Gonzalez-Porras J R, Martin-Herrero F, Garcia-Sanz R, Lopez M L, Balanzategui A, Mateos M V, Pavon P, Gonzalez M, Alberca I, San Miguel J F
Department of Hematology, University Hospital of Salamanca, Paseo de San Vicente, 58-182, Salamanca, 37007, Spain.
Thromb Res. 2007;119(6):691-8. doi: 10.1016/j.thromres.2006.06.002. Epub 2006 Sep 26.
Despite the well-known pro-coagulant effect of hyperhomocysteinemia, data is limited regarding the result on recurrent coronary event (RCE) in young people. One hundred and forty patients <55 years old with a first acute coronary syndrome (ACS) were prospectively followed for a mean (+/-S.D.) follow-up of 49+/-14 months in order to investigate the relationship between homocysteine levels (tHcy) at admission and the incidence of RCE. The tHcy values were divided into quartiles to examine their relationship with end points. Furthermore, we determined the effect of C677T methylene tetrahydrofolate reductase (MTHFR) polymorphism, as well as other risk factors for developing a RCE. The median plasma homocysteine concentration was 9.6 mumol/L (interquartile range, 3.7). In the screening of MTHFR C677T polymorphism in patients with ACS, the T allele frequency was 0.4 and the genotype frequency distributions were in Hardy-Weinberg equilibrium. At time of final evaluation, 49 (35%) of the 140 valuable patients had developed a RCE. Increasing numbers of RCE were observed for increasing quartiles of tHcy according to Kaplan-Meier survival (Log-rank test=0.0092). The MTHFR C677T polymorphism was not associated with an increased incidence of RCE. In multivariate analysis, the variables independently associated with a higher risk of RCE were age older than 45 years [HR=2.7; (95% CI, 1.3-6.1); p=0.030], body mass index more than 25 [HR=2.6; (95% CI, 1.1-5.9); p=0.034] and tHcy levels into quartile 4 (tHcy>12.37 mumol/L) [HR=2.5; (95% CI, 1.1-4.7); p=0.04]. Elevated plasma homocysteine level at admission is an independent risk factor for RCE after the first episode of ACS in young patients irrespective of the status of MTHFR C677T.
尽管高同型半胱氨酸血症具有众所周知的促凝血作用，但关于其对年轻人复发性冠状动脉事件（RCE）影响的数据有限。对140例年龄<55岁的首次急性冠状动脉综合征（ACS）患者进行前瞻性随访，平均（±标准差）随访49±14个月，以研究入院时同型半胱氨酸水平（总同型半胱氨酸，tHcy）与RCE发生率之间的关系。将tHcy值分为四分位数以检查其与终点的关系。此外，我们确定了C677T亚甲基四氢叶酸还原酶（MTHFR）多态性以及发生RCE的其他危险因素的影响。血浆同型半胱氨酸浓度中位数为9.6μmol/L（四分位间距，3.7）。在对ACS患者进行MTHFR C677T多态性筛查时，T等位基因频率为0.4，基因型频率分布符合哈迪-温伯格平衡。在最终评估时，140例有价值的患者中有49例（35%）发生了RCE。根据Kaplan-Meier生存曲线（对数秩检验=0.0092），随着tHcy四分位数增加，观察到RCE数量增加。MTHFR C677T多态性与RCE发生率增加无关。在多变量分析中，与RCE风险较高独立相关的变量为年龄大于45岁[风险比（HR）=2.7；（95%置信区间，1.3 - 6.1）；p = 0.030]、体重指数大于25[HR = 2.6；（95%置信区间，1.1 - 5.9）；p = 0.034]以及tHcy水平处于四分位数4（tHcy>12.37μmol/L）[HR = 2.5；（95%置信区间，1.1 - 4.7）；p = 0.04]。入院时血浆同型半胱氨酸水平升高是年轻患者首次ACS发作后发生RCE的独立危险因素，与MTHFR C677T状态无关。
