Christopher Rita, Nagaraja D, Shankar S K
Department of Neurochemistry, National Institute of Mental Health and Neuro Sciences, Post Box 2900, Hosur Road, Bangalore 560029, Karnataka, India.
Curr Med Chem. 2007;14(22):2393-401. doi: 10.2174/092986707781745613.
Two-thirds of stroke deaths worldwide occur in developing countries. The higher prevalence of undernutritional states and parasitic infestations in many of these countries could lead to vitamin B(12) and folate deficiencies. Hyperhomocysteinemia, a proxy measure for the nutritional status of B vitamins, has been reported in many developing countries and is found to be associated with nutrition-related low plasma folate and vitamin B(12). Several epidemiological observations have linked hyperhomocysteinemia to increased risk for stroke. The exact molecular mechanism by which homocysteine promotes atherothrombosis is not clear, although several possible roles have been suggested. Homocysteine is believed to cause atherogenesis and thrombogenesis via endothelial damage, focal vascular smooth muscle proliferation probably causing irregular vascular contraction, and coagulation abnormalities. Supplementation with the nutrient cofactors required for optimal functioning of the homocysteine metabolic pathways significantly impacts plasma homocysteine levels, and offers a new integrated possibility for prevention of stroke in the underdeveloped and rapidly developing countries.
全球三分之二的中风死亡发生在发展中国家。这些国家中许多国家营养不良状态和寄生虫感染的患病率较高，可能导致维生素B12和叶酸缺乏。高同型半胱氨酸血症是衡量B族维生素营养状况的一个替代指标，在许多发展中国家都有报道，并且发现它与营养相关的低血浆叶酸和维生素B12有关。几项流行病学观察已将高同型半胱氨酸血症与中风风险增加联系起来。尽管已经提出了几种可能的作用，但同型半胱氨酸促进动脉粥样硬化血栓形成的确切分子机制尚不清楚。同型半胱氨酸被认为通过内皮损伤、可能导致不规则血管收缩的局部血管平滑肌增殖以及凝血异常来引起动脉粥样硬化和血栓形成。补充同型半胱氨酸代谢途径最佳功能所需的营养辅助因子会显著影响血浆同型半胱氨酸水平，并为欠发达和快速发展的国家预防中风提供了一种新的综合可能性。
