Wright A D, Martin N, Dodson P M
Department Ophthalmology, Birmingham Heartlands Hospital, Birmingham, UK.
Eye (Lond). 2008 Aug;22(8):989-93. doi: 10.1038/sj.eye.6703061. Epub 2007 Dec 7.
Plasma homocysteine has been identified as a risk factor for arterial disease, retinal artery and vein occlusions, and other common eye diseases. The value of treating an elevated plasma homocysteine with folic acid for preventing further vascular disease has not been proven. Although secondary prevention of coronary artery disease using this approach has been unsuccessful, trials on primary prevention of stroke and loss of cognitive function with folic acid supplementation appear to be successful. Further trial data are awaited. In patients with premature retinovascular disease, the measurement of plasma homocysteine is suggested and reduction of elevated homocysteine with folic acid for secondary prevention of retinal arterial and venous occlusion. Meanwhile, the debate on fortification of flour for primary prevention of neural tube defects, which has already taken place in North America, continues in European countries. Such fortification could have an impact on primary and secondary prevention of vascular disease.
血浆同型半胱氨酸已被确定为动脉疾病、视网膜动静脉阻塞及其他常见眼部疾病的一个风险因素。用叶酸治疗血浆同型半胱氨酸升高以预防进一步血管疾病的价值尚未得到证实。尽管使用这种方法对冠状动脉疾病进行二级预防未获成功，但补充叶酸对中风一级预防及认知功能丧失的试验似乎是成功的。有待进一步的试验数据。对于患有早发性视网膜血管疾病的患者，建议检测血浆同型半胱氨酸，并使用叶酸降低升高的同型半胱氨酸以二级预防视网膜动静脉阻塞。与此同时，在北美已经展开的关于面粉强化以一级预防神经管缺陷的争论在欧洲国家仍在继续。这种强化可能会对血管疾病的一级和二级预防产生影响。
