Cao Yinglei, Yao Tian, Chen Hao, Liu Hui, Li Changfeng, Wang Daoyu, Wang Yanli, Qiu Fubin, Huang He
Department of Nutrition and Food Hygiene, School of Public Health, Shanxi Medical University, Taiyuan, China.
Department of Gastrointestinal Surgery, First Hospital of Shanxi Medical University, Taiyuan, China.
Transl Cancer Res. 2023 Jan 30;12(1):125-134. doi: 10.21037/tcr-22-2839. Epub 2023 Jan 13.
Venous thromboembolism is a common complication in patients with colorectal cancer who exhibit high homocysteine and low folate levels. However, whether venous thrombosis is the result of a direct effect of folic acid or the presence of a homocysteine-mediated mediating effect cannot be determined. This study aimed to explore the association and mediating effects of serum folate and homocysteine on venous thromboembolism in patients with colorectal cancer.
This study included patients with colorectal cancer who were admitted to the First Hospital of Shanxi Medical University from May 2020 to May 2022. The patients' medical records were reviewed to collect information on general demographic characteristics, the prevalence of venous thromboembolism on admission, laboratory blood indices, serum folate, and serum homocysteine. SPSS 26.0 software was used for data collation and statistical analysis; the χ test was utilized for univariate analysis and unconditional logistic regression was applied for multivariate analysis. R 4.1.2 was used to perform the mediating effect test.
A total of 236 colorectal cancer patients were investigated. The prevalence of colorectal cancer combined with venous thromboembolism was 15.3%; serum folate was <10.75 nmol/L in 25.4% of patients; and serum homocysteine was ≥22 µmol/L in 30.5% of patients. After controlling for confounding factors, the risk of venous thromboembolism was 2.48 times greater [95% confidence interval (CI): 1.04 to 5.94] in patients with low serum folate (<10.75 nmol/L) than in those with high serum folate (≥10.75 nmol/L). Also, the risk of venous thromboembolism was greater in those with high serum homocysteine (≥22 µmol/L) [odds ratio (OR) =2.99. 95% CI: 1.11 to 8.08]. The mediating effect test showed no direct effect of serum folate on venous thromboembolism combined with colorectal cancer, and a full mediating effect of serum homocysteine between serum folate and venous thromboembolism combined with colorectal cancer, with a mediating effect value of 0.002 and a total effect value of 0.0054.
Serum folate influences the formation of venous thromboembolism through serum homocysteine. It is recommended that the nutritional supplementation of patients be enhanced to control serum folate and serum homocysteine levels.
静脉血栓栓塞是结直肠癌患者中常见的并发症，这类患者常表现出高同型半胱氨酸水平和低叶酸水平。然而，静脉血栓形成是叶酸直接作用的结果，还是存在同型半胱氨酸介导的中介效应尚无法确定。本研究旨在探讨血清叶酸和同型半胱氨酸与结直肠癌患者静脉血栓栓塞之间的关联及中介效应。
本研究纳入了2020年5月至2022年5月在山西医科大学第一医院住院的结直肠癌患者。查阅患者病历，收集一般人口统计学特征、入院时静脉血栓栓塞患病率、实验室血液指标、血清叶酸和血清同型半胱氨酸等信息。使用SPSS 26.0软件进行数据整理和统计分析；采用χ检验进行单因素分析，应用非条件logistic回归进行多因素分析。使用R 4.1.2进行中介效应检验。
共调查了236例结直肠癌患者。结直肠癌合并静脉血栓栓塞的患病率为15.3%；25.4%的患者血清叶酸<10.75 nmol/L；30.5%的患者血清同型半胱氨酸≥22 µmol/L。在控制混杂因素后，血清叶酸水平低（<10.75 nmol/L）的患者发生静脉血栓栓塞的风险比血清叶酸水平高（≥10.75 nmol/L）的患者高2.48倍[95%置信区间（CI）：1.04至5.94]。此外，血清同型半胱氨酸水平高（≥22 µmol/L）的患者发生静脉血栓栓塞的风险更高[比值比（OR）=2.99，95% CI：1.11至8.08]。中介效应检验显示，血清叶酸对结直肠癌合并静脉血栓栓塞无直接效应，血清同型半胱氨酸在血清叶酸与结直肠癌合并静脉血栓栓塞之间起完全中介作用，中介效应值为0.002，总效应值为0.0054。
血清叶酸通过血清同型半胱氨酸影响静脉血栓栓塞的形成。建议加强患者的营养补充，以控制血清叶酸和血清同型半胱氨酸水平。
