血清中同半胱胺酸與冠狀動脈及頸動脈內動脈硬化程度的相關性探討

Serum Homocysteine and Traditional Cardiovascular Risk Factors in Atherosclerosis of the Coronary and Carotid Arteries

目的：利用多切面電腦斷層掃描及頸動脈超音波檢查動脈硬化程度，探討血清中同半胱胺酸與冠狀動脈及頸動脈內動脈硬化程度的相關性。方法：研究對象為2006年1月至2011年9月因不同程度胸痛至新光醫院接受心臟血管健康檢查（包含256切電腦斷層掃描及頸動脈超音波）之1,884名受檢者，並抽血測量傳統心血管疾病危險因子及同半胱胺酸，以評估其與動脈硬化的相關性。結果：整體有34%研究對象有冠狀動脈狹窄，52%有頸動脈斑塊。利用多變項邏輯回歸分析調整其他危險因子後，動脈硬化的勝算比隨著同半胱胺酸濃度上升而增加，此項結果在冠狀動脈及頸動脈皆可發現。第三及第四四分位數的同半胱胺酸與頸動脈斑塊的產生有顯著相關性（與第一四分位數比較，勝算比分別為1.5及2.1）；第四四分位數的同半胱胺酸與冠狀動脈阻塞也有較高的勝算比（與第一四分位數比較，勝算比為1.5）。結論：利用256切電腦斷層檢查及頸動脈超音波檢查發現，同半胱胺酸上升會增加冠狀動脈及頸動脈的動脈硬化風險。

Background: The present study was conducted to evaluate the association between total homocysteine (tHcy) and traditional cardiovascular risk factors and atherosclerosis in the carotid and coronary arteries. Methods: This was a cross-sectional study of 1884 patients presenting to a medical center in north Taiwan with varying degrees of chest pain between January 2006 and September 2011. Patients were referred for a comprehensive cardiovascular health checkup that included 256-slice multi slice computer tomography (MSCT) and carotid duplex scans. Traditional cardiovascular risk factors and serum tHcy levels were measured to determine the association between tHcy and atherosclerosis. Results: The mean age of the patients was 54.7 years, and 64.7% of the participants were men. Overall, 34% had coronary artery stenosis and 52% had plaque deposits in their carotid arteries. After using multiple logistic regression analysis to control for the effect of traditional cardiovascular risk factors, the odds ratio (OR) for atherosclerosis increased along with the increasing levels of tHcy. These findings were observed in both the carotid and coronary arteries. tHcy quartiles 3 and 4 were significantly associated with a greater OR for carotid plaque formation (1.5 and 2.1, respectively), while the fourth quartile of tHcy showed a higher OR for coronary stenosis (OR = 1.5, as compared to the first quartile of tHcy). Conclusion: Elevated tHcy is independently associated with an increased risk of atherosclerosis in the carotid and coronary arteries identified via carotid duplex and 256-slice MSCT scans.