Lee Bor Jen, Lin Ping Ting, Liaw Yung Po, Chang Sue Joan, Cheng Chien Hsiung, Huang Yi Chia
Intensive Care Unit, Critical Care and Respiratory Therapy, Taichung Veterans General Hospital, Taiwan, People's Republic of China.
Nutrition. 2003 Jul-Aug;19(7-8):577-83. doi: 10.1016/s0899-9007(02)01098-5.
The purposes of this study were to study the effects of folate and vitamins B6 and B12 on plasma homocysteine concentration and to estimate the risks for coronary artery disease (CAD) according to quartiles of plasma homocysteine concentration.
The study was designed as a case-reference observational study. Case subjects (CAD group, n = 60) were identified by cardiac catheterization to have at least 70% stenosis of one major coronary artery; otherwise, patients were considered for a reference group (n = 60). Risk factors of cardiovascular disease were recorded, including age, sex, blood lipid profile, hypertension, smoking habits, and drinking habits. Plasma homocysteine, folate, pyridoxal 5'-phosphate, and vitamin B12 were measured.
CAD subjects had significantly higher mean plasma homocysteine concentrations than did the reference subjects (13.9 +/- 4.9 versus 9.1 +/- 3.3 micromol/L). There were no significant differences between groups with regard to the three B vitamins; however, mean serum folate concentrations for subjects in the highest two quartiles of plasma homocysteine concentration (10.8-13.8 and >/=13.9 micromol/L) were significantly lower than those for subjects in the lowest two quartiles (</=8.0 and 8.1-10.7 micromol/L). Plasma homocysteine was strongly inversely associated with serum folate in the CAD (beta= -0.166, P < 0.05), reference (beta= -0.178, P < 0.001), and pooled (beta = -0.190, P < 0.001) groups. Age, sex, other confounding factors, and B-vitamin-adjusted odds ratios were significantly increased in the highest quartile of homocysteine concentration (odds ration, 5.54; 95% confidence interval, 0.38-81.41). The elevation of 1 ng/mL in serum folate concentration was found to decrease plasma homocysteine by 0.166 micromol/L.
Serum folate, but not vitamin B6 or B12, was a strong predictor of plasma homocysteine; while all subjects had adequate B-vitamin status. Folate should be considered as a routine supplementation for individuals who have risk factors for CAD, even for individuals with adequate folate status.
本研究旨在探讨叶酸、维生素B6和维生素B12对血浆同型半胱氨酸浓度的影响，并根据血浆同型半胱氨酸浓度的四分位数评估冠状动脉疾病（CAD）的风险。
本研究设计为病例对照观察性研究。病例组（CAD组，n = 60）通过心脏导管插入术确定至少有一条主要冠状动脉狭窄70%；否则，将患者纳入对照组（n = 60）。记录心血管疾病的危险因素，包括年龄、性别、血脂谱、高血压、吸烟习惯和饮酒习惯。测量血浆同型半胱氨酸、叶酸、磷酸吡哆醛和维生素B12。
CAD患者的平均血浆同型半胱氨酸浓度显著高于对照组（13.9±4.9对9.1±3.3μmol/L）。两组在三种B族维生素方面无显著差异；然而，血浆同型半胱氨酸浓度最高的两个四分位数（10.8 - 13.8和≥13.9μmol/L）的受试者的平均血清叶酸浓度显著低于最低的两个四分位数（≤8.0和8.1 - 10.7μmol/L）的受试者。在CAD组（β = -0.166，P < 0.05）、对照组（β = -0.178，P < 0.001）和合并组（β = -0.190，P < 0.001）中，血浆同型半胱氨酸与血清叶酸呈强烈负相关。在同型半胱氨酸浓度最高的四分位数中，年龄、性别、其他混杂因素以及经B族维生素调整后的比值比显著增加（比值比，5.54；95%置信区间，0.38 - 81.41）。血清叶酸浓度每升高1 ng/mL，血浆同型半胱氨酸降低0.166μmol/L。
血清叶酸而非维生素B6或B12是血浆同型半胱氨酸的强预测指标；而所有受试者的B族维生素状态均充足。对于有CAD危险因素的个体，即使叶酸状态充足，也应考虑将叶酸作为常规补充剂。
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