Gupta A, Moustapha A, Jacobsen D W, Goormastic M, Tuzcu E M, Hobbs R, Young J, James K, McCarthy P, van Lente F, Green R, Robinson K
Department of Internal Medicine, The Cleveland Clinic Foundation, Ohio 44195, USA.
Transplantation. 1998 Feb 27;65(4):544-50. doi: 10.1097/00007890-199802270-00016.
A high plasma homocysteine concentration is a risk factor for atherosclerosis and thrombosis, which are major causes of morbidity and mortality in heart transplant patients. High homocysteine concentrations may be caused by lower folate and vitamin B6 levels. We hypothesized that these patients might have high homocysteine concentrations and low levels of folate and vitamin B6, which could contribute to the development of vascular complications.
Total fasting plasma homocysteine was measured in 189 cardiac transplant recipients and in healthy controls, as were concentrations of folate, vitamin B12, vitamin B6, and creatinine.
Homocysteine concentrations were higher in recipients than controls (19.1+/-13.0 vs. 11.0+/-3.0 micromol/L, P<0.01), and hyperhomocysteinemia (>90th percentile for controls, 14.6 micromol/L) was seen in 68% of recipients (P<0.01). Folate and vitamin B6 concentrations were lower (5.9+/-4.2 vs. 7.9+/-4.2 pmol/L and 40+/-25 vs. 84+/-77 nmol/L, respectively; P<0.01 for both). Folate and vitamin B6 deficiencies were seen in 10.8% and 17.91% of recipients, respectively (P<0.01). Hyperhomocysteinemia was more frequent in patients with vascular complications after transplantation than in those without (79.2% vs. 63.8%, P<0.05).
Elevated plasma homocysteine and deficiencies of folate and vitamin B6 are common in transplant recipients. A high homocysteine concentration was more common in patients with vascular complications. Prospective studies are now required to evaluate the role of these abnormalities as risk factors for the atherothrombotic complications of transplantation.
高血浆同型半胱氨酸浓度是动脉粥样硬化和血栓形成的危险因素，而动脉粥样硬化和血栓形成是心脏移植患者发病和死亡的主要原因。高同型半胱氨酸浓度可能由较低的叶酸和维生素B6水平引起。我们推测这些患者可能有高同型半胱氨酸浓度以及低水平的叶酸和维生素B6，这可能导致血管并发症的发生。
对189名心脏移植受者和健康对照者测量空腹血浆总同型半胱氨酸，同时测量叶酸、维生素B12、维生素B6和肌酐的浓度。
受者的同型半胱氨酸浓度高于对照者（19.1±13.0对11.0±3.0微摩尔/升，P<0.01），68%的受者出现高同型半胱氨酸血症（>对照者第90百分位数，14.6微摩尔/升）（P<0.01）。叶酸和维生素B6浓度较低（分别为5.9±4.2对7.9±4.2皮摩尔/升和40±25对84±77纳摩尔/升；两者均P<0.01）。分别有10.8%和17.91%的受者存在叶酸和维生素B6缺乏（P<0.01）。移植后有血管并发症的患者高同型半胱氨酸血症比无血管并发症的患者更常见（79.2%对63.8%，P<0.05）。
移植受者中血浆同型半胱氨酸升高以及叶酸和维生素B6缺乏很常见。高同型半胱氨酸浓度在有血管并发症的患者中更常见。现在需要进行前瞻性研究来评估这些异常作为移植动脉粥样硬化血栓形成并发症危险因素的作用。
