高同型半胱氨酸血症诊疗专家共识

doi:10.16689/j.cnki.cn11-9349/r.2020.03.007

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Abstract High homocysteine levels, and a variety of disease development, such as cardiovascular disease, hypertension, diabetes, and closely related diseases such as kidney disease, pregnancy, almost affect the whole body organs, through oxidative damage, DNA methylation and metabolic abnormalities and other mechanism of sulfur compound affect cell function, protein synthesis and regulation, leading to the pathological changes of tissues and organs. Currently, there is no guideline for the diagnosis and treatment of demographic characteristics in China. This expert consensus is based on the review and analysis of research literature and evidence-based medicine at home and abroad in the past 30 years, combined with the characteristics of the Chinese population, recommending that tHcy ≥ 10μmol/L is defined as hyperhomocysteinemia. By adjusting the diet composition and / or using dietary supplements such as betaine, vitamins B and related coenzyme nutritional supplements, the level of tHcy can be prominently reduced, which is expected to significantly slow down the development of related diseases. It is recommended to carry out the detection indicators related to homocysteine, so as to clarify the causes of homocysteine rise, to guide the clinical precise intervention measures, effectively to improve the level of homocysteine, and to achieve the purpose of preventing the occurrence of diseases or delaying the progress of diseases.

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	Bone Health and Nutrition Branch of Chinese Nutrition Society
	Chinese Society of Parenteral and Enteral Nutrition
	North Chronic Disease Prevention and Treatment Branch of Chinese Geriatric Society

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Bone Health and Nutrition Branch of Chinese Nutrition Society,Chinese Society of Parenteral and Enteral Nutrition,North Chronic Disease Prevention and Treatment Branch of Chinese Geriatric Society. Expert consensus on hyperhomocysteinemia#br#[J]. Electron J Metab Nutr Cancer, 2020, 7(3): 283-288.

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http://182.92.200.144/EN/10.16689/j.cnki.cn11-9349/r.2020.03.007 OR http://182.92.200.144/EN/Y2020/V7/I3/283

1.AZZINI E, RUGGERI S, POLITO A. Homocysteine: its possible emerging role in at-risk population groups［J］. Int J Mol Sci, 2020, 21(4):1421.
2.DJURIC D, JAKOVLJEVIC V, ZIVKOVIC V, et al. Homocysteine and homocysteine -related compounds: An overview of the roles in the pathology of the cardiovascular and nervous systems［J］. Can J Physiol Pharmacol, 2018, 96(10):991-1003.
3.罕见病诊疗指南（2019年版）.国卫办医函〔2019〕198号, 2019, 268-275.
4.Bailey LB. 叶酸对健康和疾病的作用［M］. 郝玲,季成叶,译.2版.北京:北京大学医学出版社，2014.
5.CORTSES C, MOTTI C. MTHFR gene polymorphism, homocysteine and cardiovascular disease［J］.Public Health Nutr, 2001, 4(2B):493-497.
6.YANG B Y, LIU Y Y, LI Y F, et al. Geographical distribution of MTHFR C677T, A1298C and MTRR A66G gene polymorphisms in China: Findings from 15357 adults of Han nationality［J］. PLoS One, 2013, 8(3):e57917.
7.SONG L. Association between decreased plasma folate levels and MTHFR C677T, and MTRR A66G gene polymorphisms as determinants for elevated total homocysteine concentrations in pregnant women［J］.Hereditary Genet, 2018, 7:1.
8.VIJAYAN M, CHINNIAH R，RAVI P M, et al. MTHFR (C677T) CT genotype and CT-apoE3/3 genotypic combination predisposes the risk of ischemic stroke ［J］. Gene, 2016, 591(2):465-470.
9.MORRIS M S, JACQUES P F, SELHUB J, et al. Total homocysteine and estrogen status indicators in the third national health and nutrition examination survey［J］.Am J Epidemiol, 2000, 152(2):140-148.
10.GUILLIAMS T G. Homocysteine-a risk factor for vascular diseases: guidelines for the clinical practice［J］. JANA, 2004, 7:1-24.
11.李建平, 霍勇, 刘平, 等.马来酸依那普利叶酸片降压、降同型半胱氨酸的疗效和安全性［J］.北京大学学报（医学版）, 2007，39(6):614-618.
12.YANG Q, BOTTO L D, ERICKSON J D, et al. ImprovementiIn stroke mortality in Canada and The United States, 1990 to 2002［J］. Circulation, 2006, 113:1335-1343.
13.王薇,赵冬,刘军, 等. 北京城乡人群1168例血浆同型半胱氨酸分布及相关因素研究［J］.中华流行病学, 2002, 23(1):32-35.
14.徐希奇,张伟丽,孙凯, 等. 青岛港中老年人群血浆同型半胱氨酸分布特点及危险因素分析［J］.中国临床康复, 2006, 10(24)：7-9.
15.黄海威, 郭明辉,黄家星, 等. 1020名社区人群同型半胧氨酸水平的调查和相关分析［J］.中华流行病学杂志, 2006, 27(8):721-724.
16.HARRIS S, RASYID A, KURNIAWAN M, et al. Association of high blood homocysteine and risk of increased severity of ischemic stroke events［J］. Int J Angiol, 2019, 28(1):34-38.
17.BOSTOM A G, ROSENBERG I H, SILBERSHATZ H, et al. Nonfasting plasma total homocysteine levels and stroke incidence in elderly persons: The framingham study［J］. Ann Intern Med, 1999, 131(5):352-355.
18.SAMPSON E L, BLANCHARD M R, JONES L, et al. Dementia in the acute hospital:pro- spective cohort study of prevalence and mortality［J］.Br J Psychiatry, 2018, 195(1):61-66.
19.LONGONI A, BELLAVER B, BOBERMIN L D, et al. Homocysteine induces glial reactivity in adult rat astrocyte cultures［J］.Mol Neurobiol, 2017, 55(3):1966-1976.
20.SONODA M, SHOJI T, KUWAMURA Y, et al. Plasma homocysteine and cerebral small vessel disease as possible mediators between kidney and cognitive functions in patients with diabetes mellitus［J］.Sci Rep, 2017, 7(1):4382.
21.ROBINSON K, MAYER E L MILLER D P, et al.Hyperhomocysteinemia and low pyridoxal phosphate.Common and independent reversible risk factors for coronary artery disease［J］.Circulation, 1995, 92(10):2825-2830.
22.WALD D S, LAW M, MORRIS J K, et al. Homocysteine and cardiovascular disease:evidence on causality from a meta-analysis［J］.BMJ, 2002, 325(7374):1202.
23.NYGARD O, NORDREHAUG J E, REFSUM H, et al. Plasma homocysteine levels and mortality in patients with coronary artery disease［J］.NEJM, 1997, 337(4):230-236.
24.WU H, WANG B, BAN Q Y, et al. Association of total homocysteine with blood pressure in a general population of Chinese adults: a cross-sectional study in Jiangsu province. BMJ Open, 2018, 8:e021103.
25.袁锐,张润峰.H型高血压与心血管疾病发生机制研究进展［J］.西南军医, 2018, 20(3)：372-375.
26.PASSARO A, DELIA K, PARESCHI P L, et al. Factors influencing plasmahomocysteine levels in type 2 diabetes［J］.Diabetes Care, 2000, 23(3):420-421.
27.AMBROSCH A. Is hyperhomocysteinemia a risk factor for neuropathy in patients with non-insulin dependent diabetes mellitus［J］? Neth J Med, 1998, 52:22.
28.MA L, LIU Q, JIANG Y W, et al. Genetically elevated circulating homocysteine concentrations increase the risk of diabetic kidney disease in Chinese diabetic patients［J］.J Cell Mol Med, 2019, 23(4):2794-2800.
29.LONG Y, NIE J. Homocysteine in renal injury［J］.Kidney Dis(Basel), 2016, 2(2):80-87.
30.OSTRAKHOVITCH E A,TABIBZADEH S. Homocysteine in chronic kidney disease［J］. Adv Clin Chem, 2015, 72:77-106.
31.MALLAMACI F, ZOCCALI C,TRIPEPI G. Hyperhomocysteinemia predicts cardiovascular outcomes in hemodialysis patients Kidney Int, 61(2):609-614.
32.SAITO M, MARUMO K. The effects of homocysteine on the keleton［J］. Curr Osteoporos Rep, 2018, 16(5):554-560.
33.张慧萍.同型半胱氨酸与妊娠相关疾病和胎儿出生缺陷基础与临床［M］.北京：科学出版社, 2017.
34.CAVALLE-BUSQUETS P, INGLS-PUIG M, FERNANDEZ-BALLART J D, et al. Moderately elevated first trimester fasting plasma total homocysteine is associated with increased probability of miscarriage the Reus-Tarragona birth cohort study［J］.Biochimie, 2020, 173:62-67.
35.GAIDAY A N, TUSSUPKALIYEV A B, BERMAGAMBETOVA S K, et al. Effect of homocysteine on pregnancy: a systematic review［J］. Chem Biol Interact, 2018, 293:70-76.
36.YANG Y Q, JIANG H, TANG A, et al. Changes of serum homocysteine levels during pregnancy and the establishment of reference intervals in pregnant Chinese women［J］. Clin Chim Acta, 2019, 489:1-4.
37.HOBBS CA, MALIK S, ZHAO W Z et al. Maternal homocysteine and congenital heart defects［J］.J Am Coll Cardiol, 2006, 47(3):683-685.
38.郭翠翠,杨德辉.不孕不育患者的抑郁情绪与血清学指标水平变化异质性分析［J］.中国性科学, 2019, 28(11):111-115.
39.戈一峰,汪春晖,欧阳罗璇,等.少和/或弱精子症患者血浆同型半胱氨酸的测定及意义［J］.中华男科学杂志, 2008, 14(12):1112-1114.
40.CHEN Y, LI J, LI T Y. et al. Association between homocysteine, vitamin B12, folic acid and erectile dysfunction: a cross-sectional study in China［J］.BMJ Open, 2019, 9(5):e023003.
41.ZAHNG D, WEN X,WU W, et al. Elevated homocysteine level and folate deficiency associated with increased overall risk of carcinogenesis: meta-analysis of 83 case-control studies involving 35,758 individuals［J］.PLoS One, 2015, 10(5):1-16.
42.DU Y F, LIN F Y, LONG W Q, et al. Serum betaine but not choline is inversely associated with breast cancer risk: a case-control study in China［J］. Eur J Nutr, 2017, 56(3):1329-1337.
43.WON BY, PARK K C, LEE S H, et al. Sex difference in the association between serum homocysteine level and non-alcoholic fatty liver disease［J］.Korean J Fam Med, 2016, 37(4):242-247.
44.DAI H J, WANG J, WANG X H, et al. Association between homocysteine and non-alcoholic fatty liver disease in Chinese adults: A cross-sectional study［J］. Nutr J, 2016, 15(1):102.
45.ABDELMALEK M F, ANGULO P, JORGENSEN, R A, et al. Betaine, a promising new agent for patients with nonalcoholic steatohepatitis: results of a pilot study［J］.Am J Gastroenterol, 2015, 96(9):2711-2717.
46.HOU Y, LI J P, QIN X H, et al. Efficacy of folic acid therapy in primary prevention of stroke among adults with hypertension in China: the CSPPT randomized clinical trial［J］.JAMA, 2015, 313(13):1325-1335.
47.MARUYAMA K, EHAB S E, KINUTA M, et al. Associtation between vitamin b group supplementation with changes in% flow-mediated dilatation and plasma homocysteine levels: a randomized comtrolled trial［J］. Clin Bionchem Nutr, 2019, 64(3):243-249.
48.曾果. 中国营养学会“孕期妇女膳食指南(2016)”解读［J］.实用妇产科杂志,2018, 34(4):265-267.
49.HUEMER M, DIODATO D, SCHWAHN B,et al. Guidelines for diagnosis and management of the cobalamin-related remethylation disorders cblC, cblD, cblE, cblF, cblG, cblJ and MTHFR deficiency［J］.J Inherit Metab Dis, 2017, 40(1):21-48.
50.MISHA F V. Inter-individual differences in pharmacokinetics of vitamin B6: A possible explanation of different sensitivity to its neuropathic effects［J］.Pharma Nutr, 2020, 12:100188.
51.ZHAO G F, HE F, WU C, et al. Betaine in inflammation: mechanistic aspects and application［J］. Front Immunol, 2018, 24(9):1070.
52.OLTHOF M R, BRINK E J, KATAN MB, et al. Choline supplemented as phosphatidylcholine decreases fasting and postmethionine-loading plasma homocysteine concentrations in healthy men［J］.Am J Clin Nutr, 2005, 82:111-117.
53.DEN HEIJER M, BROUWER I A, BOS G M et al.Vitamin supplementation reduces blood homocysteine levels: A controlled trial in patients with venous thrombosis and healthy volunteers［J］. Atherioscler Thromb Vasc Biol, 1998, 18(3):356-361.
54.杨月欣.葛可佑.中国营养科学全书［M］. 2版. 北京:人民卫生出版社, 2019.
55.赵连友.高血压学［M］.北京：科学出版社, 2019.