类风湿关节炎合并心血管病变患者血清同型半胱氨酸水平及其与亚甲基四氢叶酸还原酶基因多态性的关系

目的检测类风湿关节炎（RA）患者血清同型半胱氨酸水平和亚甲基四氢叶酸还原酶（MTHFR）基因单核苷酸多态性，分析其在RA合并心血管病变患者中的作用。方法收集183例RA患者，分为合并心血管病变组和无心血管病变组，同时选取50名我院健康体检者作为对照组。采用实时荧光定量聚合酶链反应方法测定RA患者和对照组的MTHFR基因rs1801133C／T（677）和rs1801131A／C（1298）2个位点的基因单核苷酸多态性；ELISA法检测3组受试者血清同型半胱氨酸水平。结果①183例RA患者心血管病变发生率约为29．0％，其中合并心血管病变组同型半胱氨酸水平明显高于无心血管病变组（P〈0．001）。②677TT基因型组血清同型半胱氨酸水平高于CC及CT组（P〈0．05）。③RA患者血清同型半胱氨酸水平与心血管事件呈正相关。结论RA合并心血管病变患者血清同型半胱氨酸水平明显高于RA无心血病变组及正常对照组，其水平增高可能与MTHFR677C／T基因多态性有关。血清同型半胱氨酸水平升高可作为RA患者发生心血管事件的预测指标。

The association of Serum homocysteine and Polymorphisms of methylenetetrahydrofolate Gene with cardiovascular disease in rheumatoid arthritis

Objective To explore the role of Serum homocysteine and Polymorphisms of methylenetetrahydrofolate（MTHFR） Gene in rheumatoid arthritis patients with cardiovascular disease. Methods Total of 183 patients with RA were divided into CVD group ,without CVD group（ VC group）. Real-time fluorescent quantitative PCR was conducted to test MTHFR rslSO1133C/T（677）and MTHFR rslSO1131A/C （ 1298 ） gene polymorphism in RA patients and healthy controls;Serum homocysteine level was determined by ELISA assay at the same time. Results （1）The occurrence of CVD in patients with rheumatoid arthritis was 29.0% （53/183 patients with RA）, and there was significant difference on the serum homocysteine level between CVD group and VC group in RA patients（ P 〈0. 0001 ）. （2）Carriers of 677TT MTHFR genotype had serum hcy values higher than CC and CT genotype（P 〈 0.05）. （3）The serum homocysteine level in RA patients was positively correlated with CVD. Conclusion The serum homocysteine level in RA patients with CVD group was significantly higher than that in VC group and healthy controls, and 677C/T gene polymorphism presumably acting by elevating homocysteine levels. The elevated serum homocysteine level may be a predictor for CVD in patients with rheumatoid arthritis.