Cattaneo M, Vecchi M, Zighetti M L, Saibeni S, Martinelli I, Omodei P, Mannucci P M, de Franchis R
A. Bianchi Bonomi Hemophilia and Thrombosis Center, and Department of Internal Medicine, IRCCS Ospedale Maggiore, University of Milano, Italy.
Thromb Haemost. 1998 Oct;80(4):542-5.
Why patients with inflammatory bowel disease are at increased risk for thrombosis is unknown. Since they may have impaired absorption of vitamins that regulate the metabolism of homocysteine, we tested the hypothesis that they have hyperhomocysteinemia, an established risk factor for arterial and venous thrombosis.
The concentrations of total homocysteine (tHcy), folate and cobalamin were measured in blood samples from 61 consecutive patients with inflammatory bowel disease and 183 age- and sex-matched healthy controls.
The mean (+/- S.D.) concentration of plasma tHcy was higher in patients (12.2 +/- 7.7 micromol/l) than in controls (10.5 +/- 4.6, p = 0.045). Eight patients (13%) had concentrations of tHcy higher than the 95th percentile of distribution among controls, as compared with 9 healthy controls (5%, p = 0.04). The prevalence of folate deficiency was higher in patients (15%) than in controls (5%, p = 0.02). Oral administration of folate, cobalamin and pyridoxine to 15 patients for 30 days decreased their mean tHcy levels from 20.3 +/- 9.9 to 9.5 +/- 3.4 (p <0.001).
In patients with inflammatory bowel disease there is an increased prevalence of hyperhomocysteinemia, which can be corrected by the administration of folate, cobalamin and pyridoxine. The high prevalence of hyperhomocysteinemia may account for the thrombotic risk of IBD patients; whether or not its correction will decrease the thrombotic risk should be tested in properly designed clinical trials.
炎症性肠病患者血栓形成风险增加的原因尚不清楚。由于他们可能存在调节同型半胱氨酸代谢的维生素吸收受损的情况，我们检验了这样一个假设，即他们存在高同型半胱氨酸血症，这是动脉和静脉血栓形成的一个既定风险因素。
对61例连续的炎症性肠病患者及183例年龄和性别匹配的健康对照者的血样进行总同型半胱氨酸（tHcy）、叶酸和钴胺素浓度的检测。
患者血浆tHcy的平均（±标准差）浓度（12.2±7.7微摩尔/升）高于对照组（10.5±4.6，p = 0.045）。8例患者（13%）的tHcy浓度高于对照组分布的第95百分位数，而健康对照者有9例（5%，p = 0.04）。患者中叶酸缺乏的患病率（15%）高于对照组（5%，p = 0.02）。对15例患者口服叶酸、钴胺素和吡哆醇30天，其平均tHcy水平从20.3±9.9降至9.5±3.4（p<0.001）。
炎症性肠病患者高同型半胱氨酸血症的患病率增加，补充叶酸、钴胺素和吡哆醇可纠正这一情况。高同型半胱氨酸血症的高患病率可能是炎症性肠病患者血栓形成风险的原因；其纠正是否会降低血栓形成风险应在设计合理的临床试验中进行检验。
