血浆同型半胱氨酸浓度与颅外颈动脉狭窄之间的关联。

Association between plasma homocysteine concentrations and extracranial carotid-artery stenosis.

作者信息

Selhub J, Jacques P F, Bostom A G, D'Agostino R B, Wilson P W, Belanger A J, O'Leary D H, Wolf P A, Schaefer E J, Rosenberg I H

机构信息

Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, MA 02111.

出版信息

N Engl J Med. 1995 Feb 2;332(5):286-91. doi: 10.1056/NEJM199502023320502.

DOI:10.1056/NEJM199502023320502

PMID:7816063

Abstract

BACKGROUND

Epidemiologic studies have identified hyperhomocysteinemia as a possible risk factor for atherosclerosis. We determined the risk of carotid-artery atherosclerosis in relation to both plasma homocysteine concentrations and nutritional determinants of hyperhomocysteinemia.

METHODS

We performed a cross-sectional study of 1041 elderly subjects (418 men and 623 women; age range, 67 to 96 years) from the Framingham Heart Study. We examined the relation between the maximal degree of stenosis of the extracranial carotid arteries (as assessed by ultrasonography) and plasma homocysteine concentrations, as well as plasma concentrations and intakes of vitamins involved in homocysteine metabolism, including folate, vitamin B12, and vitamin B6. The subjects were classified into two categories according to the findings in the more diseased of the two carotid vessels: stenosis of 0 to 24 percent and stenosis of 25 to 100 percent.

RESULTS

The prevalence of carotid stenosis of > or = 25 percent was 43 percent in the men and 34 percent in the women. The odds ratio for stenosis of > or = 25 percent was 2.0 (95 percent confidence interval, 1.4 to 2.9) for subjects with the highest plasma homocysteine concentrations (> or = 14.4 mumol per liter) as compared with those with the lowest concentrations (< or = 9.1 mumol per liter), after adjustment for sex, age, plasma high-density lipoprotein cholesterol concentration, systolic blood pressure, and smoking status (P < 0.001 for trend). Plasma concentrations of folate and pyridoxal-5'-phosphate (the coenzyme form of vitamin B6) and the level of folate intake were inversely associated with carotid-artery stenosis after adjustment for age, sex, and other risk factors.

CONCLUSIONS

High plasma homocysteine concentrations and low concentrations of folate and vitamin B6, through their role in homocysteine metabolism, are associated with an increased risk of extracranial carotid-artery stenosis in the elderly.

摘要

背景

流行病学研究已将高同型半胱氨酸血症确定为动脉粥样硬化的一个可能危险因素。我们确定了与血浆同型半胱氨酸浓度以及高同型半胱氨酸血症的营养决定因素相关的颈动脉粥样硬化风险。

方法

我们对弗雷明汉心脏研究中的1041名老年受试者（418名男性和623名女性；年龄范围为67至96岁）进行了一项横断面研究。我们研究了颅外颈动脉狭窄的最大程度（通过超声检查评估）与血浆同型半胱氨酸浓度以及参与同型半胱氨酸代谢的维生素的血浆浓度和摄入量之间的关系，这些维生素包括叶酸、维生素B12和维生素B6。根据两条颈动脉中病变较重的那条的检查结果，将受试者分为两类：狭窄程度为0至24%和狭窄程度为25至100%。

结果

男性中颈动脉狭窄≥25%的患病率为43%，女性为34%。在对性别、年龄、血浆高密度脂蛋白胆固醇浓度、收缩压和吸烟状况进行调整后，血浆同型半胱氨酸浓度最高（≥14.4微摩尔/升）的受试者与浓度最低（≤9.1微摩尔/升）的受试者相比，狭窄≥25%的比值比为2.0（95%置信区间为1.4至2.9）（趋势P<0.001）。在对年龄、性别和其他危险因素进行调整后，血浆叶酸和磷酸吡哆醛（维生素B6的辅酶形式）浓度以及叶酸摄入量水平与颈动脉狭窄呈负相关。