Department of Clinical Laboratory, Beijing Anzhen Hospital, Capital Medical University, Anzhen Road No. 2, Chaoyang District, Beijing, 100029, China.
Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, People's Republic of China.
Immunol Res. 2020 Dec;68(6):405-413. doi: 10.1007/s12026-020-09157-1. Epub 2020 Oct 16.
Serum homocysteine (HCY) levels have been associated with the occurrence of coronary stenosis and disease activity in large-vessel vasculitis. However, whether increases in serum HCY levels and traditional lipid indicators are associated with coronary artery involvement and disease activity in Chinese Han Takayasu arteritis (TA) patients is unknown. This study aims to investigate the clinical and laboratory features of TA by assessing their association with disease activity in TA patients, and to explore the risk factors associated with coronary artery involvement in these patients. Serum HCY levels and traditional lipid indicators were tested in one hundred ninety TA patients and one hundred fifty-four healthy controls. We analyzed the relationships of serum HCY levels and traditional lipid indicators with disease activity and analyzed the risk factors for coronary artery involvement. Twenty-one TA patients were found to have coronary artery stenosis (≥ 50%). TA patients had significantly higher levels of HCY than did healthy controls (p < 0.0001). Serum levels of HCY and low-density lipoprotein cholesterol (LDL-C); the ratios of LDL-C to high-density lipoprotein cholesterol (HDL-C), total cholesterol (TC) to HDL-C, and triglycerides (TG) to HDL-C; and the values of atherogenic index of plasma (AIP) were significantly higher in patients with active TA than in patients with inactive TA and in TA patients with coronary artery involvement than in TA patients without coronary artery involvement. By contrast, the serum levels of HDL-C were significantly lower in patients with active TA than in patients with inactive TA and in TA patients with coronary artery involvement than in TA patients without coronary artery involvement (p < 0.05). In addition, the serum levels of TC and TG were significantly higher in TA patients with coronary artery involvement than those in TA patients without coronary artery involvement. Elevated serum HCY levels increased the risk of coronary artery involvement by 1.3-fold (p = 0.011, odds ratio [OR] = 1.275, 95% confidence interval [CI]: 1.056-1.539), and the cutoff value for serum HCY was 9.55 μmol/L. Elevated serum TG levels increased the risk of coronary artery involvement by 3.5-fold (p < 0.0001, OR = 3.534, 95% CI: 1.907-6.547), and the cutoff value for serum TG was 1.215 mmol/L. The risk of coronary artery involvement was 2.5-fold higher when an elevated TG/HDL-C ratio was present (p < 0.0001, OR = 2.513, 95% CI: 1.567-4.032). This study showed that serum HCY and TG levels and the TG/HDL-C ratio are independent risk factors for coronary artery involvement in TA patients.
血清同型半胱氨酸（HCY）水平与冠状动脉狭窄和大血管血管炎的疾病活动有关。然而，血清 HCY 水平和传统血脂指标的升高是否与中国汉族大动脉炎（TA）患者的冠状动脉受累和疾病活动有关尚不清楚。本研究旨在通过评估 TA 患者与疾病活动的相关性，探讨 TA 患者的临床和实验室特征，并探讨与这些患者冠状动脉受累相关的危险因素。检测了 190 例 TA 患者和 154 例健康对照者的血清 HCY 水平和传统血脂指标。我们分析了血清 HCY 水平和传统血脂指标与疾病活动的关系，并分析了冠状动脉受累的危险因素。发现 21 例 TA 患者存在冠状动脉狭窄（≥50%）。与健康对照组相比，TA 患者的 HCY 水平显著升高（p<0.0001）。与无冠状动脉受累的 TA 患者相比，活动期 TA 患者的 HCY 和低密度脂蛋白胆固醇（LDL-C）水平；LDL-C 与高密度脂蛋白胆固醇（HDL-C）的比值、总胆固醇（TC）与 HDL-C 的比值、甘油三酯（TG）与 HDL-C 的比值；以及血浆致动脉粥样硬化指数（AIP）的值均显著升高。与无冠状动脉受累的 TA 患者相比，活动期 TA 患者的 HDL-C 水平显著降低，且有冠状动脉受累的 TA 患者的 HDL-C 水平显著降低（p<0.05）。此外，有冠状动脉受累的 TA 患者的 TC 和 TG 血清水平明显高于无冠状动脉受累的 TA 患者。血清 HCY 水平升高使冠状动脉受累的风险增加 1.3 倍（p=0.011，比值比[OR]为 1.275，95%置信区间[CI]为 1.056-1.539），血清 HCY 的截断值为 9.55μmol/L。血清 TG 水平升高使冠状动脉受累的风险增加 3.5 倍（p<0.0001，OR 为 3.534，95%CI 为 1.907-6.547），血清 TG 的截断值为 1.215mmol/L。当 TG/HDL-C 比值升高时，冠状动脉受累的风险增加 2.5 倍（p<0.0001，OR 为 2.513，95%CI 为 1.567-4.032）。本研究表明，血清 HCY 和 TG 水平以及 TG/HDL-C 比值是 TA 患者冠状动脉受累的独立危险因素。
