Potter Kathleen, Lenzo Nat, Eikelboom John W, Arnolda Leonard F, Beer Christopher, Hankey Graeme J
School of Medicine and Pharmacology, University of Western Australia, W.A., Australia.
Cerebrovasc Dis. 2009;27(3):259-65. doi: 10.1159/000199463. Epub 2009 Feb 6.
Homocysteine may promote atherosclerosis by exacerbating inflammatory processes within the arterial wall. B-vitamin supplements reduce total plasma homocysteine concentrations (tHcy), but it is not known whether the treatment also reduces arterial wall inflammation. We used (18)F-fluorodeoxygluose positron emission tomography ((18)F-FDG PET) to investigate whether long-term homocysteine-lowering treatment alters arterial wall inflammation in patients with a history of ischemic stroke.
30 stroke patients were randomly assigned to B-vitamin therapy (folic acid 2 mg, vitamin B(6) 25 mg and vitamin B(12) 0.5 mg) or placebo in a double-blind clinical trial. After a mean treatment period of 4.0 +/- 0.7 years, all subjects had tHcy, carotid intima-medial thickness (CIMT) and flow-mediated dilation (FMD) of the brachial artery measured and underwent an (18)F-FDG PET scan. Standardised uptake values (SUV) were measured at six sites in the carotid, femoral and aortic arteries. Areas of locally increased tracer uptake in the arterial wall ('hot spots') were also identified and counted.
Long-term B-vitamin treatment significantly reduced tHcy compared with placebo (8.4 micromol/l, 95% confidence interval, CI, 7.2-9.6 vs. 11.6 micromol/l, 95% CI 10.0-13.4, p = 0.002). The treatment did not affect mean arterial SUV (2.0 +/- 0.3 vitamins vs. 2.1 +/- 0.3 placebo, p = 0.65) or the number of hot spots (n = 1.1 +/- 1.0 vitamins vs. n = 1.2 +/- 1.0 placebo, p = 0.65). There was no significant correlation between mean arterial SUV and CIMT or FMD.
These results suggest that a long-term Hcy reduction with B vitamins does not affect arterial wall inflammation assessed by (18)F-FDG PET.
同型半胱氨酸可能通过加剧动脉壁内的炎症过程来促进动脉粥样硬化。B族维生素补充剂可降低血浆总同型半胱氨酸浓度（tHcy），但尚不清楚这种治疗是否也能减轻动脉壁炎症。我们使用（18）F - 氟脱氧葡萄糖正电子发射断层扫描（（18）F - FDG PET）来研究长期降低同型半胱氨酸的治疗是否会改变有缺血性中风病史患者的动脉壁炎症。
在一项双盲临床试验中，30名中风患者被随机分配接受B族维生素治疗（叶酸2毫克、维生素B6 25毫克和维生素B12 0.5毫克）或安慰剂治疗。在平均4.0±0.7年的治疗期后，测量所有受试者的tHcy、颈动脉内膜中层厚度（CIMT）和肱动脉血流介导的舒张功能（FMD），并进行（18）F - FDG PET扫描。在颈动脉、股动脉和主动脉的六个部位测量标准化摄取值（SUV）。还识别并计数动脉壁中局部示踪剂摄取增加的区域（“热点”）。
与安慰剂相比，长期B族维生素治疗显著降低了tHcy（8.4微摩尔/升，95%置信区间，CI，7.2 - 9.6对11.6微摩尔/升，95% CI 10.0 - 13.4，p = 0.002）。该治疗不影响平均动脉SUV（维生素组2.0±0.3对安慰剂组2.1±0.3，p = 0.65）或热点数量（维生素组n = 1.1±1.0对安慰剂组n = 1.2±1.0，p = 0.65）。平均动脉SUV与CIMT或FMD之间无显著相关性。
这些结果表明，用B族维生素长期降低同型半胱氨酸水平并不影响通过（18）F - FDG PET评估的动脉壁炎症。
