Wei James Cheng-Chung, Jan Ming-Shiou, Yu Chen-Tung, Huang Yi-Chia, Yang Chi-Chiang, Tsou Hsi-Kai, Lee Hong-Shan, Chou Chang-Tei, Tsay Gregory, Chou Ming-Chih
Division of Allergy, Immunology and Rheumatology, Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.
Clin Rheumatol. 2007 May;26(5):739-42. doi: 10.1007/s10067-006-0396-x. Epub 2006 Sep 21.
Homocysteine (Hcy), a sulfur-containing amino acid, is eliminated through B vitamins-dependent pathways. Hyperhomocysteinemia has been found to be an independent risk factor for atherosclerotic cardiovascular, cerebrovascular, and peripheral vascular diseases. Recently, psoriasis, lupus, and rheumatoid arthritis were reported to be associated with hyperhomocysteinemia. This study was aimed to evaluate the changes of plasma Hcy level before and after sulfasalazine and MTX therapy in patients with ankylosing spondylitis (AS). One hundred and two patients with AS and ten normal controls were enrolled in the cross-sectional case-control study. Fasting plasma Hcy levels were determined by ELISA kits (IMX, Abbott). Hcy levels were compared to their Bath AS disease activity index (BASDAI) and the usage of sulfasalazine and/or MTX. Active disease was defined by BASDAI as more than 3 in a 10-cm scale with ESR >20 mm/h. For those patients with plasma Hcy >or=15 micromol/l, a perspective trial of daily supplement of vitamin B-12 0.5 mg, B-6 50 mg, and folic acid 5 mg for 2 weeks were also tested for the efficacy. Plasma Hcy level increased significantly in AS patients under sulfasalazine (10.4+/-3.8 micromol/l, p<0.05), MTX (11.9+/-4.7, p<0.05) and sulfasalazine/MTX combination treatment (11.2+/-2.6, p<0.05) compared with normal controls (8.6+/-1.2 micromol/l) and AS patients without DMARD(9.4+/- 2.6 micromol/l). No correlation between disease activity and plasma Hcy level was found. Daily supplement of vitamin B-12 0.5 mg, B-6 50 mg, and folic acid 5 mg can lower Hcy level in 2 weeks (32.3+/-24.0 vs 15.6+/-11.1 micromol/l, p=0.007). Plasma homocysteine level did significantly increase in AS patients under sulfasalazine or MTX treatment. B-vitamins should be considered as a routine supplementation for patients who underwent sulfasalazine and/or MTX treatment. Further longitudinal studies are required to confirm the conclusions.
同型半胱氨酸（Hcy）是一种含硫氨基酸，通过依赖维生素B的途径被清除。高同型半胱氨酸血症已被发现是动脉粥样硬化性心血管疾病、脑血管疾病和外周血管疾病的独立危险因素。最近，有报道称银屑病、狼疮和类风湿性关节炎与高同型半胱氨酸血症有关。本研究旨在评估强直性脊柱炎（AS）患者在使用柳氮磺胺吡啶和甲氨蝶呤治疗前后血浆Hcy水平的变化。102例AS患者和10名正常对照者纳入了这项横断面病例对照研究。采用酶联免疫吸附测定试剂盒（IMX，雅培公司）测定空腹血浆Hcy水平。将Hcy水平与其巴氏AS疾病活动指数（BASDAI）以及柳氮磺胺吡啶和/或甲氨蝶呤的使用情况进行比较。BASDAI将疾病活动定义为在10厘米的量表上大于3且红细胞沉降率>20毫米/小时。对于血浆Hcy≥15微摩尔/升的患者，还进行了为期2周的每日补充0.5毫克维生素B-12、50毫克维生素B-6和5毫克叶酸的前瞻性试验，以测试其疗效。与正常对照者（8.6±1.2微摩尔/升）和未使用改善病情抗风湿药（DMARD）的AS患者（9.4±2.6微摩尔/升）相比，接受柳氮磺胺吡啶治疗（10.4±3.8微摩尔/升，p<0.05）、甲氨蝶呤治疗（11.9±4.7，p<0.05）和柳氮磺胺吡啶/甲氨蝶呤联合治疗（11.2±2.6，p<0.05）的AS患者血浆Hcy水平显著升高。未发现疾病活动与血浆Hcy水平之间存在相关性。每日补充0.5毫克维生素B-12、50毫克维生素B-6和5毫克叶酸可在2周内降低Hcy水平（32.3±24.0对15.6±11.1微摩尔/升，p=0.007）。接受柳氮磺胺吡啶或甲氨蝶呤治疗的AS患者血浆同型半胱氨酸水平确实显著升高。对于接受柳氮磺胺吡啶和/或甲氨蝶呤治疗的患者，应考虑将B族维生素作为常规补充剂。需要进一步的纵向研究来证实这些结论。
