腹部肥胖之代謝症候群的B-維生素（維生素B-6、B-12及葉酸）與同半胱胺酸、發炎反應及脂質過氧化之相關性

B-vitamins (vitamin B-6, B-12 and folate) in relation to homocysteine, inflammatory responses and lipid peroxidation in metabolic syndrome with central obesity

孫志銘(Chih-Ming Sun)

指導教授 ： 黃怡嘉

中山醫學大學/健康管理學院/營養學研究所/碩士(2008年)

https://doi.org/10.6834/CSMU.2008.00044

摘要

代謝症候群、同半胱胺酸、發炎反應及脂質代謝異常皆被認為是心血管疾病之危險因子。B-維生素（維生素B-6、B-12、葉酸）與同半胱胺酸、發炎反應及脂質代謝異常的關係已在心血管疾病模式中被廣泛討論，但卻少有以代謝症候群為研究模式之研究。有研究指出代謝症候群各項指標當中，腹部肥胖為造成發炎及脂質代謝異常之主要原因。因此，本研究目的是以代謝症候群受試者為研究模式，依據有無腹部肥胖探討B-維生素與同半胱胺酸、發炎反應及脂質過氧化指標的相關性。本橫斷面研究是依據行政院衛生署國民健康局之代謝症候群定義，由台中市中山醫學大學附設醫院新陳代謝科募集55位代謝症候群受試者。代謝症候群受試者依其是否具有腹部肥胖指標（男性腰圍≧90 cm，女性腰圍≧80 cm）分為腹部肥胖組（共42 人）及非腹部肥胖組（共13 人）。受試者接受體位測量及抽取空腹血液，分析臨床血液生化值、血清葉酸與維生素B-12、血漿維生素B-6（磷酸比哆醛、4-比哆酸）、尿液4-比哆酸、同半胱胺酸、發炎反應指標（高敏感度C-反應蛋白、細胞介素-6、纖維蛋白）及脂質過氧化指標（氧化型低密度脂蛋白、硫代巴比妥酸反應物）。研究結果顯示，非腹部肥胖組的血漿磷酸比哆醛濃度 (78.4 ± 40.5 vs. 53.1 ± 34.12nmol/L, p=0.006) 顯著高於腹部肥胖組；高敏感度C-反應蛋白 (0.1 ±0.1 vs. 0.4 ± 0.4 mg/dL, p=0.007) 及纖維蛋白 (287.2 ± 75.9 vs. 350.1 ±72.5 mg/dL, p=0.011) 則顯著低於腹部肥胖組。血清葉酸、維生素B-12與脂質過氧化指標在兩組間則無顯著差異。維生素B-6 與同半胱胺酸無顯著相關性，但是維生素B-12 及血清葉酸皆與同半胱胺酸呈顯著負相關。腹部肥胖組的血漿磷酸比哆醛與高敏感度C-反應蛋白 (r =-0.31, p = 0.045)，非腹部肥胖組的血漿磷酸比哆醛與細胞介素-6 (r =-0.57, p = 0.044) 皆呈顯著負相關。但血清葉酸及維生素B-12 與發炎反應及脂質過氧化指標在任何一組皆無顯著相關性。當所有受試者合併分析後，血漿磷酸比哆醛與高敏感度C-反應蛋白 (r = -0.40, p =0.003) 仍呈顯著負相關。具腹部肥胖的代謝症候群受試者有顯著較低的血漿磷酸比哆醛及較高的發炎反應指標濃度，且維生素B-6 與發炎反應指標呈顯著相關性，但與同半胱胺酸無顯著相關性。

關鍵字

代謝症候群 ； B-維生素 ； 同半胱胺酸 ； 發炎反應 ； 脂質過氧化

並列摘要

Metabolic syndrome, homocysteine, inflammatory response and abnormal lipid metabolism were considered to be the risk factors of cardiovascular disease. The relationships among B-vitamins (vitamin B-6, B-12 and folate), homocysteine, inflammatory responses and abnormal lipid metabolism have been widely discussed in cardiovascular disease, but not in metabolic syndrome. Studies have shown that central obesity is a major cause of inflammatory responses and abnormal lipid metabolism among metabolic syndrome indicators. This cross-sectional study was undertaken to study the relationships among B-vitamins, homocysteine, inflammatory responses and lipid peroxidation in metabolic syndrome with central obesity. The inclusion criteria of metabolic syndrome was based on Bureau of Health Promotion, Department of Health in Taiwan. Fifty-five subjects with metabolic syndrome were recruited from the Division of Metabolism, Chung Shan Medical University Hospital, Taichung. Subjects were further divided into either central obesity group (n = 42) and non-central obesity (n = 13) according to whether subjects having abdominal obesity (waist circumference ≧90 cm in men;≧ 80 cm in women). Subjects’ weight and height were measured, and body mass index was then calculated. Fasting blood sample was obtained to estimate
hematological parameters, serum B-12 and folate, plasma B-6 (pyridoxal 5’-phosphate, PLP; 4-pyridoxic acid, 4-PA), urine 4-PA, homocysteine,inflammatory (high-sensitivity C-reactive protein, hs-CRP; interleukin-6,IL-6; fibrinogen) and lipid peroxidation indicators (thiobarbituric acid
reactive substances, TBARs; oxidized low-density lipoprotein, ox-LDL).Results showed that plasma PLP concentration (78.4 ± 40.5 vs. 53.1 ±4
34.1 nmol/L, p=0.006) was significantly higher in the non-central obesity group than that in the central obesity group; whereas the levels of hs-CRP (0.1 ± 0.1 vs. 0.4 ± 0.4 mg/dL, p=0.007) and fibrinogen (287.2 ± 75.9 vs.
350.1 ± 72.5 mg/dL, p=0.011) were significantly lower in the non-central obesity group than those in the central obesity group. There were no significant differences in serum B-12 and folate, inflammatory and lipid peroxidition indicators between two groups. There was no correlation
between plasma PLP and homocysteine, while vitamin B-12 and serum folate significantly and negatively correlated with homocysteine. Plasma PLP was negatively correlated with hs-CRP (r = -0.31, p = 0.045) in the central obesity group and with IL-6 (r = -0.57, p = 0.044) in the non-central obesity group. No significant correlation was found between vitamin B-12 or folate and inflammatory responses or lipid peroxidation indicators in either groups. Negative correlation still remained between
plasma PLP and hs-CRP after subjects were pooled (r = -0.40, p = 0.003). Metabolic syndrome subjects with central obesity had significantly lower plasma PLP and higher inflammatory response indicators. In addition, plasma PLP had a significant correlation with inflammatory responses.

並列關鍵字

metabolic syndrome ； B-vitamin ； homocysteine ； inflammatory responses ； lipid peroxidation

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