Tselmin S, Rodionov R N, Müller G, Bornstein S, Julius U
Department of Internal Medicine III, University Hospital Carl Gustav Carus Dresden, D-01307 Dresden, Germany.
Atheroscler Suppl. 2013 Jan;14(1):123-8. doi: 10.1016/j.atherosclerosissup.2012.10.011.
There is an obvious contrast between the data from the epidemiological studies on hyperhomocysteinemia and the negative results of the homocysteine-lowering clinical trials. Moderate hyperhomocysteinemia might only be relevant in certain subgroups of subjects. The current study was focused on lipoprotein apheresis patients; the study goals were to determine the prevalence of hyperhomocysteinemia, to identify the association between homocysteine levels and cardiovascular events and to test the effects of lipoprotein apheresis and of the conventional homocysteine-lowering therapy.
Sixty patients from our Lipoprotein Apheresis Center (37 males, 23 females, age 63.1 ± 10.8 years) were included in the study. All patients' records were reviewed with respect to age, sex, BMI, dyslipidemias, arterial hypertension, diabetes mellitus and incidence of vascular events in coronaries, carotids and lower extremities. Homocysteine was measured before and immediately after the apheresis procedure. We also observed the effects of conventional homocysteine-lowering therapy.
The prevalence of hyperhomocysteinemia was 50%. Homocysteine levels correlated positively with number of cardiovascular events (p < 0.03) and serum creatinine (p < 0.0001) and negatively with serum HDL-cholesterol (p < 0.03). Neither oral nor intravenous medication with vitamin B and folic acid showed a significant homocysteine lowering effect. The median relative change value of homocysteine after apheresis session was -12% but was not statistically significant.
The prevalence of hyperhomocysteinemia in lipoprotein apheresis patients is high. Neither apheresis nor more conventional methods appear to markedly influence homocysteine serum levels.
高同型半胱氨酸血症的流行病学研究数据与降低同型半胱氨酸的临床试验阴性结果之间存在明显对比。中度高同型半胱氨酸血症可能仅在特定亚组受试者中具有相关性。当前研究聚焦于脂蛋白分离置换法患者；研究目的是确定高同型半胱氨酸血症的患病率，识别同型半胱氨酸水平与心血管事件之间的关联，并测试脂蛋白分离置换法及传统降低同型半胱氨酸疗法的效果。
本研究纳入了来自我们脂蛋白分离置换中心的60例患者（37例男性，23例女性，年龄63.1±10.8岁）。查阅了所有患者关于年龄、性别、体重指数、血脂异常、动脉高血压、糖尿病以及冠状动脉、颈动脉和下肢血管事件发生率的记录。在进行分离置换术前及术后立即测定同型半胱氨酸。我们还观察了传统降低同型半胱氨酸疗法的效果。
高同型半胱氨酸血症的患病率为50%。同型半胱氨酸水平与心血管事件数量（p<0.03）和血清肌酐（p<0.0001）呈正相关，与血清高密度脂蛋白胆固醇呈负相关（p<0.03）。口服或静脉注射维生素B和叶酸均未显示出显著的降低同型半胱氨酸的效果。分离置换术后同型半胱氨酸的中位相对变化值为-12%，但无统计学意义。
脂蛋白分离置换法患者中高同型半胱氨酸血症的患病率较高。无论是分离置换法还是更传统的方法似乎都未对血清同型半胱氨酸水平产生明显影响。
