den Heijer M, Rosendaal F R, Blom H J, Gerrits W B, Bos G M
Department of Hematology, Leyenburg Hospital, The Hague, The Netherlands.
Thromb Haemost. 1998 Dec;80(6):874-7.
Hyperhomocysteinemia is an established risk factor for atherosclerosis and vascular disease. Until the early nineties the relationship with venous thrombosis was controversial. At this moment ten case-control studies on venous thrombosis are published. We performed a metaanalysis of these reports. We performed a MEDLINE-search from 1984 through June 1997 on the keywords "homocysteine" or "hyperhomocysteinemia" and "venous thrombosis", which yielded ten eligible case-control studies. We found a pooled estimate of the odds ratio of 2.5 (95% CI 1.8-3.5) for a fasting plasma homocysteine concentration above the 95th percentile or mean plus two standard deviations calculated from the distribution of the respective control groups. For the post-methionine increase in homocysteine concentration we found a pooled estimate of 2.6 (95% CI 1.6-4.4). These data from case-control studies support hyperhomocysteinemia as a risk factor for venous thrombosis. Further research should focus on the pathophysiology of this relationship and on the clinical effects of reducing homocysteine levels by vitamin supplementation.
高同型半胱氨酸血症是动脉粥样硬化和血管疾病公认的危险因素。直到九十年代初，它与静脉血栓形成的关系仍存在争议。目前已发表了十项关于静脉血栓形成的病例对照研究。我们对这些报告进行了荟萃分析。我们在1984年至1997年6月期间通过MEDLINE检索了关键词“同型半胱氨酸”或“高同型半胱氨酸血症”以及“静脉血栓形成”，得到了十项符合条件的病例对照研究。我们发现，空腹血浆同型半胱氨酸浓度高于第95百分位数或根据各个对照组分布计算的均值加两个标准差时，比值比的合并估计值为2.5（95%可信区间1.8 - 3.5）。对于蛋氨酸负荷后同型半胱氨酸浓度的升高，我们发现合并估计值为2.6（95%可信区间1.6 - 4.4）。这些病例对照研究的数据支持高同型半胱氨酸血症作为静脉血栓形成的一个危险因素。进一步的研究应聚焦于这种关系的病理生理学以及通过补充维生素降低同型半胱氨酸水平的临床效果。
