急性缺血性中風病患血漿同半胱胺酸與營養因子之相關性探討

The Relationship of Plasma Homocysteine and Nutrition Factors in Acute Stroke Patients

黃士懿(Shih-Yi Huang) ； 陳晉誼(Chin-I Chen) ； 邱弘毅(Hung-Yi Chiou) ； 翁百昱(Pai-Yu Weng) ； 劉偑姎(Pei-Yang Liu) ； 洪啟宗(Chi-Tzong Hong)

《中華民國營養學會雜誌》 27卷4期 (2002/12) Pp. 211-220

https://doi.org/10.6691/JCNS.200212_27(4).0003

摘要

近年來在流行病學研究發現，血漿中同半胱胺酸 (homocysteine, Hcy)濃度，不論在週邊血管、冠狀動脈與腦血管之粥狀硬化中均是重要的獨立危險因子，但對於急性缺血性中風患者，其血液中Hey濃度則少有探討。故本研究除了了解急性缺血性中風患者的營養狀態外，亦針對血漿中Hey濃度與其代謝過程之輔因子(維生素B12、葉酸) 濃度加以探討，藉以了解急性缺血性中風患者Hcy與維生素B12、葉酸、維生素B6之相關性與所扮演的角色。本研究招募153位的45~80歲無心血管相關疾病之健康者及萬芳醫院神經內、外科因罹患急性缺血性中風住院者155位，取其入院後72小時內之禁食血液。進行血液中基本生化值(血糖、總蛋白、肌酐酸、AST、ALT)與血脂質(總膽固醇、高密度脂蛋白膽固醇、低密度脂蛋白膽固醇、三酸甘油酯)之分析，以高效能液相層析螢光偵測法(HPLC)分析血漿中Hcy與維生素B群濃度，旦進行顱外腦血管超音波檢查頸動脈血管之IMT值(carotid intimal-media wall thickness)與其血斑值(plaque score)檢測，反應動脈粥狀硬化情形。結果發現在調整性別、年齡、抽煙、喝酒後，血漿Hcy濃度兩組間並無統計上的差異，但在少數的急性缺血性患者確實可看到較低的血漿Hcy濃度。在營養狀況上，急性缺血性中風患者之血漿中維生素B12濃度較高；血漿中總蛋白及白蛋白濃度兩組間並無明顯差異。由本研究結果，急性缺血性中風患者與血漿中Hcy濃度並無相關；血漿中維生素B群濃度的變化可能與其營養狀態、是否使用藥物治療、補充劑的使用等有關，真正原因尚待釐清。

關鍵字

急性缺血性中風 ； 同半胱胺酸 ； 維生素B12 ； 葉酸 ； 維生素B6

並列摘要

The incidence and prevalence of cardiovascular and cerebrovascular diseases have increased in Taiwan. In recent years, epidemiological and clinical studies have found that higher plasma homocysteine (Hcy) and lower plasma vitamin B12, folic acid, and vitamin B6 represent independent risk factors for atherosclerotic vascular disease. Consequently, nutrition status is highly correlated with the occurrence of atherosclerotic vascular disease. The specific aim of this study was to elucidate the association of nutrition status, plasma homocysteine, and vitamins, with the risk of carotid atherosclerosis among elderly people. In total, 155 inpatients from Wang-Fang hospital and 153 age and sex-matched healthy community dwelling controls aged from 45 to 80 years were recruited as study subjects. Fasting venous blood from all subjects was examined for basic biochemical parameters including glucose, total protein, globulin, albumin, creatinine, AST, and ALT in serum. The lipid profile including total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triglyceride was also examined. Plasma Hcy, vitamin B12, folic acid, and vitamin B6 were determined. Carotid intimal-media wall thickness (IMT), a marker of atherosclerosis, was also evaluated in all. There were no significant differences in plasma homocysteine levels between patients and healthy controls. A significant inverse correlation between plasma vitamin B12 and homocysteine was observed. In addition, the level of plasma vitamin B12 of patients was higher than that of healthy controls.

並列關鍵字

acute ischemic stroke ； homocysteine ； vitamin B12 ； folic acid ； vitamin B6