不同年龄和类型视网膜静脉阻塞患者血同型半胱氨酸水平检测

Serum homocysteine levels of retinal vein occlusion patients with different ages and types

目的 观察不同年龄和类型视网膜静脉阻塞（RVO）患者血同型半胱氨酸（Hcy）水平。方法 临床确诊的RVO患者79例79只眼（RVO组）纳入研究。其中，男性46例，女性33例；平均年龄（57.00±9.29）岁。选取同期年龄、性别匹配的非视网膜血管性疾病患者82例82只眼作为对照组。其中，男性50例，女性32例；平均年龄（60.0±10.2）岁。再将RVO组患者分为年龄≤50岁组（年轻RVO组）和年龄＞50岁组（老年RVO组），分别为24、55例。视网膜中央静脉阻塞（CRVO）组、视网膜分支静脉阻塞（BRVO）组，分别为35、44例。测定所有患者血Hcy及其代谢中的重要中间物质血维生素（Vit）B6、VitB12、叶酸浓度。分析高Hcy、低VitB6、低叶酸血症与不同年龄RVO的相关性。 结果 与对照组患者比较，RVO组患者血Hcy浓度升高，血叶酸、VitB6浓度降低，差异均有统计学意义（t=2.946、2.641、2.889，P＜0.01）；血VitB12浓度降低但差异无统计学意义（t=1.665，P＞0.05）。CRVO组、BRVO组患者血Hcy、叶酸、VitB12、VitB6浓度比较，差异均无统计学意义（t=0.756、1.306、0.682、1.306，P＞0.05）。 年轻RVO组患者血Hcy浓度高于老年RVO组，差异有统计学意义（t=2.394，P＜0.05）；血叶酸、VitB6浓度低于老年RVO组，差异无统计学意义（t=1.318、1.694，P＞0.05）。RVO组患者中高Hcy［χ2=13.67，比值比（OR）=3.327，95%可信区间（CI）为1.742～6.354］、低VitB6（χ2=5.28，OR=2.068，95%CI为1.103～3.878）、低叶酸血症（χ2=8.64，OR=2.546，95%CI为1.349～4.806）者明显高于对照组，差异均有统计学意义（P=0.000 1、0.023 0、0.004 0）。 结论 血高Hcy、低叶酸、低VitB6水平是RVO发病的危险因素；血Hcy在年轻RVO患者的发病中可能起到更重要的作用；CRVO、BRVO患者间血Hcy、叶酸、VitB6水平无明显差异。

Objective To observe serum homocysteine （Hcy） levels in retinal vein occlusion （RVO） patients with different ages and types. Methods A total of 79 patients （79 eyes） diagnosed with RVO were enrolled. There were 33 females and 46 males, the mean age was （57.00±9.29） years. Eighty-two age- and sex-matched patients （82 eyes） without retinal vascular disease were included as controls. There were 32 females and 50 males, the mean age was （60.00±10.15） years. Among RVO patients, there were 24 patients younger than 50 years old （young patients） and 55 patients older than 50 years old （elderly patients）; 35 patients with central RVO （CRVO） and 44 patients with branch RVO （BRVO）. Fasting plasma Hcy, serum vitamin （Vit） B6, B12 and folate levels were measured in all patients. The relationship of high Hcy, low VitB6, low folate and RVO with different age were analyzed. Results Hcy level was significantly higher in RVO patients than control subjects （t=2.946, P〈0.01）. Blood concentration of folate and VitB6 were significantly lower in RVO patients than control subjects （t=2.641, 2.889; P〈0.01）. Blood level of VitB12 was significantly different in RVO patients from control subjects （t=1.665, P〉0.05）. Concentrations of Hcy, folate, VitB12 and VitB6 were not different between patients with CRVO and BRVO （t=0.756,1.306,0.682,1.306;P〉0.05）. Hcy level was significantly higher in the young RVO patients than in the elderly RVO patients （t=2.394, P〈0.05）. Blood concentration of folate and VitB6 were lower in the young RVO patients than in the elderly RVO patients, but the difference were not significant （t=1.318, 1.694; P〉0.05）. The number of patients with high Hcy [χ2=13.67,odds ratio （OR）=3.327,95% confidence interval （CI）=1.742 - 6.354], low VitB6 （χ2=5.28,OR=2.068,95%CI=1.103 - 3.878） and low folate status （χ2=8.642,OR=2.546,95%CI=1.349 - 4.806） in RVO patients were more than control subjects （P=0.0001, 0.023, 0.004）. Conclusions High Hcy, low folate and low VitB6 were risk factors for the onset of RVO. Hcy may play more important role in young patients with RVO. Hcy, folate and VitB6 levels were similar in CRVO and BRVO patients.