Department of Vascular Surgery, Qingpu Branch of Zhongshan Hospital, Fudan University, Shanghai, China.
Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
Vasc Med. 2022 Aug;27(4):358-364. doi: 10.1177/1358863X221080486. Epub 2022 Mar 31.
Venous ulceration is a multifactorial disease, and whether hyperhomocysteinemia (HHcy) promotes deterioration from primary varicose veins to venous ulcers remains unproven.
This study retrospectively analyzed clinical data from 717 patients to investigate the potential correlation between HHcy and primary varicose veins ulcer formation, including 611 patients without ulcers (control group) and 106 with ulcers (case group).
In this study, 46.2% (49/106) of patients in the case group and 17.5% (107/611, < 0.001) in the control group suffered from HHcy. Multivariate logistic analysis revealed that HHcy was closely associated with the incidence of venous ulceration in patients with primary varicose veins ( < 0.001). Propensity score matching created 101 matched pairs of patients with and without ulcers, and the analysis pointed to a potential link between HHcy and ulcer formation in the context of primary varicose veins ( < 0.001). Additional experiments showed that HHcy could induce endothelial dysfunction and phenotypic switching of vascular smooth muscle cells.
Both clinical and experimental findings implicated HHcy as a key factor in the development of venous ulceration. Further research is needed to appraise the effectiveness of HHcy-lowering therapy in the prevention of venous ulcers in patients with varicose veins.
静脉溃疡是一种多因素疾病，高同型半胱氨酸血症（HHcy）是否会促进原发性静脉曲张恶化至静脉溃疡尚未得到证实。
本研究回顾性分析了 717 例患者的临床资料，以探讨 HHcy 与原发性静脉曲张溃疡形成之间的潜在相关性，包括 611 例无溃疡患者（对照组）和 106 例有溃疡患者（病例组）。
在本研究中，病例组有 46.2%（49/106）的患者和对照组有 17.5%（107/611，<0.001）的患者患有 HHcy。多变量逻辑分析显示，HHcy 与原发性静脉曲张患者静脉溃疡的发生密切相关（<0.001）。通过倾向评分匹配创建了 101 对有和无溃疡的患者匹配对，分析表明 HHcy 与原发性静脉曲张患者的溃疡形成之间存在潜在联系（<0.001）。进一步的实验表明，HHcy 可诱导内皮功能障碍和血管平滑肌细胞的表型转换。
临床和实验研究都表明 HHcy 是静脉溃疡发展的关键因素。需要进一步研究评估降低 HHcy 治疗在预防静脉曲张患者静脉溃疡中的有效性。
