黃怡嘉Yi-Chia Huang陳婉馨Wan-Shin營養學研究所2026-03-249999-12-312008https://handle.ncl.edu.tw/11296/gsm7uqhttps://scholars.csmu.edu.tw/handle/123456789/6750高同半胱胺酸血症已被證實是增加心血管疾病危險性的獨立因子。葉酸、維生素B-12、維生素B-6 (B-維生素) 因參與同半胱胺酸代謝，被認為可做為評估同半胱胺酸血症的指標。本研究目的是探討何種B-維生素為評估高同半胱胺酸濃度的敏感指標。研究設計以橫斷方式進行，以海報及網路招募共130位健康男（n = 50）、女性（n = 80）受試者，平均年齡為23.3 ± 3.1歲 (19-30歲)。受試者接受體位測量，抽取空腹血液分析臨床血液生化值、血清、紅血球葉酸、血清維生素B-12、血漿磷酸比哆醛及血漿同半胱胺酸濃度。分別以同半胱胺酸濃度 ≧ 10 μmol/L或 ≧ 12 μmol/L定義高同半胱胺酸血症。受試者依血漿同半胱胺酸濃度分為高同半胱胺酸組 (同半胱胺酸濃度 ≧ 10 μmol/L，共69位；或 ≧ 12 μmol/L，共32位) 及正常同半胱胺酸組 (同半胱胺酸濃度 ＜ 10 μmol/L，共61位；或＜ 12 μmol/L，共98位)。正常同半胱胺酸組的血清及紅血球葉酸、維生素B-12及維生素B-6濃度顯著高於高同半胱胺酸組。調整影響同半胱胺酸濃度的相關危險因子，包括年齡、性別、身體質量指數、血液肌酸酐及收縮壓後，血清葉酸濃度與同半胱胺酸濃度呈顯著負相關p ＜ 0.01；若進一步調整血清維生素B-12及血漿磷酸比哆醛後，血清葉酸與同半胱胺酸濃度仍呈顯著負相關。回歸分析結果顯示調整影響同半胱胺酸濃度的相關危險因子後，血清葉酸（OR = 0.837, 95% CI: 0.759-0.922, p＜0.001; OR = 0.815, 95% CI: 0.719-0.924, p = 0.001）、紅血球葉酸（OR = 0.997, 95% CI: 0.995-1.000, p = 0.024; OR = 0.996, 95% CI: 0.993-0.999, p = 0.006）及血清維生素B-12 （OR = 0.994, 95% CI: 0.989-0.999, p = 0.032; OR = 0.991, 95% CI: 0.984-0.998, p = 0.012） 顯著降低高同半胱胺酸血症 (≧ 10 μmol/L或 ≧ 12 μmol/L) 的相對危險比。進一步調整其他任兩種維生素後，血清葉酸 （OR = 0.866, 95% CI: 0.781-0.961, p = 0.007; OR = 0.851, 95% CI: 0.748-0.968, p = 0.014）仍然顯著降低高同半胱胺酸血症的相對危險比。進一步以接受者操作特性曲線 ( receiver operating characteristic curve, ROC curve ) 評估B-維生素對診斷高同半胱胺酸濃度之準確性。不論血漿同半胱胺酸濃度 ≧ 10 mol/L或 ≧ 12 mol/L時，血清葉酸在ROC曲線下面積(area under the ROC curve；AUC) 皆大於紅血球葉酸、維生素B-12及維生素B-6的ROC曲線下面積。血清葉酸應可做為評估高同半胱胺酸血症的較敏感指標。Hyperhomocysteinemia has been demonstrated to be an independent risk factor of cardiovascular disease. Folate, vitamin B-12 and vitamin B-6 (B-vitamins) all involve in homocysteine (Hcy) metabolism and were considered to be possible indicators of Hcy concentration. The purpose of this cross-sectional study was to investigate whether serum and RBC folate or vitamin B-12 or vitamin B-6 status could be a more sensitive indicator of hyperhomocysteinemia. One hundred thirty healthy males (n = 50) and females (n = 80) subjects with mean age of 23.3 ± 3.1 years raged from 19 to 30 years were recruited from university campus by advertisement . Subjects’ health characteristics were recorded. Fasting blood sample was obtained to estimate hematological parameters, B-vitamins status and plasma Hcy concentration. Hyperhomocysteinemia was defined as Hcy concentration ≧ 10 μmol/L or ≧ 12 μmol/L. Subjects were divided into either hyper-Hcy (≧ 10 μmol/L, n = 69; or ≧ 12 μmol/L, n = 32) or normo-Hcy (< 10 μmol/L, n = 61; or < 12 μmol/L, n = 98) based on Hcy concentration . Subjests in the normo-Hcy group had significantly higher folate, vitamin B-12 and vitamin B-6 levels than did subjects in the hyper-Hcy group. Serum folate concentration strongly negatively correlated with plasma Hcy level (p＜0.01) after adjusting for age, gender, body mass index, serum creatinine and systolic blood pressure. Serum folate remained significantly negatively correlated with Hcy after additionally adjusting for serum vitamin B-12 and plasma pyridoxal 5‘-phosphate (PLP). Unconditional logistic regression analysis showed that high serum folate（OR = 0.837, 95% CI: 0.759-0.922, p＜0.001; OR = 0.815, 95% CI: 0.719-0.924, p = 0.001, respectively） RBC folate （OR = 0.997, 95% CI: 0.995-1.000, p = 0.024; OR = 0.996, 95% CI: 0.993-0.999, p = 0.006, respectively）and vitamin B-12（OR = 0.994, 95% CI: 0.989-0.999, p = 0.032; OR = 0.991, 95% CI: 0.984-0.998, p = 0.012, respectively）significantly decreased the risk of hyperhomocysteinemia (≧ 10 μmol/L；≧ 12 μmol/L, respectively). A significan association of serum folate with Hcy remained after serum vitamin B-12 and plasma PLP were additionally adjusted. We further used receiver operating characteristic curve (ROC curve) to compare the ability of identifying hyperhomocysteinemia using serum, RBC folate, vitamin B-12 and vitamin B-6. The area under the ROC curve (AUC) for serum folate is the greatest among all indicators. When hyperhomocysteinemia was defined as either ≧10 mol/L or ≧ 12 mol/L, serum folate had a higher discriminate ability in identifyling hyperhomocysteinemia and appears as the better screening tool in this young adult population.thesis