Diabetic retinopathy is a vascular complication of diabetes, and homocysteine is an intermediate product of methionine metabolism. Hyperhomocysteinemia can directly or indirectly damage vascular endothelial cells, causing vascular endothelial cells dysfunction and participating in the occurrence and development of diabetic retinopathy. Uric acid is the final product of purine metabolism. Hyperuricemia can cause vascular endothelial dysfunction, oxidative metabolism, platelet adhesion and aggregation dysfunction, thus participating in the occurrence and development of diabetic retinopathy. In recent years, there have been many studies on the correlation between diabetic retinopathy and levels of homocysteine and uric acid. This article reviews the relevant literature at home and abroad in order to provide new information for the prevention and treatment of diabetic retinopathy.
ObjectiveTo observe serum homocysteine (Hcy) levels in retinal vein occlusion (RVO) patients with different ages and types. MethodsA total of 79 patients (79 eyes) diagnosed with RVO were enrolled. There were 33 females and 46 males, the mean age was (57.00±9.29) years. Eighty-two age-and sex-matched patients (82 eyes) without retinal vascular disease were included as controls. There were 32 females and 50 males, the mean age was (60.00±10.15) years. Among RVO patients, there were 24 patients younger than 50 years old (young patients) and 55 patients older than 50 years old (elderly patients); 35 patients with central RVO (CRVO) and 44 patients with branch RVO (BRVO). Fasting plasma Hcy, serum vitamin (Vit) B6, B12 and folate levels were measured in all patients. The relationship of high Hcy, low VitB6, low folate and RVO with different age were analyzed. ResultsHcy level was significantly higher in RVO patients than control subjects (t=2.946, P<0.01). Blood concentration of folate and VitB6 were significantly lower in RVO patients than control subjects (t=2.641, 2.889; P<0.01). Blood level of VitB12 was significantly different in RVO patients from control subjects (t=1.665, P>0.05). Concentrations of Hcy, folate, VitB12 and VitB6 were not different between patients with CRVO and BRVO (t=0.756,1.306,0.682,1.306;P>0.05). Hcy level was significantly higher in the young RVO patients than in the elderly RVO patients (t=2.394, P<0.05). Blood concentration of folate and VitB6 were lower in the young RVO patients than in the elderly RVO patients, but the difference were not significant(t=1.318, 1.694; P>0.05). The number of patients with high Hcy [χ2=13.67,odds ratio (OR)=3.327,95% confidence interval (CI)=1.742-6.354], low VitB6 (χ2=5.28,OR=2.068,95%CI=1.103-3.878) and low folate status (χ2=8.642,OR=2.546,95%CI=1.349-4.806) in RVO patients were more than control subjects (P=0.0001, 0.023, 0.004). ConclusionsHigh Hcy, low folate and low VitB6 were risk factors for the onset of RVO. Hcy may play more important role in young patients with RVO. Hcy, folate and VitB6 levels were similar in CRVO and BRVO patients.
【Abstract】ObjectiveTo detect the levels of homocysteine (Hcy) and anti-phospholipid antibodies (APLA) in the hematoplasma of the patients with deep venous thrombosis (DVT), discuss the reason of DVT recurrence and search for the predictors of it. MethodsSixty cases with DVT in our department from January 2001 to April 2003 were collected, which were divided equally into two groups as primary and recurrent, and first degree relative of the 30 DVT recurrent patients were also collected. The author established a control group using 30 cases of outpatient clinic without varicose veins of lower extremity or insufficient venae profundae. Hcy was detected with fluorescence polarization immunoassay (FPIA) and APLA 〔anticardiolipin antibody, ACLA (IgG, IgM); lupus antibody (LA)〕were detected with enzyme linked immunosorbent assay (ELISA). Odds ratios (OR) were also calculated to assess the relative risk of each study group. ResultsThe values of Hcy and ACLA （IgG， IgM） in the primary group and recurrent group were both significantly higher than those of control group and first degree relative group of DVT recurrent patients (Plt;0.01). The values of Hcy in first degree relative group of DVT recurrent patients was were also much higher than that of control group (Plt;0.05). The 90% quantity of Hcy in control group was 13.1 μmol/L and if taking it as the normal value, the number of cases exceeded this value in primary group, recurrent group and first degree relative group of DVT recurrent patients were 14, 21 and 13 and the OR of them were 2.31, 2.20 and 1.90, respectively. The positive rates of LA were not statistically significant in each group. Conclusion The values of Hcy and APLA both rise in the hematoplasma of DVT patients. There are close relationship between the levels of Hcy and APLA and DVT. The recurrence of DVT is related to high level of Hcy and Hcy is possibly a predictor of DVT.
Objective To observe the serum homocysteine (Hcy) levels in retinal branch vein occlusion (BRVO) patients with with hypertension or non-hypertension. Methods A total of 120 patients (120 eyes) with BRVO were divided into hypertension group [72 eyes, blood pressure 140 - 175/90 - 105 mmHg (1 mmHg=0.133 kPa)] and non-hypertension group (48 eyes, blood pressure 100 - 139/70 - 88 mmHg). According to the sex and age, 78 patients with hypertensive non-retinal vascular diseases and 48 patients with non-hypertensive and non-retinal vascular diseases were collected by a way of same-size ratio as hypertension control group and non-hypertension control group, respectively. Fasting venous blood was collected from all patients in the morning and serum Hcy levels were measured by rate method. The total Hcy concentration over 15.0 μ mol/L was defined as high level Hcy. Fasting serum glucose and fasting serum lipid were also measured. Measurement data among groups were compared with t test. Results The serum Hcy levels were (26.82±28.0), (8.39±3.11), (21.37±4.24), (9.25±3.31) μmol/L in the hypertension group, hypertension control group, non-hypertension group and non-hypertension control group, respectively. The serum Hcy levels of patients in the hypertension group was significantly higher than that in the hypertension control group (t=3.324, P=0.004). The serum Hcy levels of patients in the non-hypertension group was significantly higher than that in the non-hypertension control group (t=2.216, P=0.049). The serum Hcy levels of patients in the hypertension group was significantly higher than that in the non-hypertension group, but the difference had not statistical significance (t=0.581, P=0.566). Among 120 patients, there were 68 patients (56.67%) with high level of Hcy (40 patients in the hypertension group and 28 patients in the non-hypertension group). Among the 40 patients with high levels of Hcy in the hypertension group, 36 patients were older than 50 years old (90.00%) and 4 patients were less or equal than 50 years old (10.00%). Among the 28 patients with high levels of Hcy in the non-hypertension group, 16 patients were older than 50 years old (57.14%); 12 patients were less or equal than 50 years old (42.86%), whose indexes of serum glucose and serum lipid were not abnormal. There was significant difference in age distribution of patients with high level of Hcy between the hypertension group and the non-hypertension group (χ2=9.882, P=0.002), but there was no significant difference in sex distribution (χ2=2.052, P=0.216). Conclusions The level of serum Hcy increased both in BRVO patients with hypertension and non-hypertension. The indexes of serum glucose and serum lipid were not abnormal in BRVO patients aged less or equal than 50 years old with non-hypertensive except for the increase of serum Hcy level.
Homocysteine is an intermediate product of methionine and cysteine metabolism, and plays a key role in methylation. Epilepsy is one of the common diseases of the nervous system, long-term repeated seizures will not only cause damage to the brain tissue, but also cause cognitive impairment. At present, the clinical treatment for epilepsy is still mainly to control symptoms, the fundamental etiology of epilepsy still needs to be improved, to explore the etiology of seizures, fundamentally control seizures, is still our long-term struggle direction. High homocysteine is associated with many diseases. Epidemiological studies have shown that the serum homocysteine level of 10% ~ 40% of epilepsy patients is higher than that of the normal population. By exploring the relationship between serum Hcy and epilepsy,We expect to provide help for the diagnosis and treatment of clinical epilepsy.
ObjectiveTo investigate the relationship between the level of homocysteine (HCY) and the overall burden of cerebral small vessel disease (CSVD) in patients with ischemic stroke.MethodsA total of 322 patients with first-ever ischemic stroke admitted to the People’s Hospital of Deyang City between January 2016 and December 2017 were enrolled. The patients’ demographic information, clinical information, and serum HCY concentration were collected after admission. The presence or absence of a CSVD was assessed by MRI and the overall burden score for the CSVD was determined. Multivariate logistic regression analysis was used to assess whether serum HCY level was associated with the overall burden of CSVD.ResultsThe median level of HCY was 13.2 μmol/L (inter-quartile range: 4.3 to 22.6 μmol/L). Univariate analysis showed that the difference of HCY levels among patients with different total CSVD scores was statistically significant (F=6.874, P=0.001); Spearman correlation analyses showed that the HCY level grouped by quartiles was correlated to the number of lacunar infarctions (rs=0.267, P=0.001), Fazekas score of white matter lesions (rs=0.122, P=0.042), and enlarged perivascular space (EPV) score (rs=0.319, P=0.001), but was not correlated to cerebral microhemorrhage (rs=−0.010, P=0.869). After multivariate regression analysis to adjust the effects of other factors, compared with the patients with HCY levels in the lowest quartile group, the patients with HCY levels in the highest quartile group were more likely to develop lacunar infarction [odds ratio (OR)=1.892, 95% confidence interval (CI) (1.012, 2.987)], white matter lesions [OR=1.548, 95%CI (1.018, 1.654)], severe EPV [OR=6.347, 95%CI (3.592, 13.978)], and the increase in the CSVD score [OR=2.981, 95%CI (1.974, 5.398)].ConclusionIn patients with ischemic stroke, elevated HCY levels may be associated with the overall burden of the CSVD.
ObjectivesTo evaluate the association between high homocysteine (Hcy) levels and risk of contrast-induced nephropathy (CIN).MethodsCNKI, VIP, WanFang Data, PubMed, The Cochrane Library and Web of Science databases were electronically searched to collect the case-control studies on the association between Hcy and risk of CIN from inception to November 30th, 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was performed by using Stata 12.0 software.ResultsTen case-control studies involving 6 124 subjects were included. Meta-analysis showed that the high Hcy level was associated with an increased risk of CIN (OR=1.59, 95%CI 1.33 to 1.89, P<0.001), and the homocysteine level in CIN group was higher than that in non-CIN group (WMD=8.74, 95%CI 6.18 to 11.31,P<0.001).ConclusionsAccording to the current evidence, the high Hcy level is a risk factor for CIN. Due to limited quality and quantity of the included studies, more high quality studies are required to verify the above conclusion.
ObjectiveTo analyze insulin resistance in patients with cerebral infarction and its correlation with plasma homocysteine level. MethodsA total of 100 cerebral infarction patients diagnosed between July 2013 and August 2014 and 100 healthy physical examination subjects were included in our research. The plasma homocysteine level was detected; the levels of fasting plasma glucose and fasting insulin were detected at the same time. ResultsPlasma homocysteine level (34.95±14.55) μmol/L in patients with cerebral infarction was significantly higher than that of the control group (8.84±2.27) μmol/L (P<0.05). Insulin resistance index (6.24±3.15) in patients with cerebral infarction was significantly higher than that of the control group (2.19±0.63) (P<0.05). The plasma homocysteine level in the infarction group with insulin resistance was significantly higher than that in the infarction group without insulin resistance (P<0.05). The plasma homocysteine level in the infarction group without insulin resistance was significantly higher than that of the patients with insulin resistance in the control group (P<0.05). In the cerebral infarction group, insulin resistance index was positively correlated with plasma homocysteine level (r=0.600, P<0.01). ConclusionInsulin resistance and plasma homocysteine level play important roles in clinical cerebral infarction. Improving insulin resistance and decreasing plasma homocysteine level may be effective ways to reduce the incidence of cerebral infarction.
Objective To explore the correlation between homocysteine （Hcy） level and the risk of breast cancer，and try to find a new method to reduce the risk factors and benefit for treatment of breast cancer. Methods From January2010 to December 2012， 245 cases of breast cancer （breast cancer group）， 109 cases of benign breast tumor （benign breast tumor group）， and 78 cases of healthy women （healthy control group） in the Sichuan Provincial People’s Hospital， who were in accordance with the inclusion criteria， were analyzed retrospectively. The difference of Hcy level was compared among three groups. Meanwhile the relation between Hcy level and patients’s age， blood glucose， serum creatinine， estrogen receptor （ER）， progesterone receptor （PR）， Ki-67 （%）， tumor diameter， or axillary lymph node status was analyzed.Results ① The Hcy level was significantly different among the breast cancer group， benign breast tumor group， and healthy control group （P＜0.001）. The Hcy level of the breast cancer group was significantly higher than those of the benignbreast tumor group （P＜0.001） or healthy control group （P＜0.001）， but the Hcy level was not significantly different bet-ween the benign breast tumor group and healthy control group （P=0.082） . ② The Hcy levels of different types of the breastcancer （type of Luminal A， Luminal B， Her-2， and triple negative） were significantly higher than those of the benign breast tumor group （except for Her-2 type， P＜0.05） or healthy control group （P＜0.05）. ③Plasma Hcy level of the patients with benign and malignant breast tumor was positively correlated with age （r=0.197， P=0.004） or serum creatinine level （r=0.381， P＜0.001）， but not correlated with blood glucose （r=0.023， P=0.668）. ④Plasma Hcy level of the patients with malignant breast tumor was positively correlated with age （r=0.267， P=0.007） or serum creatinine level （r=0.341， P＜0.001）， but not correlated with blood glucose （r=-0.005， P=0.935）， tumor diameter （r=-0.049， P=0.443）， axillary lymph node status （r=-0.006， P=0.921）， or Ki-67 （%） （rs=-0.029， P=0.650）. Conclusions Plasma Hcy level of breast cancer patient is abnormally elevated， and it may have some relation with the occurrence of breast cancer.
Objective To assess the effect of B vitamins supplementation on cardiovascular and cerebrovascular diseases, and also to evaluate the relationship between homocysteine and risk of cardiovascular and cerebrovascular diseases. Methods Using the words ‘homocysteine’, ‘cardiovascular disease’, ‘cerebrovascular disease’, ‘B vitamins’, and ‘randomized controlled trial’, we searched PubMed, Ovid, and Springer. We also hand searched relevant journals and conference proceedings. Randomized controlled trials published between 1998 and July 2008 which evaluated the effect of B vitamins supplementation on vascular diseases were collected. Two reviewers independently screened trials, extracted data, and evaluated the quality of included trials. The Cochrane Collaboration’s RevMan 4.2 software was used for statistical analysis. Results Sixteen trials involving 27,043 patients with vascular disease were included. Results of meta-analyses showed that no significant differences were identified between the B vitamins group and the control group for each of the four endpoints, including the risk of cardiovascular events (RR 0.98, 95%CI 0.94 to 1.03), the risk of coronary heart disease (RR 0.99, 95%CI 0.92 to 1.07), the risk of stroke (RR 0.90, 95%CI 0.80 to 1.02), and the total mortality (RR 0.98, 95%CI 0.92 to 1.05). Sensitivity analyses conducted by a random effect model or with the exclusion of low-quality trials did not change the overall results. Conclusion The trials currently available cannot confirm the causal relationship between homocysteine and risk of cardiovascular and cerebrovascular diseases. More evidence from large-scale randomized controlled trials is needed to confirm this. There is not sufficient evidence to show that B vitamins supplementation can lower the risk of cardiovascular and cerebrovascular diseases. B vitamins supplementation should not be recommended for the secondary prevention of such diseases.