| 摘要: | 高同半胱胺酸血症已被認為是導致心血管疾病的獨立危險因子，而相關B-維生素的缺乏是造成同半胱胺酸濃度上升的主要原因。本研究目的為：（1）比較冠狀動脈心臟病及非冠狀動脈心臟病病人，其維生素B6、葉酸、維生素B12及血漿同半胱胺酸之營養狀況；（2）探討冠狀動脈疾病的危險因子及相關B-維生素的營養狀況對血漿同半胱胺酸的影響；（3）根據血漿同半胱胺酸濃度分層，評估罹患CAD的危險性。志願參與本實驗受試者是由台中榮總心臟內科門診病人取得。若病人經心導管檢查結果至少有一條冠狀動脈狹窄程度大於70 % 者，則判定為患有冠狀動脈心臟病。於研究期間總共篩選了60位患有冠狀動脈心臟病（CAD組）（男性54位；女性6位）及60位非冠狀動脈心臟病病人（非CAD組）（男性39位；女性21位）。受試者接受問卷調查、體位測量、血液生化值檢驗、血漿同半胱胺酸（Hcy）、磷酸比哆醛（PLP）、紅血球丙胺酸及天門冬胺酸轉胺活性係數（EAST-AC 及EALT-AC）、血清葉酸及維生素B12濃度測量。另外，利用二十四小時回憶法紀錄受試者營養素攝取量。結果顯示CAD組病人的年齡、身高、體重、上臂環圍、臂肌肉環圍、臂肌肉面積、血清尿素氮、肌酐胺酸、總膽固醇、三酸甘油酯、鹼性磷酸及低密度脂蛋白濃度顯著高於非CAD組病人（p < 0.05），而三頭肌皮層厚度及高密度脂蛋白濃度則顯著低於非CAD組病人。CAD組病人比起非CAD組病人有顯著較低的醣類攝取及較高的膳食纖維與鈉鹽的攝取。CAD組病人血漿Hcy濃度顯著高於非CAD組病人（13.88 ±4.93及9.14 ±3.33 μmol/L），但血漿PLP濃度及轉胺活性係數（EAST-AC及EALT-AC）、血清葉酸及維生素B12濃度在兩組間無顯著的差異。將血漿同半胱胺酸濃度分層後，發現當受試者血漿Hcy濃度介於10.8 — 13.8及大於13.8 μmol/L者的血清葉酸濃度顯著低於血漿Hcy濃度介於8.0-10.7及小於8.0 μmol/L者。利用回歸分析，發現CAD危險因子中以年齡及性別會顯著影響血漿Hcy的濃度。利用Multiple logistic regression分析後發現，血漿Hcy濃度大於13.8 μmol/L者，會顯著增加罹患CAD的危險性；且在回歸分析發現，相關B-維生素中只有葉酸對血漿Hcy有顯著的影響。血清葉酸濃度每上升1 ng/mL，可以降低約1倍的血漿Hcy 濃度（β = -0.0145，p < 0.001）。因此具有CAD危險因子的人可藉由增加葉酸的攝取來降低血漿同半胱胺酸的濃度，進而降低罹患冠狀動脈心臟病的危險性。
Hyperhomocysteinemia has been known as an independent risk factor of coronary artery disease (CAD). The deficiencies of related B-vitamins are one of the major reasons. The purposes of this study were (1) to compare plasma pyridoxal 5’-phosphate (PLP), homocysteine (Hcy), serum folate and vitamin B12 status in subjects with and without CAD; (2) to investigate the effects of risk factors of CAD and related B-vitamins on plasma Hcy concentration; (3) to assess the risk for CAD according to the quartiles of plasma Hcy concentration. The subjects were recruited from cardiology clinical department of Taichung Venteran General Hospital. Sixty (54 males, 6 females) patients (CAD group) were identified by cardiac catheterization to have at least 70 % occlusion of one major coronary artery, and sixty (39 males, 21 females) subjects (non-CAD group) with no or minor coronary stenosis. Anthropometry and hematology, plasma PLP and Hcy concentrations, erythrocyte aspartate and alanine transaminase activity coefficients (EAST-AC and EALT-AC), serum folate and vitamin B12 concentrations were measured. A 24-h diet recall was used to obtain subjects’ nutrient intakes. Results showed that mean age, height, weight, mid-arm circumference (MAC), mid-arm muscle circumference (MAMC), arm muscle area (AMA), serum blood urea nitrogen (BUN), creatinine, total cholesterol (TC), triglyceride (TG), alkaline phosphatase (ALP), low density lipoprotein (LDL), dietary fiber and sodium salt intakes were significantly higher in the CAD group. However, the mean values of triceps skinfold (TSF), high density lipoprotein (HDL), and carbohydrate intakes were significantly higher in the non-CAD group. The CAD group had significantly higher plasma Hcy concentration than the non-CAD group (13.88 ±4.93 vs. 9.14 ±3.33 μmol/L). There were no significant differences in plasma PLP, EAST-AC, EALT-AC, serum folate and vitamin B12 levels between two groups. According to the quartiles of plasma Hcy concentration, mean serum folate concentration for subjects in the third and forth quartiles of plasma Hcy concentration (10.8-13.8 μmol/L and >13.8) were significantly lower than in the first and second quartiles (< 8.0 μmol/L and 8.0-8.7). Multiple regression analysis showed that age and sex significantly affected plasma Hcy concentration. Multiple logistic regression analysis showed that odds ratio for all CAD and non-CAD subjects was significantly increased in the fourth quartile of plasma Hcy concentration ( > 13.8 μmol/L). Plasma Hcy concentration was significantly increased and affected by serum folate concentration after adjusted for CAD risk factors (age, gender, TC, TG, LDL), serum creatinine and the other two B-vitamins (β = -0.0145，p < 0.001). The elevation of 1 ng/mL in serum folate concentration would decrease 1-fold plasma Hcy concentration. In conclusion, subjects with CAD risk factors are suggested to increase the consumption of dietary folate in order to prevent the increase of plasma Hcy concentration, and further reduce the incidence of coronary artery disease. |
