Sustained increases of plasma homocysteine, copper, and serum ceruloplasmin after coronary artery bypass grafting
Sustained increases of plasma homocysteine, copper, and serum ceruloplasmin after coronary artery bypass grafting
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DOI：
10.1016/s0003-4975(02)03807-9
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发表时间：
2002-11-01
影响因子：
4.6
通讯作者：
Ascione, R
中科院分区：
文献类型：
--
作者：
Jeremy, JY;Shukla, N;Ascione, R
背景同型半胱氨酸（Hcy）是冠心病的独立危险因素，但目前尚无关于冠状动脉旁路移植术（CABG）患者Hcy水平的报道。同型半胱氨酸和铜之间的相互作用可能介导同型半胱氨酸的血管病变的影响，这可能在静脉移植失败中发挥作用。本研究的目的是评估接受心肌血运重建手术的患者围手术期Hcy、铜、铜蓝蛋白（CP）、叶酸和维生素B-12的水平。从55名接受择期常规CABG的连续患者（43名男性;平均年龄63.2 ± 5.2岁）中采集术前1天和术后1天、6天和6周的血液样本。然后使用标准临床化学方法测量Hcy、铜、CP、红细胞叶酸、维生素B-12、肌酐和C反应蛋白（CRP）。10例非体外循环冠状动脉旁路移植术（OPCAB）患者（7例男性，平均年龄63.3 ± 5.2岁）采用相同的方案。在常规CABG组中，术后6天和6周血浆Hcy（分别从10.1增加到11.6和13.5 mumol/L）、血浆铜（从13.5增加到20.3和18.5 mumol/L）和血清铜蓝蛋白（从0.3增加到0.41和0.44 g/L）的浓度显著增加。CRP和维生素B-12在术后第6天升高，但未在术后第6周升高。相比之下，红细胞叶酸和肌酐没有显着变化。OPCAB患者的亚组分析显示与常规组相同的趋势。冠状动脉手术促使Hcy和铜的血液浓度显著且持续增加，这不是由于叶酸和维生素B-12减少、肾功能改变或炎症。需要进一步的研究来确定是否同型半胱氨酸和铜的伴随增加在静脉移植物疾病中起病因学作用。(C)2002年由胸外科医师协会出版。
Background. Homocysteine (Hcy) is an independent risk factor for coronary artery disease, but there are no reports on Hcy levels in patients undergoing coronary artery bypass graft (CABG) surgery. Interactions between Hcy and copper may mediate the vasculopathic impact of Hcy, and this may play a role in vein graft failure. The aim of this study was to assess the perioperative levels of Hcy, copper, ceruloplasmin (CP), folate, and vitamin B-12 in patients undergoing myocardial revascularization surgery.Methods. Blood samples were taken from 55 consecutive patients undergoing elective conventional CABG (43 male; mean age, 63.2 +/- 5.2 years) 1 day preoperatively and postoperatively at 1 day, 6 days, and 6 weeks. Hcy, copper, CP, red cell folate, vitamin B-12, creatinine, and C-reactive protein (CRP) were then measured using standard clinical chemistry methods. The same protocol was applied to 10 patients (7 male; mean age, 63.3 +/- 5.2 years) undergoing off-pump coronary artery bypass (OPCAB) surgery.Results. In the conventional CABG group, there were significant increases in the plasma concentrations at 6 days and 6 weeks postoperatively of Hcy (from 10.1 to 11.6 and 13.5 mumol/L, respectively), plasma copper (from 13.5 to 20.3 and 18.5 mumol/L), and serum ceruloplasmin (from 0.3 to 0.41 and 0.44 g/L). CRP and vitamin B-12 were elevated at 6 days but not 6 weeks after the operation. In contrast, red cell folate and creatinine were not significantly changed. The subgroup analysis for the OPCAB patients showed the same trend as for the conventional group.Conclusions. Coronary surgery precipitates a significant and sustained increase in the blood concentrations of Hcy and copper, which is not due to a decrease in folate and vitamin B-12, altered renal function, or inflammation. Further studies are required to establish whether the concomitant increase in Hcy and copper plays an etiological role in vein graft disease. (C) 2002 by The Society of Thoracic Surgeons.