Refai T M K, Al-Salem I H, Nkansa-Dwamena D, Al-Salem M H
Amiri Hospital, Kuwait.
Clin Rheumatol. 2002 Nov;21(6):457-61. doi: 10.1007/s100670200115.
Hyperhomocysteinaemia is strongly associated with increased relative risk of occlusive vascular disease, mainly of the carotid and coronary arteries. The aim of our study was to assess whether raised plasma homocysteine is a risk factor for thrombotic events in patients with systemic lupus erythematosus (SLE), a condition known to be associated with premature atherothrombotic complications. The study included 34 consecutive consenting SLE patients who were seen in the Rheumatology Unit of Al-Amiri hospital, one of the main teaching hospitals in Kuwait. Twenty consenting healthy subjects were included in the control group. Twenty-four patients were grouped as SLE without thrombosis and 10 had different types of thromboses. Vitamin B(12), folate, anticardiolipin antibodies (IgG and IgM), activated partial thromboplastin time (APTT) and total homocysteine level were measured for both patients and controls. A raised homocysteine concentration was defined as plasma homocysteine level above 9.4 mmol/l. Hyperhomocysteinaemia was found in 21 (61.8%) SLE patients. Low levels of folate and vitamin B(12) were significantly associated with high concentrations of plasma homocysteine (r = -0.35 and -0.39, respectively, P<0.01). SLE patients with elevated homocysteine concentration have a threefold increase in odds ratio of thrombotic events after adjusting for other risk factors (male sex, shortened APTT, treatment with prednisone, low folate and vitamin B(12) levels). We concluded that homocysteine is an independent risk factor for thrombosis in patients with SLE and is potentially modifiable.
高同型半胱氨酸血症与闭塞性血管疾病（主要是颈动脉和冠状动脉疾病）相对风险的增加密切相关。我们研究的目的是评估血浆同型半胱氨酸升高是否是系统性红斑狼疮（SLE）患者发生血栓事件的危险因素，SLE是一种已知与过早发生动脉粥样硬化血栓形成并发症相关的疾病。该研究纳入了科威特主要教学医院之一的阿米里医院风湿病科连续收治的34例同意参与研究的SLE患者。对照组纳入了20例同意参与研究的健康受试者。24例患者被归类为无血栓形成的SLE患者，10例患有不同类型的血栓形成。对患者和对照组均检测了维生素B12、叶酸、抗心磷脂抗体（IgG和IgM）、活化部分凝血活酶时间（APTT）和总同型半胱氨酸水平。同型半胱氨酸浓度升高定义为血浆同型半胱氨酸水平高于9.4 mmol/L。在21例（61.8%）SLE患者中发现了高同型半胱氨酸血症。低水平的叶酸和维生素B12与高浓度的血浆同型半胱氨酸显著相关（r分别为-0.35和-0.39，P<0.01）。在调整其他危险因素（男性、APTT缩短、泼尼松治疗、低叶酸和维生素B12水平）后，同型半胱氨酸浓度升高的SLE患者发生血栓事件的优势比增加了两倍。我们得出结论，同型半胱氨酸是SLE患者发生血栓形成的独立危险因素，并且可能是可改变的。
