同型半胱氨酸血脂与老人颈动脉粥样硬化的相关性研究  

The relationship between homocysteine, folate, vitamin B12, lipids and carotid artery atherosclerosis in older patients

作　　者：朱立华[1] 毕艳[2] 祁芸芸[2] 

机构地区：[1]北京大学第一医院检验科，北京 100034 [2]北京大学第一医院老年科，北京 100034

出　　处：《中华检验医学杂志》2001年第2期94-97,共4页Chinese Journal of Laboratory Medicine

摘　　要：目的　比较血清同型半胱氨酸、叶酸、维生素B12 (VitB12 )、血脂等与颈动脉粥样硬化(CAAs)程度的关系 ,探讨其血浓度在预测老年人心脑血管事件发病中的意义。方法　对 74名受试者以血管超声检查双侧颈总动脉、颈内动脉血管 ,按照血管狭窄程度分为A、B、C、D 4组和正常对照组。取空腹静脉血 ,测定胆固醇 ,甘油三酯 ,高、低密度脂蛋白 ,载脂蛋白AI(ApoAI) ,载脂蛋白B(ApoB) ,脂蛋白 (a)、[Lp(a) ]、肌酐、血糖、叶酸、VitB12及血浆同型半胱氨酸 (Hcy)水平 ,比较各组间的差异。结果　随着颈动脉狭窄程度的加重 ,Hcy水平升高 ;正常及A、B、C、D组病人血清Hcy浓度分别为 (10 .2± 3.6 ) μmol/L ,(11.5± 4.4) μmol/L ,(17.9± 4.5 ) μmol/L ,(2 4.7± 10 .3) μmol/L ,(4 1.4± 2 2 .3) μmol/L。经SNK检验 ,各组与D组之间差异有显著意义 (P <0 .0 5 )。叶酸、VitB12水平随颈动脉粥样硬化的加重而降低 ,但只有在A组与D组之间才存在统计学差异。Spearman等级相关系数表明血清同型半胱氨酸水平与叶酸 (P =0 .0 35 )和ApoAI(P =0 .0 0 0 )显著负相关。各危险因素与CAAs多元回归分析表明ApoAI与CAAs负相关 ,ApoB、LP(a)、Hcy与CAAs正相关 ,且具有统计学意义 ,尤以Hcy相关性显著 (P =0 .0 0 9)。Objectives To investigate the relationship between homocysteine (Hcy), folic acid, vitamin B12(VitB12),lipids and the carotid artery atherosclerosis(CAAs) and the significance of their levels in predicting cardiac and cerebral vascular events of older patients. Methods Both sides of the common carotid artery and internal carotid artery were measured by B mode ultrasound in 74 examinees in A, B, C, and D groups and a control group. With fasting serum, cholesterol, triglyceriade, apolipoprotein AI(Apo AI), apolipoprotein B (Apo B), lipoprotein (a) [Lp(a)], creatinine, glucose, folic acid, Vit B12 and Hcy were detected. Results When carotid artery atherosclerosis became severer, serum Hcy was higher. The levels of the control and A, B, C, D groups were (10.2±3.6) μmol/L, (11.5±4.4) μmol/L, (17.9±4.5) μmol/L, (24.7±10.3) μmol/L, and (41.4±22.3) μmol/L respectively. SNK test showed a significant difference between D and other groups ( P >0 05). Folic acid and Vit B12 were negatively correlated with the severity of carotid artery atherosclerosis, but only A and D groups showed statistical significance. Spearman correlation coefficient showed that serum Hcy had significant negative correlation with folic acid and Apo AI( P =0.035 and P =0.000).Multiple linear regression analysis between CAAs and various risk factors showed Apo AI had negative correlation, but Apo B, Lp(a) and Hcy had positive correlation with CAAs, especially Hcy( P =0.009).Conclusion Hyperhomocysteinaemia is an important risk factor of artery atherosclerosis and the degree of CAAs is highly correlated with Hcy concentration. Hcy, Apo AⅠ,Apo B, Lp(a) are sensitive and reliable indexes for evaluating and predicting CAAs.

关 键 词：同型半胱氨酸 叶酸 载脂蛋白类 脂蛋白(a) 颈动脉粥样硬化 老年人 

分 类 号：R392.1[医药卫生—免疫学]