Hansrani M, Gillespie J I, Stansby G
Department of Surgery, University of Newcastle upon Tyne, Newcastle upon Tyne, UK.
Eur J Vasc Endovasc Surg. 2002 Jan;23(1):3-10. doi: 10.1053/ejvs.2001.1526.
homocysteine, a sulphur-containing non-essential amino acid, appears to play a role in the pathophysiology of atherosclerosis. However, its role in myointimal hyperplasia, the cause of almost 30% of failures of interventional therapeutic procedures, is much less clear.
a review of the published scientific data concerning the role of homocysteine in myointimal hyperplasia was performed using MEDLINE and other on-line databases. Evidence was sought from cell culture experiments, animal models and clinical studies.
several clinical studies have recently been published linking plasma homocysteine levels to restenosis in coronary and peripheral arterial disease. However, several contradictory studies also exist making the role of homocysteine unclear. There are currently no published randomised trials. Cell culture and animal model experiments have elucidated several potential mechanisms by which may stimulate myointimal hyperplasia. Possible mechanisms include endothelial cell activation with the enhanced release of inflammatory cytokines and growth factors and a direct effect on vascular smooth muscle cell migration and proliferation.
further studies are required before the true role of homocysteine in the pathogenesis of myointimal hyperplasia can be clearly evaluated. If evidence does confirm a role, the ease with which homocysteine levels can be normalised makes it an attractive alternative therapeutic target for intervention.
同型半胱氨酸是一种含硫的非必需氨基酸，似乎在动脉粥样硬化的病理生理过程中发挥作用。然而，其在肌内膜增生（介入治疗失败率近30%的原因）中的作用却远不那么清楚。
使用MEDLINE和其他在线数据库对已发表的有关同型半胱氨酸在肌内膜增生中作用的科学数据进行综述。从细胞培养实验、动物模型和临床研究中寻找证据。
最近发表了几项临床研究，将血浆同型半胱氨酸水平与冠状动脉和外周动脉疾病的再狭窄联系起来。然而，也存在一些相互矛盾的研究，使得同型半胱氨酸的作用尚不明确。目前尚无已发表的随机试验。细胞培养和动物模型实验已经阐明了几种可能刺激肌内膜增生的潜在机制。可能的机制包括内皮细胞激活，伴有炎症细胞因子和生长因子释放增加，以及对血管平滑肌细胞迁移和增殖的直接影响。
在能够清楚评估同型半胱氨酸在肌内膜增生发病机制中的真正作用之前，还需要进一步研究。如果证据确实证实其作用，同型半胱氨酸水平易于正常化这一点使其成为一个有吸引力的替代性治疗干预靶点。
