈显著非线性负相关，即血清叶酸或维生素B12浓度越低，血浆HCY浓度越高（P<0.01）。纯合突变患者血浆HCY浓度更高。冠心病患者血清胆固醇（Chol）、低密度脂蛋白胆固醇（LDL - C）和载脂蛋白B（Apo - B）水平升高（分别为P<0.01、P<0.05和P<0.05）。但血浆HCY浓度与血脂水平无关。24.1%的患者血脂和HCY水平高，25.9%的患者血脂水平高但HCY水平正常，20.4%患者血脂正常但HCY水平高，29.6%患者血脂和HCY水平正常。
HCY可能与冠心病的发生密切相关。血浆叶酸和维生素B12浓度低可能导致高同型半胱氨酸血症[HH（e）]。血浆HCY浓度与血脂水平无关，因此HCY可能是一个独立的危险因素。冠心病可能由不同机制引起，可分为高脂血症、HH（e）以及血脂正常、同型半胱氨酸正常血症。
