Dierkes J, Bissé E, Nauck M, Orth M, Mayer H, Luley C, Wieland H
Institut für Klinische Chemie und Pathobiochemie, Otto-von-Guericke Universität Magdeburg, Germany.
Clin Chem Lab Med. 1998 Jun;36(7):453-7. doi: 10.1515/CCLM.1998.076.
Hyperhomocysteinemia is now regarded as an established risk factor for coronary artery disease and is present frequently in the general population. However, the diagnostic value of this risk factor relative to others has only occasionally been investigated. We compared the diagnostic value of classic risk factors and of homocysteine in a retrospective case-control study in 191 cases with angiographically established coronary artery disease and 231 healthy controls. Life style habits were assessed by a detailed questionnaire. Laboratory parameters including lipoproteins and blood lipids, homocysteine, folate, and vitamin B12 were measured and their diagnostic value compared with each other by use of receiver-operator characteristic analysis. Comparison of the receiver-operator characteristic curves revealed that homocysteine significantly discriminated between cases and control subjects. High-density-lipoprotein cholesterol, triglycerides and non-esterified fatty acids also had an area under the curve significantly different from 0.5 (the area under the curve representing no discrimination). Homocysteine was weakly related to folate, vitamin B12, age and serum creatinine concentration. We conclude that hyperhomocysteinemia is at least as important as conventional risk factors for coronary artery disease and that receiver operator characteristic analysis of homocysteine is suitable to determine patients at the highest risk for coronary artery disease. Clinical trials testing the effect of homocysteine lowering by vitamin supplementation in the prevention of coronary artery disease are needed.
高同型半胱氨酸血症现已被视为冠状动脉疾病的既定危险因素，且在普通人群中经常出现。然而，相对于其他危险因素，这一危险因素的诊断价值仅偶尔得到研究。在一项回顾性病例对照研究中，我们比较了经典危险因素和同型半胱氨酸的诊断价值，该研究纳入了191例经血管造影确诊为冠状动脉疾病的患者和231名健康对照者。通过详细问卷评估生活方式习惯。测量包括脂蛋白和血脂、同型半胱氨酸、叶酸和维生素B12在内的实验室参数，并使用受试者工作特征分析比较它们的诊断价值。受试者工作特征曲线的比较显示，同型半胱氨酸能显著区分病例组和对照组。高密度脂蛋白胆固醇、甘油三酯和非酯化脂肪酸的曲线下面积也显著不同于0.5（曲线下面积代表无区分能力）。同型半胱氨酸与叶酸、维生素B12、年龄和血清肌酐浓度呈弱相关。我们得出结论，高同型半胱氨酸血症对于冠状动脉疾病至少与传统危险因素同样重要，并且同型半胱氨酸的受试者工作特征分析适用于确定冠状动脉疾病风险最高的患者。需要进行临床试验，以测试通过补充维生素降低同型半胱氨酸对预防冠状动脉疾病的效果。
