恶性血液病患者的血浆同型半胱氨酸和血清叶酸水平的临床研究

目的 探讨血浆同型半胱氨酸(Hcy)和血清叶酸(FA)水平与恶性血液病患者的关系.方法 采用电化学发光法检测86名恶性血液病患者血浆中Hcy浓度、血浆叶酸、维生素B12的浓度.其中急性白血病63例,恶性淋巴瘤8例,多发性骨髓瘤8例;慢性粒细胞白血病慢性期(CML-CP)7例.并同时检查健康成人30名作为正常对照.结果 急性白血病、恶性淋巴瘤、多发性骨髓瘤、慢性白血病患者组中血浆Hcy水平显著高于健康对照组(P＜0.05),而FA水平明显降低(P＜0.05).结论 高同型半胱氨酸血症可能是恶性血液病患者的危险因素.     

VitB12、叶酸、同型半胱氨酸和血管内皮生长因子水平与胎儿生长受限的相关性

目的 探讨妊娠晚期孕妇空腹静脉血及脐带静脉血中维生素B12(VitB12)、叶酸、同型半胱氨酸(HCY)及血管内皮生长因子(VEGF)的水平与胎儿生长受限(FGR)的关系。方法 选取2019年1月1日至2021年12月31日在郑州市妇幼保健院住院分娩的138例妊娠合并FGR孕妇为FGR组,同期住院分娩的无妊娠并发症且新生儿体重正常的138例孕妇为对照组,比较两组间孕妇空腹静脉血及脐带静脉血中VitB12、叶酸、HCY和VEGF水平,采用Pearson相关分析以上指标与FGR新生儿出生体重之间的关系。结果 FGR组孕妇年龄、妊娠合并子痫前期的比例高于对照组,孕期增重低于对照组,差异均有统计学意义(t/χ²值分别为2.027、43.371、-4.513,P<0.05);FGR组孕妇空腹静脉血及脐带静脉血中VitB12、叶酸及VEGF的水平低于对照组,而孕HCY的水平高于对照组,差异均有统计学意义(t值介于-4.757～6.968之间,P<0.05);FGR组孕妇空腹静脉血及脐带静脉血VitB12、叶酸及VEGF水平与新生儿出生体重正相关(r值介于0.540...     

叶酸与甲钴胺对H型高血压患者血浆同型半胱氨酸水平及血管内皮功能的影响

目的:研究叶酸与甲钴胺对H型高血压患者血浆同型半胱氨酸水平及血管内皮功能的影响。方法:选取2018年7月~2019年7月我院收治的180例H型高血压患者,根据治疗方法不同将患者分为实验组组和对照组,每组各90例。对照组和实验组患者均接受常规治疗和护理,对照组患者采用甲钴胺注射液进行治疗,实验组患者在对照组患者基础上利用叶酸进行治疗,对比两组患者的治疗后血管内皮功能指标,记录对比患者的NO(一氧化氮)、ET-1(血管内皮素-1)及PAG(血小板聚集率)等指标水平的相关数据。观察并记录两组组患者治疗前后血浆Hcy(同型半胱氨酸)水平。结果:实验结果显示,实验组患者血清中NO水平明显高于对照组患者,实验组患者ET-1和PAG水平明显低于对照组患者,且数据差异较大,差异具有统计学意义(P<0.05)。实验组患者治疗后半胱氨酸血含量明显低于对照组患者,且差异具有统计学意义(P<0.05)。结论:叶酸联合甲钴胺对H型高血压患者进行治疗,可以有效改善患者血浆同型半胱氨酸水平及血管内皮功能情况,具有一定的推广和应用意义。     

同型半胱氨酸和动脉粥样硬化

同型半胱氨酸是蛋氨酸的代谢产物，体内含量极微。遗传性代谢障碍和获得性代谢障碍均可造成其在体内蓄积，形成同型半胱氨酸血症，并与动脉粥样硬化等心血管系统病变有关。     

血浆同型半胱氨酸和尿酸与老年冠心病的相关性分析

目的 测定不同类型老年冠心病(CHD)患者血浆同型半胱氨酸(Hcy)和尿酸(UA)的水平,并探讨其临床意义.方法 选择89例不同类型老年CHD患者和60例对照组,测定血浆中Hcy和UA的水平,并分析两者的关系.结果 急性心肌梗死组(AMI;28例)、不稳定型心绞痛组(UAP;35例)血浆Hcy和UA含量高于稳定型心绞痛组(SAP;26例)、对照组,差异有统计学意义(P＜0.05);血浆Hcy和UA水平变化呈正相关(r=0.512,P＜0.05).结论 血浆Hcy和UA可能参与了急性冠脉综合征(ACS)的发病过程,血浆Hcy和UA水平的测定对ACS的预测和疗效观察有一定的临床意义.     

叶酸和同型半胱氨酸对血管病的影响及其机制

该文主要介绍膳食叶酸摄入不足对血浆同型半胱氨酸(homocysteine,Hcy)水平的影响,并总结了机体叶酸缺乏及Hcy水平过高与高血压、心血管疾病、脑血管疾病、外周血管疾病及先天性血管缺陷的关联。同时,从内皮细胞NO合成、氧化应激、炎症反应、脂质代谢、凝血系统-抗凝系统、血管平滑肌细胞增殖等角度分别阐述了两者导致血管病发生、发展的可能机制。     

补充叶酸、甲钴胺对血液透析患者血浆同型半胱氨酸的影响

目的探讨补充叶酸、甲钴胺对血液透析（血透）患者血浆同型半胱氨酸（Hcy）的影响。方法将60例门诊血透患者随机分成五组,每组12例。Ⅰ组：口服叶酸5mg1次/d;Ⅱ组：口服叶酸5mg3次/d;Ⅲ组：口服甲钴胺0.5mg3次/d;Ⅳ组：每次血透后静脉注射甲钴胺0.5mg3次/周;Ⅴ组：口服叶酸5mg1次/d联合静脉注射甲钴胺0.5mg3次/周。观察每组患者用药前、用药2个月后和停药2个月后血浆Hcy、叶酸和维生素B12浓度,另选择32例健康体检者作为对照组。结果与对照组比较,各组治疗前血浆Hcy浓度明显升高,维生素B12和叶酸浓度差异无统计学意义。治疗2个月后除Ⅲ组外各组血浆Hcy浓度较治疗前明显下降,其中Ⅴ组血浆Hcy下降效果最好,但均未达正常水平。停药2个月后各组血浆Hcy浓度又恢复到用药前水平。结论血透患者普遍存在高Hcy血症,补充叶酸和/或甲钴胺可以降低血浆Hcy浓度,但不能使其正常,5mg/d叶酸和15mg/d叶酸所取得的效果相似,甲钴胺只有静脉应用才有降低血浆Hcy的作用。     

血浆同型半胱氨酸和糖尿病大血管病变

糖尿病大血管病变是糖尿病患者常见的慢性并发症，也是糖尿病患者致死、致残的主要原因之一，其发病机制尚未完全明了。已有研究表明血浆同型半胱氨酸（Homocysteine，Hcy）是心血管疾病的一种危险因素，然而近年来众多流行病学研究表明高同型半胱氨酸血症也是糖尿病大血管病变独立而强有力的危险因素。本文就血浆高同型半胱氨酸血症与糖尿病大血管病变之间关系的研究进展做一综述。     

老年冠心病患者血浆同型半胱氨酸水平及叶酸的干预效果

研究结果表明 ,血浆同型半胱氨酸 (Hcy)升高与冠心病(CAD)的发生和发展密切相关。我们旨在了解老年CAD患者血浆Hcy、叶酸和维生素B12 的变化特点及叶酸的干预效果。选择 2 0 0 0年 6月至 2 0 0 2年 4月在我院行冠状动脉 (冠脉 )造影确诊为冠心病 (1支以上主要冠脉狭窄≥ 5 0 % )的患者 94例 ,男 5 8例 ,女 36例 ,年龄 38～ 77岁 ,平均 (5 2± 17)岁。其中年龄≥ 6 0岁 5 1例 (A组 ) ,男 32例 ,女 19例 ,平均年龄 (6 7± 6 )岁 ;<6 0岁 4 3例 (B组 ) ,男 2 6例 ,女 17例 ,平均年龄 (5 1± 8)岁。另外选择同期冠脉造影未见明显狭窄的老年…     

心理应激对大鼠叶酸和同型半胱氨酸的影响及补充叶酸的调节作用

目的明确应激状态下机体血浆和脑脊液中同型半胱氨酸(Hcy)浓度及组织叶酸含量的变化,探讨叶酸在应激状态下对Hcy水平的调节作用。方法以束缚作为应激原建立大鼠心理应激模型,动物分为对照组、束缚3w组,束缚3w同时补充叶酸组。认识心理应激对机体Hcy和叶酸水平的影响,及应激状态下补充叶酸对机体Hcy水平的调节作用。结果心理应激动物叶酸代谢发生了显著的变化,血浆叶酸水平显著低于对照组,小肠粘膜上皮、肝脏、皮层和海马组织中叶酸的含量也明显降低。补充叶酸可以显著升高心理应激后机体的叶酸水平,降低心理应激所致的血浆同型半胱氨酸水平升高。结论应激状态下机体叶酸含量的降低可能是同型半胱氨酸水平升高的重要原因之一。     

Methoxistasis: Integrating the Roles of Homocysteine and Folic Acid in Cardiovascular Pathobiology

Over the last four decades, abnormalities in the methionine-homocysteine cycle and associated folate metabolism have garnered great interest due to the reported link between hyperhomocysteinemia and human pathology, especially atherothrombotic cardiovascular disease. However, clinical trials of B-vitamin supplementation including high doses of folic acid have not demonstrated any benefit in preventing or treating cardiovascular disease. In addition to the fact that these clinical trials may have been shorter in duration than appropriate for modulating chronic disease states, it is likely that reduction of the blood homocysteine level may be an oversimplified approach to a complex biologic perturbation. The methionine-homocysteine cycle and folate metabolism regulate redox and methylation reactions and are, in turn, regulated by redox and methylation status. Under normal conditions, a normal redox-methylation balance, or “methoxistasis”, exists, coordinated by the methionine-homocysteine cycle. An abnormal homocysteine level seen in pathologic states may reflect a disturbance of methoxistasis. We propose that future research should be targeted at estimating the deviation from methoxistasis and how best to restore it. This approach could lead to significant advances in preventing and treating cardiovascular diseases, including heart failure.     

同型半胱氨酸诱发鸡胚神经管畸形及叶酸的保护作用

为了揭示同型半胱氨酸（ｈｏｍｏｃｙｓｔｅｉｎｅ，ＨＣＹ）是否能导致胚胎发生神经管畸形（ＮＴＤｓ）和可能的致畸机制及验证叶酸和ＶＢ１２的干预效果，本研究应用鸡胚致畸试验、扫描电镜观察、尼罗兰盐活体染色、原位ＤＮＡ片段末端标记、甲基绿—派若宁染色显示核酸法、叶酸和Ｂ１２干预实验等方法检测了用ＨＣＹ（０～１６μｍｏｌ／胚胎）的不同胚龄胚胎１２７４只。结果显示ＨＣＹ对神经胚形成期和器官形成期的胚胎均有显著的致畸性并呈剂量－反应关系（Ｐ＜０．０００１），鸡胚发生ＮＴＤｓ的主要表现是露脑，裂脑和脊柱裂。首次发现ＨＣＹ能诱发神经系统细胞凋亡过度，其部位与ＮＴＤｓ发生部位相吻合。ＨＣＹ能抑制卵黄囊血管分化；损伤羊膜组织及细胞超微结构，如微绒毛变短，胞膜上出现空洞样变等。注射５μｇ叶酸明显拮抗ＨＣＹ（８μｍｏｌ／胚胎）的致畸性，ＮＴＤｓ发生率由４３．５％降至０（Ｐ＜０．０５）；注射１μｇＶＢ１２不能明显保护胚胎（Ｐ＞０．０５）。本研究结果说明ＨＣＹ能诱导胚胎发生ＮＴＤｓ；细胞凋亡在ＮＴＤｓ发生过程中起重要作用；叶酸能有效地预防ＮＴＤｓ；ＨＣＹ自身所诱发的ＮＴＤｓ可能是多种机制相互作用或联合作用的结果     

Effects of Periconceptional Multivitamin Supplementation on Folate and Homocysteine Levels Depending on Genetic Variants of Methyltetrahydrofolate Reductase in Infertile Japanese Women

Methylenetetrahydrofolate reductase (MTHFR) has various polymorphisms, and the effects of periconceptional folic acid supplementation for decreasing neural tube defects (NTDs) risk differ depending on the genotypes. This study analyzed the effectiveness of multivitamin supplementation on folate insufficiency and hyperhomocysteinemia, depending on MTHFR polymorphisms. Of 205 women, 72 (35.1%), 100 (48.8%) and 33 (16.1%) had MTHFR CC, CT and TT, respectively. Serum folate and homocysteine levels in women with homozygous mutant TT were significantly lower and higher, respectively, than those in women with CC and CT. In 54 women (26.3% of all women) with a risk of NTDs, multivitamin supplementation containing folic acid and vitamin D for one month increased folate level (5.8 ± 0.9 to 19.2 ± 4.0 ng/mL, p < 0.0001) and decreased the homocysteine level (8.2 ± 3.1 to 5.8 ± 0.8 nmol/mL, p < 0.0001) to minimize the risk of NTDs in all women, regardless of MTHFR genotype. Regardless of MTHFR genotype, multivitamin supplements could control folate and homocysteine levels. Tests for folate and homocysteine levels and optimal multivitamin supplementation in women with risk of NTDs one month or more before pregnancy should be recommended to women who are planning a pregnancy.     

Methionine-Loading Rapidly Impairs Endothelial Function,by Mechanisms Independent of Endothelin-1: Evidence for an Association of Fasting Total Homocysteine with Plasma Endothelin-1 Levels

Objective: Homocysteinemia is associated with elevated oxidative stress and impaired endothelial function. In the present study we examined the impact of oxidative stress in the development of endothelial dysfunction in both chronic and acute (methionine-induced) homocysteinemia in humans. We also examined the role of endothelin-1 (ET-1) in the development of endothelial dysfunction in these two conditions.

Methods: In this double-blind placebo controlled study, 28 subjects of both genders (14 with homocysteinemia and 14 healthy controls) underwent methionine-loading (100mg/Kg body weight) in a standard juice, containing vitamins C (2g) plus E (800IU) (n = 14) or no vitamins (placebo group, n = 14). Forearm vasodilatory response to reactive hyperemia, plasma total homocysteine (tHcy), oxidized LDL (ox-LDL), ET-1 and soluble vascular cell adhesion molecule (sVCAM-1), were evaluated at baseline and 4 hours post methionine loading (4hPML).

Results: Chronic homocysteinemia was associated with increased oxLDL (p < 0.01), higher ET-1 (p < 0.05) and impaired endothelial function (p < 0.01). However, oxLDL (but not ET-1) was increased 4hPML in the placebo group, an effect prevented by antioxidant vitamins. The development of severe endothelial dysfunction 4hPML was not however prevented by antioxidants. In linear regression analysis, fasting tHcy was an independent predictor of baseline oxLDL (p = 0.0001), but not of ET-1 levels. On the contrary, oxLDL was the main predictor of ET-1 (p = 0.008), suggesting that tHcy may increase ET-1 by enhancing the production of oxLDL.

Conclusions: Both chronic and acute methionine-induced homocysteinemia are associated with elevated oxidative stress status. Although ET-1 is increased in chronic homocysteinemia, it does not participate in the rapid development of endothelial dysfunction after methionine loading. These findings suggest that despite its potential role in chronic homocysteinemia, ET-1 has a limited contribution to the development of endothelial dysfunction in acute, methionine-induced homocysteinemia in humans.     

Folate Deficiency and Folic Acid Supplementation: The Prevention of Neural-Tube Defects and Congenital Heart Defects

Diet, particularly vitamin deficiency, is associated with the risk of birth defects. The aim of this review paper is to show the characteristics of common and severe neural-tube defects together with congenital heart defects (CHD) as vitamin deficiencies play a role in their origin. The findings of the Hungarian intervention (randomized double-blind and cohort controlled) trials indicated that periconceptional folic acid (FA)-containing multivitamin supplementation prevented the major proportion (about 90%) of neural-tube defects (NTD) as well as a certain proportion (about 40%) of congenital heart defects. Finally the benefits and drawbacks of three main practical applications of folic acid/multivitamin treatment such as (i) dietary intake; (ii) periconceptional supplementation; and (iii) flour fortification are discussed. The conclusion arrived at is indeed confirmation of Benjamin Franklin’s statement: “An ounce of prevention is better than a pound of care”.     

妊娠妇女RDW与血清叶酸变化及其临床意义

目的探讨妊娠妇女红细胞体积分布宽度（RDW）与血清叶酸变化及其临床意义、方法随机选择2008年1月～12月正常妊娠妇女225例作为观察组,孕早、中、晚期各75例．同期健康体检的非妊娠妇女225例作为对照组,比较两组及妊娠各期红细胞（RBC）、血红蛋白（Hb）、RDW、叶酸的变化．结果观察组血清叶酸、Hb水平、RBC计数低于对照组,而RDW则高于对照组（P〈0．05）,随着孕期的延长叶酸、Hb、RBC水平进行性下降,RDW进行性升高,各期比较有显著性差异（P〈0．05）结论整个妊娠期血清叶酸低,并随妊娠进展降低,血清叶酸、RDW呈一定的反相关,通过对孕妇叶酸、RDW的测定．判断妊娠期妇女贫血的类型,推测引起孕期贫血发生的可能原因,是一种简单易行的诊断方法,对于孕期贫血临床治疗有一定的指导意义、     

Homocysteine Elevation in Sickle Cell Disease

Objective: Ischemic complications are common in patients with sickle cell disease. Hyperhomocysteinemia is a risk factor for arteriosclerosis and venous thrombosis, and given the propensity of patients with sickle cell disease to develop ischemic complications, we hypothesized that they might have elevated plasma homocysteine concentrations.

Methods: Plasma concentrations of homocysteine, vitamin B12 and folate were measured in 49 adults with sickle cell disease and 16 normotensive Black controls. All subjects with sickle cell disease had been prescribed folic acid 1 mg by mouth daily.

Results: The median plasma concentration of homocysteine of subjects with sickle cell disease was approximately 1.5-fold higher than that of controls (p=0.0008). This difference persisted, even when subjects with renal insufficiency were excluded. Plasma folate levels were 1.5-fold higher in subjects with sickle cell disease than in controls (p=0.0498). There was no significant difference in plasma vitamin B12 concentrations between the two groups. There was no difference in plasma homocysteine concentrations between transfused and non-transfused sickle cell subjects.

Conclusions: Patients with sickle cell disease have elevated plasma concentrations of homocysteine in spite of elevated plasma folate levels and vitamin B12 concentrations similar to those observed in controls. Based on these data, we hypothesize that the concentration of folate required to normalize plasma homocysteine levels in patients with sickle cell disease may be higher than that of normal controls and that patients with sickle cell disease have a higher nutritional requirement for folic acid than the general population.     

Effectiveness of Folic Acid Supplementation Recommendations among Polish Female Students from the Podkarpackie Region

Adequate folic acid supplementation during the preconception period is an important element in the primary prevention of neural tube defects (NTDs). This study aims to study the effectiveness of folic acid supplementation recommendations among women of childbearing age, and to assess and characterise their awareness about this public health measure. The cross-sectional study included women (N = 1285) aged 22.27 ± 4.6 years old on average. Some of the results were obtained on a subgroup of women (N = 1127) aged 21.0 ± 2.1. This study was performed using a questionnaire. The analysis was performed with the use of a logistic regression model, chi-square test for independence and odds ratio (OR). According to the results, only 13.9% of women supplement folic acid, and 65.3% of them do so daily. A total of 91.1% of the respondents were not aware of its recommended dose and 43% did not know the role it plays in the human body. Among women who do not currently supplement folic acid (N = 1052), 52.4% declared doing so while planning their pregnancy. Women’s awareness about the role of folic acid in NTD prevention (OR = 4.58) and the information they got from physicians (OR = 1.68) are key factors that increased the odds of the women taking folic acid before pregnancy. There is therefore a need for more information and education campaigns to raise awareness about folic acid.