同型半胱氨酸、叶酸、维生素B12与缺血性脑血管病的关系

目的通过检测缺血性脑血管病患者血清中同型半胱氨酸(Hcy)、叶酸(FA)、维生素B12(VitB12)含量的变化,探讨Hcy、FA、VitB12与缺血性脑血管病的相关性及其在发病机制中的作用。方法使用东芝120全自动生化分析仪和雅培i2000化学发光分析仪进行检测。165例患者包括85例一过性脑缺发作(TIA)患者和80例急性脑梗死患者;健康对照组60人。结果与健康对照组相比,缺血性脑血管病Hcy水平较高,差异有统计学意义(P<0.05)FA和VitB12水平偏低,差异有统计学意义(P<0.05)。结论 Hcy是缺血性脑血管病的危险因素,与FA和VitB12的含量成负相关。     

孕妇血清同型半胱氨酸、叶酸与维生素B12的水平及临床意义

目的研究孕妇血清中同型半胱氨酸(Hcy)、叶酸(FA)与维生素B12(Vit B12)水平及临床意义。方法 146例孕妇为研究对象,分析不同病理特征下孕妇血清Vit B12、FA、Hcy水平,并探究其与血糖、血压的相关性。结果年龄≥30岁、合并妊娠期高血压与糖尿病、早产孕妇血清Vit B12、FA水平低于年龄<30岁、无妊娠期高血压与糖尿病、未早产孕妇,血清Hcy水平高于年龄<30岁、无妊娠期高血压与糖尿病、未早产孕妇(P<0. 05);经Spearman相关性分析,血清Vit B12水平与血糖、收缩压、舒张压呈负相关;血清FA水平与血糖、收缩压、舒张压呈负相关;血清Hcy水平与血糖、收缩压、舒张压呈正相关。结论孕妇血清Vit B12、FA、Hcy水平与其年龄、是否存在妊娠期合并症、早产、血糖、血压密切相关。     

急性脑梗死患者血清叶酸、VitB12水平及其临床意义

目的探讨急性脑梗死患者血清叶酸、VitB12水平及其临床意义。方法对88例首次发病的急性缺血性脑中风患者分为两个亚组，动脉硬化性脑梗死组32例，腔隙性脑梗死组56例，并设对照组35例，入院后用罗氏公司Elecsys2010型全自动电化学发光免疫分析仪测定血清叶酸、VitB12浓度。结果（1）脑梗死组、腔隙性脑梗死组的血清叶酸、VitB12平均水平均显著低于对照组（P值分别〈0．01、0．05）；（2）脑梗死组的血清叶酸、VitB12平均水平显著低于腔隙性脑梗死组（P值均〈0．05）。结论血清叶酸、VitB12可作为急性脑梗死、腔隙性脑梗死比较特异重要的监测指标，对临床鉴别脑梗死与腔隙性脑梗死有一定的帮助，并对脑梗死的预防、治疗可能有一定的指导意义。     

血清铁蛋白、同型半胱氨酸、叶酸、维生素B12对老年高血压脑室出血患者预后的影响

目的探讨分析血清铁蛋白(SF)、同型半胱氨酸(Hcy)、叶酸、维生素B12对老年高血压脑室出血患者预后的影响。方法选择高血压性脑出血破入脑室患者156例作为病例组,同时随机抽取同期健康体检人群50例作为对照组,此外根据患者美国国立卫生研究院脑卒中量表(NIHSS)评分分为轻度损伤组60例、中度损伤组96例,根据患者治疗3个月Rankin评分分为预后良好组134例、预后不良组22例。分别比较病例组与对照组、不同病情及不同预后患者之间SF、Hcy、叶酸及维生素B12水平。结果病例组SF、Hcy水平显著高于对照组(P0.05),而病例组血清叶酸及维生素B12水平显著低于对照组(P0.05)。轻度损伤组SF、Hcy均显著高于中度损伤组(P0.05),轻度损伤组叶酸、维生素B12水平显著高于中度损伤组(P0.05)。预后良好组SF、Hcy水平显著低于预后不良组(P0.05),预后良好组患者叶酸、维生素12水平显著高于预后不良组(P0.05)。受试者工作特征(ROC)曲线分析各指标对患者不良预后预测价值结果显示,SF对老年高血压脑室出血患者不良预后预测曲线下面积为0.837,血清Hcy对患者不良预后预测曲线下面积为0.863,叶酸水平对患者不良预后预测曲线下面积为0.817,维生素B12对患者不良预后预测曲线下面积为0.737。结论 SF、Hcy、叶酸及维生素B12与老年高血压脑室出血疾病发生发展密切相关,且可作为患者临床预后的重要指标。     

皮层下动脉硬化性脑病患者血浆同型半胱氨酸、VitB12、叶酸测定的意义

皮质下动脉硬化性脑病（Subcortical arteriosclerotic encephalopathy,SAE）是脑血管病的一种特殊类型,随着神经影像学的发展,人口老龄化,该病越来越多见,严重危害老年人的生活质量。高同型光胱氨酸（Hcy）血症已被证实是脑血管病的独立危险因素,而VitB12、叶酸与Hcy密切相关。本文探讨SAE与血浆Hcy、VitB12、叶酸之间的关系。     

血清同型半胱氨酸、叶酸水平及脂代谢紊乱与结直肠息肉发病的相关性

目的探讨血脂、血清同型半胱氨酸(Hcy)、叶酸(FA)水平与结直肠息肉发病的相关性。方法对入选的250例患者分别检测血清Hcy、FA、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)。结果年龄、性别与结直肠息肉发生明显相关;血清Hcy水平与结直肠息肉的发生无相关性;FA、维生素B12水平与结直肠息肉的发生明显相关;脂代谢紊乱与结直肠息肉的发生无相关性。结论 FA与结直肠息肉的发病风险呈正相关,维生素B12与结直肠息肉的发病风险呈负相关。     

同型半胱氨酸、叶酸和亚硝酸盐代谢与脑卒中关系研究进展

脑卒中是威胁人类健康的“头号杀手”,2008年公布的我国居民第三次死因抽样调查结果显示,脑血管病已成为我国国民第一位的死亡原因。动脉粥样硬化是脑卒中发生的一个重要病理基础,其发生的机制非常复杂,而研究表明同型半胱氨酸（Homocysteine,Hcy）升高是导致动脉粥样硬化的新的独立的危险因素,     

脑梗死患者血清同型半胱氨酸、尿酸、叶酸水平变化及其临床意义

目的分析脑梗死患者血清同型半胱氨酸(Hcy)、尿酸(UA)、叶酸水平变化及其临床意义。方法选取东南大学医学院附属江阴市人民医院2014年10月—2016年12月收治的脑梗死患者150例作为脑梗死组,同期健康体检者50例作为健康对照组。比较两组及不同牛津郡社区卒中计划分型(OCSP分型)脑梗死患者血清Hcy、UA及叶酸水平;各指标间的相关性分析采用直线相关分析。结果脑梗死组患者血清Hcy、UA水平高于健康对照组,血清叶酸水平低于健康对组(P<0.05)。直线相关分析结果显示,脑梗死患者血清Hcy水平与血清UA水平呈正相关(r=0.526,P<0.05),血清Hcy水平与血清叶酸水平呈负相关(r=-0.484,P<0.05),血清UA水平与血清叶酸水平呈负相关(r=-0.541,P<0.05)。后循环梗死(POCI)型、完全前循环梗死(TACI)型脑梗死患者血清Hcy、UA水平高于腔隙性脑梗死(LACI)型、部分前循环梗死(PACI)型脑梗死患者,血清叶酸水平低于LACI型、PACI型脑梗死患者(P<0.05);TACI型脑梗死患者血清Hcy水平高于POCI型脑梗死患者,血清叶酸水平低于POCI型脑梗死患者(P<0.05)。结论脑梗死患者血清Hcy、UA水平升高,血清叶酸水平降低,检测血清Hcy、UA及叶酸水平有利于诊断脑梗死及判断其分型、病情严重程度等。     

同型半胱氨酸与叶酸、维生素B12及维生素B6的关系

目的　探讨正常人群血同型半胱氨酸 (Hcy)水平分布及Hcy与年龄和性别的关系 ,Hcy水平与叶酸 ,维生素B1 2 及维生素B6之间的关系。方法　应用高效液相色谱 (HPLC)荧光检测法测定6 88例正常人血浆Hcy水平 ,用放射免疫方法测定叶酸及维生素B1 2 水平 ,用 96孔板微生物学法测定血清维生素B6水平。结果　相关分析结果显示 :血浆Hcy水平在正常人中呈非正态分布 ,随年龄增长血浆Hcy水平增加 ,男性比女性高。血浆Hcy水平与维生素B6、维生素B1 2 及叶酸水平呈负相关 (r分别为 - 0 35 4 8,- 0 2 91 6 ,- 0 32 76 ,P值均 <0 0 1 )。高Hcy血症者较非高Hcy血症者其血维生素B6、维生素B1 2 及叶酸水平均明显降低 (P值均 <0 0 1 )。结论　正常人中增高的血浆Hcy浓度与体内的维生素水平低下有关。     

叶酸对高血压患者血同型半胱氨酸疗效观察

目的探讨叶酸对高血压患者高同型半胱氨酸治疗效果。方法采用荧光标记免疫检测法进行检测。结果治疗组血同型半胱氨酸水平显著低于对照组。结论叶酸可降低高血压患者血同型半胱氨酸水平，减少其危害作用。     

Food-bound B12 absorption and serum total homocysteine in patients with low serum B12 levels

This study was undertaken to determine whether measurements of serum total homocysteine (Hcys) and bound B12 absorption are useful in determining which patients with low- or low-normal levels of serum B12 are B12 deficient. In 40 patients with low or borderline serum levels of B12, food-bound B12 absorptions were determined using a body counter in an iron room, and were related to serum total Hcys levels. Food-bound B12 absorption was decreased in 16 patients and in an additional four, absorption of the free vitamin was also decreased. Homocysteine levels were elevated in four of the 16; in three of the four who had both decreased bound and free B12 absorptions, Hcys was elevated. If elevation of the Hcys level indicates tissue deficiency of B12, the 75% incidence of normal levels of Hcys in these patients with low food-bound B12 absorptions suggests the existence of a cohort of patients who may be at risk to develop, but have not yet developed, B12 deficiency. Only long term follow-up will reveal how many ultimately will become B12 deficient. Am. J. Hematol. 59:42–45, 1998. © 1998 Wiley-Liss, Inc.     

Relation of plasma total homocysteine, folate and vitamin B12 levels to bone mineral density in Moroccan healthy postmenopausal women

To test whether in Moroccan healthy postmenopausal women, levels of plasma total homocysteine (tHcy), folate, and vitamin B12 are related to BMD. A total of 188 volunteer postmenopausal women were recruited from our blood taking center between April 2008 and December 2008. Each subject completed a standardized questionnaire designed to document putative risk factors of osteoporosis. Bone mineral density was determined by a Lunar Prodigy Vision DXA system, and blood samples for plasma tHcy, folate, vitamin B12, and serum parathyroid hormone (PTH) were taken. Comparison between women with osteoporosis, osteopenia and normal BMD showed that the osteoporotic women were significantly older, had lower weight and height than the women of the other groups. Plasma tHcy was significantly higher in the osteoporotic group. Levels of tHcy were inversely related to BMD at the lumbar spine, at the total hip and plasma vitamin B12 and positively related to age and creatinine. Multiple regression analysis showed that age and BMI were the main predictors of BMD at the lumbar spine, whereas the main predictors of BMD at the total hip were age, BMI, plasma tHcy, and plasma vitamin B₁₂. tHcy and vitamin B12 are independent risk factors for osteoporosis in Moroccan healthy postmenopausal women.     

178例老年男性骨密度及25羟维生素D水平分析

目的评估178名老年男性骨密度与25羟维生素D(25OHD)水平,分析两者之间的关系。方法记录178名受试者的年龄、身高、体重、体重指数(BMI),测量受试者腰椎1-4(L1-4)、左侧股骨颈(femeralneck,FN)、Wards三角(Wards)、大粗隆(troch)、左侧股骨上端(femur)的骨密度,并用电化学免疫发光法测定血清25OHD水平,根据骨密度水平将受试者分为3组:骨量正常组、骨量减少组和骨质疏松组,对每组受试者身高、体重、体重指数(BMI)、25OHD进行统计学描述,并进行方差分析。分别对3组受试者血清25OHD水平进行充足(75～375nmol/L)、相对缺乏(50～75nmol/L)、绝对缺乏(<50nmol/L)的描述。结果骨量正常组、骨量减少组、骨质疏松组的人数分别为70例(39.33%)、66例(37.08%)和42例(23.59%)人。各组年龄差异无统计学意义(P>0.05),身高、体重、体重指数之间的差异有统计学意义(P<0.05);各组25OHD充足的比例分别为22.86%、18.18%、19.05%,血清25OHD在骨量正常组、骨量减少组、骨质疏松组的平均值分别为60.00、59.88和52.88nmol/L,3组之间血清25OHD水平差异无统计学意义(P>0.05)。结论老年男性人群中广泛存在骨质疏松及维生素D缺乏,应注意加强宣教及防治。骨密度与身高、体重、体重指数呈负相关,尚未发现25OHD与骨密度之间存在着直接相关关系,需扩大样本进一步探讨。     

Elevated serum homocysteine as a predictor for vitamin B12 or folate deficiency

Abstract: Tissue deficiency of vitamin B₁₂ and folate results in an increase in serum homocysteine (sHcy). We have measured sHcy in patients with reduced serum vitamin B₁₂ and/or red cell folate (RCF) to determine its usefulness as a discriminant for the diagnostic interpretation of reduced vitamin levels. Of 3846 patients who had serum vitamin B₁₂ and RCF assayed, 335 (9%) had reduced vitamin levels. Multivariate analysis showed a significant association between sHcy and serum creatinine (p = 0.0001), positive intrinsic factor (IF) antibody or neutrophil hypersegmentation (NHS) (p = 0.001), increased MCV (p = 0.014) and low RCF (p = 0.025) but no relationship with the level of serum vitamin B₁₂ or haemoglobin. After censoring the patients with renal impairment (n = 54), the distribution of the remaining 72 patients with elevated sHcy was 37/151 (25%) with low serum vitamin B₁₂ with or without low RCF and 35/130 (27%) with low RCF alone. sHcy correctly identified response to vitamin therapy in 33/35 (94%) patients who had adequate parameters to assess response. The positive predictive values of IF antibody/NHS, macrocytosis and/or low RCF for elevated sHcy were 100% and 34% respectively. Twenty-four percent of patients with a low serum vitamin B₁₂ and elevated sHcy had no abnormal haematologic parameters as determined by the routine laboratory staff. These data suggest that the usefulness of measuring sHcy in a routine diagnostic setting is limited and a careful review of the peripheral blood for macrocytosis and NHS plus determination of RCF may be a more cost-effective process than sHcy assay in most instances to determine the presence of tissue deficiency.     

恶性血液病患者贫血与FA、VB12、SF和Epo的关系

目的研究恶性血液病患者血清叶酸(FA)、维生素B12(VB12)、血清铁蛋白(SF)和促红细胞生成素(Epo)水平,以及骨髓铁染色和红系巨幼样变率,了解其与贫血的关系,为临床治疗提供依据.方法选择83例恶性血液病患者及30例健康人血清标本,30例骨髓象大致正常骨髓涂片.用化学发光免疫法检测血清FA、VB12、SF水平,放射免疫法检测血清Epo水平,对红系增生尚可的患者行骨髓涂片铁染色;同时观察骨髓红系巨幼样变率.结果①初治、部分缓解(PR)和血红蛋白(Hb)<100g/L患者的血清Epo与Hb呈负相关关系,血清FA、VB12、SF与Hb无相关关系.②骨髓中红系巨幼样变率PR明显高于初治和完全缓解(CR)患者;红系巨幼样变率与FA在PR和初治患者存在相关关系,而CR和FA<2.5ng/ml患者间无相关关系.③骨髓红系百分比与Hb在初治患者存在正相关关系,与Epo水平呈负相关关系.结论恶性血液病患者贫血与FA、VB12、SF、Epo无关,其骨髓红系巨幼样变率与化疗药物致骨髓红系造血受抑制有关.     

Low levels of vitamin B12 and venous thromboembolic disease in elderly men

OBJECTIVES: Hyperhomocysteinaemia is a well-known risk factor for venous thromboembolic disease (VTD). However, it is not clear whether homocysteine (Hc) itself or a related metabolite or a cofactor is primarily responsible for VTD. We carried out a case-control study to investigate whether vitamin concentrations that are involved in the Hc metabolism are associated or not with an elevated risk of VTD. DESIGN: Case-control study. METHODS: We measured serum vitamin B12, folate, creatinine and albumin concentrations and plasma Hc concentrations in 101 consecutive patients with VTD, diagnosed by image tests and 101 control subjects, matched for age and sex. RESULTS: Serum vitamin B12 concentrations were significantly lower in VTD patients than in the control subjects. There were no differences in plasma Hc or serum folate concentrations between the groups. Among the male subgroup aged more than 70 years, serum vitamin B12 concentrations were significantly lower (240.88 +/- 103.07 vs. 421.20 +/- 314.31 pmol L(-1); P = 0.03) and plasma Hc concentrations were significantly higher (13.1 +/- 4.18 vs. 10.56 +/- 3.06 micromol L(-1); P =0.04) in VTD patients than in the control group. On multivariate analysis, in patients aged more than 70 years, serum vitamin B12 concentrations were independently associated with VTD. Compared with the highest quartile of vitamin B12 (>512.6 pmol L(-1)) the odds ratio (OR) for VTD in the lowest quartile (<230.9 pmol L(-1)) was 3.8 (95% CI 1.44-10.18; P = 0.01). In the VTD group, lowest vitamin B12 concentrations (percentile 10 <152.8 pmol L(-1)) were associated with the factor V Leiden mutation (OR = 6.07, 95% CI 0.93-38.55; P = 0.04). CONCLUSIONS: Measuring vitamin B12 concentrations in elderly males may help in identifying people at risk of venous thromboembolism in our population.     

脑梗死患者血清叶酸和维生素B12水平的测定

目的探讨血清叶酸、维生素B12与脑梗死的关系及其临床意义.方法采用放射免疫法测定88例脑梗死患者及39例健康对照组血清叶酸、维生素B12的浓度.结果脑梗死患者血清叶酸、维生索B12水平分别是(4.4±1.8)ng/L及(569±386)pg/L;对照组分别是(7.8±5.2)ng/L及(785±427)pg/L,两组比较均P＜0.05.结论血清叶酸和维生素B12水平可能分别是脑梗死的独立危险因子.     

The relationship between serum resistin, leptin, adiponectin, ghrelin levels and bone mineral density in middle-aged men

OBJECTIVE: Body weight is a significant predictor of bone mass. Hormonal factors such as sex hormones, insulin, leptin and adiponectin are thought to play a role in the mechanisms controlling the association of body weight and fat mass with bone mass. However, contradictory results have been reported for the association between serum adipocytokines and bone mineral density (BMD). We therefore examined whether the serum adipocytokine and ghrelin levels, markers of fat metabolism, are associated with BMD in male adults. PATIENTS AND MEASUREMENTS: For 80 male adults (average age 54.5 +/- 6.4 years; average body mass index (BMI) 24.4 +/- 2.5 kg/m2), the correlations between serum resistin, leptin, adiponectin and ghrelin levels with BMD were investigated. RESULTS: Among the adipocytokines, serum resistin levels were negatively correlated with lumbar spine BMD (r = -0.237, P = 0.05). After adjustment was made for age and BMI, log-transformed serum leptin showed a significant negative correlation with lumbar spine BMD, which was not seen on bivariate analysis (r = -0.237, P = 0.039). Femoral neck BMD was marginally associated only with serum adiponectin levels (r = -0.226, P = 0.062). In multiple regression analyses, among the adipokines, only resistin was a significant determinant of lumbar spine BMD, although the variance was small (R2 = 0.256). Serum ghrelin levels were not correlated with the BMD of either body site. CONCLUSIONS: Serum resistin level showed a significant negative correlation with lumbar spine BMD, although the variance was small. Further studies are needed to elucidate the role of adipocytokines in bone metabolism.     

The relationship between plasma homocysteine levels and bone mineral density in post-menopausal women

BackgroundWhether or not mild hyperhomocysteinemia and low serum levels of folates or vitamin B12 are risk factors for osteoporosis in the elderly is controversial.Aims and methodsTo investigate whether or not plasma levels of total homocysteine (tHcy) and serum levels of folates and vitamin B12 are associated with bone mineral density (BMD), we carried out a cross-sectional study on 446 post-menopausal women (mean age: 65.1 ± 9.4 years), consecutively seen at the Siena Unit (Tuscany region, Central Italy) for BMD evaluation over a two-year period. BMD of the total femur, femoral neck and lumbar spine was detected by dual-energy X-ray absorptiometry.ResultsThe age-adjusted geometric mean of plasma tHcy levels (µmol/L) was 9.96 ± 1.29 in women with normal BMD, 11.06 ± 1.32 in those with osteopenia and 11.88 ± 1.35 in those with osteoporosis (p < 0.0001). On multiple linear regression analysis, adjusting for age, body mass index, folates, vitamin B12, creatinine clearance, smoking habit and alcohol intake, tHcy was negatively related to BMD of the total femur [β estimate for log-homocysteine: ? 0.050 (95% CI: ? 0.100 to ? 0.001, p = 0.048; R² = 0.02)], but not of femoral neck or lumbar spine. There was no significant association between BMD and serum levels of folates and vitamin B12.ConclusionstHcy is negatively associated with BMD of the total femur. The contribution of tHcy to explain the variance of BMD is small (2% of the total variance) but clinically relevant, considering the high prevalence of osteoporosis among post-menopausal women and the possibility to lower tHcy by vitamin supplementation.