van den Berg M, Franken D G, Boers G H, Blom H J, Jakobs C, Stehouwer C D, Rauwerda J A
Department of Surgery, Free University Hospital, Amsterdam, The Netherlands.
J Vasc Surg. 1994 Dec;20(6):933-40. doi: 10.1016/0741-5214(94)90230-5.
Hyperhomocysteinemia is associated with arteriosclerotic and thromboembolic events. The homocysteine-lowering effect of combined treatment with vitamin B6 plus folic acid has never been explored in a large group of patients with vascular disease. Therefore we studied the effects of at least 6 weeks treatment with these vitamins in 72 patients with cardiovascular disease and mild hyperhomocysteinemia (defined as an increase of the plasma homocysteine level after methionine loading greater than 97.5 percentile of age-matched control subjects but less than 200 mumol/L).
The existence of mild hyperhomocysteinemia was investigated in 309 consecutive patients under 50 years of age with peripheral arterial occlusive disease, cerebral arterial occlusive disease, or coronary artery occlusive disease. All patients with an abnormal loading test result were treated with vitamin B6, 250 mg daily, plus folic acid, 5 mg daily. After 6 weeks of treatment a second methionine loading test was performed to assess the homocysteine-lowering effect.
Mild hyperhomocysteinemia was detected in 72 patients (23%), 33 (46%) of whom also had hyperhomocysteinemia when fasting. Treatment with vitamin B6 plus folic acid normalized the postload plasma homocysteine concentration in 66 of the 72 patients (92%), whereas fasting hyperhomocysteinemia was normalized in 30 of 33 (91%) patients. In six patients therapy failed to achieve normalization of the postload homocysteine levels. In three of these patients, the same treatment was continued for an additional 6 weeks, and in the remaining three patients betaine was added to the treatment regimen. After 6 weeks of additional treatment all six patients had normal postload plasma homocysteine concentrations.
The prevalence of mild hyperhomocysteinemia in young patients with arterial occlusive disease is high. Simple and inexpensive therapy with vitamin B6 plus folic acid will normalize homocysteine metabolism, as assessed by the homocysteine plasma level after methionine loading, in virtually all these patients.
高同型半胱氨酸血症与动脉硬化及血栓栓塞事件相关。维生素B6联合叶酸治疗降低同型半胱氨酸的效果从未在一大组血管疾病患者中进行过研究。因此，我们研究了这些维生素对72例心血管疾病合并轻度高同型半胱氨酸血症患者（定义为蛋氨酸负荷后血浆同型半胱氨酸水平升高超过年龄匹配对照受试者的第97.5百分位数但低于200μmol/L）至少6周治疗的效果。
对309例年龄在50岁以下的外周动脉闭塞性疾病、脑动脉闭塞性疾病或冠状动脉闭塞性疾病患者连续进行轻度高同型半胱氨酸血症的检测。所有负荷试验结果异常的患者均接受每日250mg维生素B6加每日5mg叶酸的治疗。治疗6周后进行第二次蛋氨酸负荷试验以评估降低同型半胱氨酸的效果。
72例患者（23%）检测到轻度高同型半胱氨酸血症，其中33例（46%）空腹时也存在高同型半胱氨酸血症。维生素B6联合叶酸治疗使72例患者中的66例（92%）负荷后血浆同型半胱氨酸浓度恢复正常，而33例空腹高同型半胱氨酸血症患者中的30例（91%）恢复正常。6例患者治疗后负荷后同型半胱氨酸水平未恢复正常。其中3例患者继续相同治疗6周，其余3例患者在治疗方案中添加了甜菜碱。额外治疗6周后，所有6例患者负荷后血浆同型半胱氨酸浓度均恢复正常。
年轻动脉闭塞性疾病患者中轻度高同型半胱氨酸血症的患病率较高。通过蛋氨酸负荷后血浆同型半胱氨酸水平评估，维生素B6联合叶酸这种简单且廉价的治疗方法几乎可使所有这些患者的同型半胱氨酸代谢恢复正常。
