Naruszewicz Marek, Jankowska Ewa A, Zymlinski Robert, Bukowska Hanna, Millo Barbara, Banasiak Waldemar, Ponikowski Piotr
Department of Clinical Biochemistry and Laboratory Diagnostics, Pomeranian Medical University, al. Powstańców Wlkp. 72, 70-111 Szczecin, Poland.
Atherosclerosis. 2007 Oct;194(2):408-14. doi: 10.1016/j.atherosclerosis.2006.08.014. Epub 2006 Sep 12.
Patients with chronic heart failure (CHF) may be particularly susceptible to unfavorable effects of hyperhomocysteinemia (HHcy). The aim of this study was to assess the prevalence of HHcy (plasma homocysteine [Hcy]>or=14 micromol/L) in an unselected cohort of CHF patients, its clinical determinants, and prognostic implications.
In 108 consecutive CHF patients (81 men, age: 66+/-11 years) with mean plasma Hcy level 12.5+/-5.5 micromol/L (range 2.3-28.3 micromol/L), 38 (35%) patients demonstrated HHcy. Among clinical and metabolic parameters, in multivariable regression models, advanced NYHA class (P<0.0001), plasma NT-proBNP (P<0.001), peak oxygen consumption (P<0.05), reduced glomerular filtration rate (P<0.0001) and elevated serum uric acid (P<0.05) predicted high plasma Hcy level. HHcy was related to increased mortality (HR=3.26, 95% CI: 1.78-5.98, P=0.0001), also when adjusted for conventional prognosticators in multivariable models (all P<0.01). In patients with HHcy, a 3-year survival was 37% (95% CI: 22-52%) as compared to 73% (95% CI: 63-83%) in those with normal Hcy levels (P<0.0001).
HHcy is common in CHF, is related to the disease severity, depicts generalized metabolic imbalance (evidenced by hyperuricaemia), and independently predicts poor long-term prognosis.
慢性心力衰竭（CHF）患者可能特别容易受到高同型半胱氨酸血症（HHcy）不利影响。本研究旨在评估未经选择的CHF患者队列中HHcy（血浆同型半胱氨酸[Hcy]≥14μmol/L）的患病率、其临床决定因素及预后意义。
连续纳入108例CHF患者（81例男性，年龄：66±11岁），平均血浆Hcy水平为12.5±5.5μmol/L（范围2.3 - 28.3μmol/L），其中38例（35%）患者存在HHcy。在临床和代谢参数中，多变量回归模型显示，纽约心脏协会（NYHA）心功能分级晚期（P<0.0001）、血浆N末端脑钠肽前体（NT-proBNP）（P<0.001）、峰值耗氧量（P<0.05）、肾小球滤过率降低（P<0.0001）和血清尿酸升高（P<0.05）可预测血浆Hcy水平升高。HHcy与死亡率增加相关（风险比[HR]=3.26，95%置信区间[CI]：1.78 - 5.98，P=0.0001），在多变量模型中校正传统预后指标后也是如此（所有P<0.01）。HHcy患者的3年生存率为37%（95%CI：22 - 52%），而Hcy水平正常者为73%（95%CI：63 - 83%）（P<0.0001）。
HHcy在CHF中常见，与疾病严重程度相关，表明存在全身性代谢失衡（高尿酸血症证明），并独立预测不良的长期预后。
