Prevalence and mechanisms of hyperhomocysteinemia in chronic alcoholics
Prevalence and mechanisms of hyperhomocysteinemia in chronic alcoholics
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DOI：
10.1097/01.alc.0000169265.36440.ee
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发表时间：
2005-06-01
影响因子：
3.2
通讯作者：
Rodés, J
中科院分区：
文献类型：
--
作者：
Blasco, C;Caballería, J;Rodés, J
背景：同型半胱氨酸（homocysteine，Hcy）是蛋氨酸代谢的中间产物。同型半胱氨酸再甲基化或转硫作用受损导致高同型半胱氨酸血症，这被认为是慢性酒精中毒者动脉粥样硬化性血管疾病和中风的危险因素。本研究旨在探讨慢性酒精中毒患者高同型半胱氨酸血症的患病率以及饮酒、维生素缺乏和肝损害对血浆同型半胱氨酸水平的影响。228例慢性酒精中毒患者连续住院解毒，根据临床和生化数据分类，正常肝脏（n = 117）和轻度至中度肝病（n = 111），49名健康对照者。结果：慢性酒精中毒者血浆Hcy水平明显高于对照组（9.66 ± 8.1 μ mol/L对6.93 ± 2.33 μ mol/L，p <0.025）。此外，慢性酒精中毒伴肝损伤者血浆Hcy水平（12.17 ± 10.14 μ mol/L）明显高于正常肝者和对照组（p <0.001）。高同型半胱氨酸血症的患病率在伴有肝损害的酗酒者中也显著高于肝正常者和对照组（分别为29.7%、5.1%和2%，p <0.001）。慢性酗酒者的血清叶酸值低于对照组（4.7 +/-2.6 vs. 7.6 +/-2.4 nmol/L，p <0.001）。最低值的叶酸被发现在酗酒者与肝脏疾病，特别是在那些与高同型半胱氨酸血症，与负相关的两个参数。中度高同型半胱氨酸血症在慢性酒精中毒者中很常见，主要是在那些肝损伤的人中，这表明，尽管叶酸缺乏可能有贡献作用，但肝损伤，通过甲硫氨酸代谢的变化，是这些患者血浆Hcy升高的最重要机制。
Background: Homocysteine (Hcy) is formed as an intermediary in methionine metabolism. Impairment of Hcy remethylation or transulfuration leads to hyperhomocysteinemia, which is considered as a risk factor for atherosclerotic vascular disease and stroke in chronic alcoholics. The aim of the study was to investigate the prevalence of hyperhomocysteinemia in chronic alcoholics and the influence of alcohol consumption, vitamin deficiencies and liver damage on the plasma levels of Hcy.Methods: 228 chronic alcoholic patients consecutively admitted for detoxication, classified according to clinical and biochemical data in normal liver (n = 117), and in mild to moderate liver disease (n = 111), and 49 healthy controls were studied. Blood levels of Hcy, vitamin B6, vitamin B12 and folate were measured.Results: Plasma Hcy was significantly higher in chronic alcoholics than in controls (9.66 +/- 8.1 vs. 6.93 +/- 2.33 mu mol/liter,p < 0.025). Furthermore, plasma Hcy levels were significantly higher in chronic alcoholics with liver injury (12.17 +/- 10.14 mu mol/liter) than in those with normal liver and in controls (p < 0.001). The prevalence of hyperhomocysteinemia was also significantly higher in alcoholics with liver damage than in those with normal liver and in controls (29.7%, 5.1%, and 2%, respectively,p < 0.001). Serum folate values were lower in chronic alcoholics than in controls (4.7 +/- 2.6 vs. 7.6 +/- 2.4 nmol/liter,p < 0.001). The lowest values of folate were found in alcoholics with liver disease, especially in those with hyperhomocysteinemia, with a negative correlation between the two parameters.Conclusions: Moderate hyperhomocysteinemia is common in chronic alcoholics, mainly in those with liver damage, suggesting that, although folate deficiencies may have a contributory role, liver impairment, through changes in methionine metabolism, is the most important mechanism for the elevated plasma Hcy found in these patients.