血浆总同型半胱氨酸水平与肺动脉血栓栓塞的关联

Plasma total homocysteine and pulmonary thromboembolism

目的 探讨血浆总同型半胱氨酸水平增高是否增加国人肺动脉血栓栓塞的危险。方法 对 6 9例放射性核素肺通气 灌注扫描和 /或超高速CT检查及临床资料确诊的肺动脉血栓栓塞患者。进行环境危险因素调查 ,高效液相色谱法测定血浆总同型半胱氨酸水平。并设性别、年龄匹配的健康对照 90名。结果 (1)栓塞组心血管疾病家族史、吸烟与饮酒百分率略高于健康对照组 ,体重指数略低于健康对照组 ,但两组间差异无显著意义。 (2 )栓塞组血浆总同型半胱氨酸水平显著高于健康对照 (16 .6 μmol/L± 1.8μmol/L和 12 .5 μmol/L± 1.5 μmol/L ;t=3.82 1,P <0 .0 1) ,调整环境因素后这种差异依然存在。合并下肢静脉血栓形成的患者血浆总同型半胱氨酸水平高于单纯肺动脉血栓栓塞患者 ,但差异无显著意义 (17.2 μmol/L± 1.9μmol/L和 15 .7μmol/L± 1.6 μmol/L ;t =0 .6 11,P =0 5 43)。 (3)高同型半胱氨酸血症使肺动脉血栓栓塞的相对危险增加 3.99倍。结论 高同型半胱氨酸血症是国人肺动脉血栓栓塞的独立危险因素。

Objective To investigate whether the elevated plasma homocysteine increases the risk of pulmonary thromboembolism in the Chinese population. Methods Sixty-nine patients with pulmonary thromboembolism and 90 sex- and age-matched healthy controls were recruited, and the patients were diagnosed using lung ventilation/perfusion scan and/or ultrafast CT as well as medical history. The concentration of plasma total homocysteine (tHcy) was measured with high performance liquid chromatography and environmental factors were collected. Results No significant difference was seen in family history of pulmonary thromboembolism and cardiovascular diseases, cigarette smoking, alcoholic drinking, oral contraceptive and body mass index between cases and healthy controls. The concentration of plasma tHcy in cases was significantly higher than that in healthy controls (16.60 μmol/L±1.75 μmol/L vs 12.48 μ mol/L±1.47 μmol/L; t =3.821, P <0.05), and adjusting for environmental factors did not change the significance. The plasma tHcy in the isolated pulmonary thromboembolism patients was lower than that in the patients who had lower limb deep venous thrombosis, but no significant difference was found. Compared with normal plasma tHcy, hyperhomocysteinemia was associated with a 4.99-fold risk of pulmonary thromboembolism. Conclusion Our results show that the elevated plasma tHcy increases the risk of pulmonary thromboembolism, and hyperhomocysteinemia is an independent risk factor of pulmonary thromboembolism in the Chinese population.