van den Berg M, Stehouwer C D, Bierdrager E, Rauwerda J A
Department of Vascular Surgery, Free University Hospital, Amsterdam, Netherlands.
Arterioscler Thromb Vasc Biol. 1996 Jan;16(1):165-71. doi: 10.1161/01.atv.16.1.165.
Elevated plasma homocysteine levels are recognized as an independent risk factor for atherosclerotic disease. It is not known (1) whether the severity of atherosclerotic disease is related to hyperhomocyst(e)inemia or (2) whether any such relation differs between fasting and post-methionine loading plasma homocysteine levels. Therefore, in 171 consecutive patients under 55 years of age with first symptoms of lower-limb disease, we examined the relation between severity of atherosclerosis and plasma homocysteine concentration. Severity of atherosclerotic disease was estimated from the prevalence of coronary artery disease and cerebrovascular disease and from the angiographic extent of lower-limb disease. Plasma homocysteine was measured after a period of fasting and in response to methionine loading (0.1 g/kg). In multivariate analysis, the prevalence of coronary artery disease plus cerebrovascular disease was related to both fasting and postmethionine homocysteine levels (odds ratio [OR] for the upper quartile versus the lower three quartiles, 2.8, 95% confidence interval [CI], 1.1 to 7.5; and OR 3.0, 95% CI, 1.1 to 7.8, respectively). The extent of lower-limb disease was weakly related to the fasting homocysteine level (partial correlation coefficient, .12; P = .17) and more strongly related to the postmethionine homocysteine level (partial correlation coefficient, .25; P = .003). These relations tended to be more pronounced in women than in men. They were independent of age, total serum cholesterol, blood pressure, and smoking habit. We concluded that the severity of atherosclerotic disease in young patients with lower-limb atherosclerotic disease is associated with high postmethionine and fasting homocysteine concentrations.
血浆同型半胱氨酸水平升高被认为是动脉粥样硬化疾病的一个独立危险因素。目前尚不清楚：（1）动脉粥样硬化疾病的严重程度是否与高同型半胱氨酸血症有关；（2）空腹和蛋氨酸负荷后血浆同型半胱氨酸水平之间的这种关系是否存在差异。因此，我们对171例年龄在55岁以下出现下肢疾病首发症状的连续患者进行了研究，以探讨动脉粥样硬化严重程度与血浆同型半胱氨酸浓度之间的关系。动脉粥样硬化疾病的严重程度通过冠状动脉疾病和脑血管疾病的患病率以及下肢疾病的血管造影范围来评估。在禁食一段时间后以及给予蛋氨酸负荷（0.1 g/kg）后测定血浆同型半胱氨酸。在多变量分析中，冠状动脉疾病加脑血管疾病的患病率与空腹和蛋氨酸负荷后的同型半胱氨酸水平均相关（上四分位数与下三个四分位数的比值比[OR]分别为2.8，95%置信区间[CI]为1.1至7.5；OR为3.0，95%CI为1.1至7.8）。下肢疾病的范围与空腹同型半胱氨酸水平呈弱相关（偏相关系数为0.12；P = 0.17），与蛋氨酸负荷后的同型半胱氨酸水平相关性更强（偏相关系数为0.25；P = 0.003）。这些关系在女性中往往比在男性中更明显。它们独立于年龄、总血清胆固醇、血压和吸烟习惯。我们得出结论，患有下肢动脉粥样硬化疾病的年轻患者中，动脉粥样硬化疾病的严重程度与蛋氨酸负荷后及空腹时的高同型半胱氨酸浓度相关。
