Annals of Laboratory Medicine

Korean Society for Laboratory Medicine (대한진단검사의학회)
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Hyperhomocysteinemia as a Risk Factor for Coronary Artery Disease

혈장 호모시스테인이 관상동맥질환에 미치는 영향

Oh, Gwi-Yeung;Lee, Gyeong-In;Hong, Ki-Sook;Chung, Ick-Mo
오귀영;이경인;홍기숙;정익모

  • Published : 20020000
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Abstract

Background : Hyperhomocysteinemia is considered as a risk factor for coronary artery disease(CAD). In this study, we investigated the relationship between plasma homocysteine concentration and coronary artery disease. Methods : We measured plasma homocysteine concentration by fluorescent polarization immunoassay (IMx, Abbott) in 58 healthy controls (39-72 years) and in 37 patients (42-84 years) who were diagnosed with stable angina (11), unstable angina (14), acute myocardial infarction (8), old myocardial infarction (1) and silent myocardial ischemia (3). Results : The risk of CAD was independently associated with old age, decreased HDL cholesterol and hyperhomocysteinemia ($\geq$12.8 $\mu$mol/L) and adjusted odds ratios were 2.8, 3.4, and 6.0, respectively. The risk for CAD in the upper two homocysteine quartiles ($\geq$10.8 $\mu$mol/L & 8.1-10.7 $\mu$mol/L) was 11.1 (95% CI, 2.5-49.4) times and 6.3 (95% CI, 1.4-27.7) times higher than in the lowest quartile (<6.9 $\mu$mol/L) (P=0.002 & 0.014, respectively). The mean plasma homocysteine values (M${\pm}$SD) were higher in CAD patients (11.8${\pm}$7.4 $\mu$mol/L) than in the control group (8.0${\pm}$2.4 $\mu$mol/L) (P=0.0006). In the control group, the mean plasma homocysteine concentration in men was significantly higher than in women (9.1 vs. 7.2 $\mu$mol/L, P=0.002). Age and logarithmically transformed plasma homocysteine levels exhibited significant positive correlation in controls (r=0.43, P=0.001), but no significant correlation in CAD patients (r=-0.024, P=0.9). Plasma homocysteine levels were significantly higher in the elderly, male subjects and smokers in the univariate analysis. Conclusions : Hyperhomocysteinemia is one of the independent risk factors for CAD.

배경 : 고호모시스테인 혈증은 관상동맥질환의 위험인자이다. 본 연구에서 저자는 혈장 호모시스테인 농도와 관상동맥질환과의 상관관계를 분석하고자 하였다. 방법 : 연구방법은 58명의 정상대조군(39-72세)과 37명의 환자들(42-84세)에서 형광편광 면역법(IMx, Abbott)으로 혈장 호모시스테인 농도를 측정하였으며 환자들은 질환별로 안정 협심증 11명, 불안정 협심증 14명, 급성심근경색증 8명과 진구성 심근경색증 1명, 기타 허혈성 심질환 3명이었다. 결과 : 고령, 고밀도 지단백의 감소와 호모시스테인 증가가 각각 2.8배, 3.4배와 6.0배 만큼 높은 위험률을 보이는 관상동맥질환의 독립적인 위험인자로 평가되었다. 혈장 호모시스테인 사분위수중 가장 높은 농도를 보이는 두군($\geq$10.8 $\mu$mol/L & 8.1-10.7 $\mu$mol/L)은 가장 낮은 호모시스테인 농도를 보이는 군(<6.9 $\mu$mol/L)에 비해 각각 11.1 (95% CI, 2.5-49.4)배와 6.3 (95% CI, 1.4-27.7)배만큼 관상동맥질환의 위험률이 높았다(P=0.002 & P=0.014). 호모시스테인 평균농도(M${\pm}$SD)는 관상동맥질환군(11.8${\pm}$7.4 $\mu$mol/L)에서 정상대조군(8.0${\pm}$2.4 $\mu$mol/L)보다 유의하게 높았다(P=0.0006). 정상대조군에서 평균 호모시스테인 농도는 남자에서 여자보다 높았다(9.1 vs 7.2 $\mu$mol/L, P=0.002). 정상대조군에서는 나이와 혈장 호모시스테인 농도간에 양의 상관관계 (r=0.43, P=0.001)가 있었으나 관상동맥질환군에서는 통계적으로 유의한 상관관계를 보이지 않았다(r=-0.024, P=0.9). 혈장 호모시스테인 농도는 연령, 성별 및 흡연에 의해 영향받는 것으로 분석되었으며, 다변량분석상 성별이 독립적으로 혈장 호모시스테인 농도를 결정하는 인자인 것으로 분석되었다. 결론 : 혈장 호모시스테인 농도의 증가는 관상동맥질환의 독립적인 위험인자중의 하나로 사료된다.

Keywords

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