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研究生:林娉婷
研究生(外文):Ping-Ting
論文名稱:五-甲基四氫葉酸還原酶基因多型性及B-維生素與血漿同半胱胺酸濃度及冠狀動脈心臟病危險因子之關係
論文名稱(外文):5-Methylenetetrahydrofolate reductase gene polymorphism and B-vitamins in relation to plasma homocysteine concentration and risk factors of coronary artery disease
指導教授:黃怡嘉黃怡嘉引用關係
學位類別:博士
校院名稱:中山醫學大學
系所名稱:營養學研究所
學門:醫藥衛生學門
學類:營養學類
論文種類:學術論文
論文出版年:2007
畢業學年度:95
語文別:英文
論文頁數:120
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本研究探討五甲基四氫葉酸還原酶(MTHFR 677C->T)基因多型性、B-維生素(葉酸、維生素B-6、B-12)營養狀況與高同半胱胺酸血症、高血脂、高血壓及冠狀動脈心臟病(CAD)危險性之關係;及給予低劑量葉酸補充劑後對於降低血漿同半胱胺酸之效果。本研究共募集184位CAD受試者及516位健康受試者,測量血脂質、血漿同半胱胺酸、B-維生素濃度及分析MTHFR 677C->T之基因多型性。根據MTHFR基因型,追蹤46位CAD病人,並隨機分配給與安慰劑(n = 22)及葉酸補充劑(400ug/天, n = 24)。結果顯示攜帶677TT基因型受試者之血漿同半胱胺酸濃度顯著高於677CC基因型受試者。調整CAD危險因子後,發現MTHFR 677C->T基因多型性對血漿同半胱胺酸濃度及血壓有顯著的相關性。當血漿同半胱胺酸濃度(>= 12.5umo/L)時會增加罹患CAD的危險對比值(OR, 3.490; 95% CI, 1.233 – 9.877),但MTHFR 677C->T基因多型性對罹患CAD之危險對比值無顯著影響。當受試者維生素B-6濃度小於30 nmol/L時血脂質濃度顯著上升且顯著增加罹患CAD (OR, 1.85; 95% CI, 1.16 – 2.95)及高血壓(OR, 16.44, P < 0.001)的危險性。給予低劑量葉酸介入8週後,並無顯著降低CAD受試者血漿同半胱胺酸濃度,但可顯著降低高同半胱胺酸血症病人血漿同半胱胺酸濃度,尤其是攜帶677TT基因型的CAD病人。677TT基因型會顯著增加血漿同半胱胺酸濃度,低維生素B-6濃度(< 30 nmol/L)與高血脂及高血壓有顯著的相關性,而同半胺酸為CAD的危險因子;高同半酸血症之CAD病人使用低劑量葉酸補充劑(400ug/天)可顯著降低胱胺酸濃度。
The purposes of this study were to investigate B-vitamins (folate, vitamin B-6 and B-12) status, methylenetetrahydrofolate reductase (MTHFR 677C->T) gene polymorphism, homocysteine in relation to the risk of hyperlipidemia, hypertension and coronary artery disease (CAD). Furthermore, the effect of a low oral dose of folic acid on lowering the plasma homocysteine concentration in response to the MTHFR 677C->T genotypes in patients with CAD was also evaluated. Patients who were identified by cardiac catheterization as having at least 70% stenosis of one major coronary artery were assigned to the case group (n = 184). Healthy individuals with normal blood biochemical values were assigned to the control group (n = 516). MTHFR 677C->T gene polymorphism, lipid profiles, plasma homocysteine and B-vitamins concentrations were measured. Forty-six CAD patients were randomly assigned to one of two groups: a placebo group (n = 22) and a folic acid group (400ug/d folate; n = 24). Intervention was administered for 2 months (8 weeks). The results showed T-allele carriers were positively associated with blood pressure and plasma homocysteine concentration when compared to subjects with 677CC genotype. Plasma homocysteine (>= 12.5 umol/L) (OR, 3.490; 95% CI, 1.233 – 9.877) had a significant association with increased risk of CAD. However, MTHFR 677C->T genotypes had no effect on the risk of CAD. In addition, subjects with plasma PLP < 30 nmol/L exhibited higher blood lipid status and significantly increased risk of CAD (OR, 1.85; 95% CI, 1.16 – 2.95) or risk of hypertension (OR, 16.44, P < 0.001) than subjects with plasma PLP (>= 30 nmol/L. After 8 weeks of supplementation, folic acid supplements did not significantly lower fasting plasma homocysteine concentration. However, 400ug folic acid significantly reduced homocysteine by 1.8 umol/L at week 8 for those subjects with hyperhomocysteinemia, especially for subjects with the T-mutation genotype. In conclusion, T-allele carriers and low PLP (< 30 nmol/L) increased plasma homocysteine concentration, lipid profiles and blood pressure; and plasma homocysteine is associated with the risk of CAD. In addition, a low-dose folic acid supplementation (400 ug/d) may have a significant lowering effect on plasma homocysteine concentration in hyperhomocysteinemic CAD patients.
中文摘要---------------------------------------------------------------------------------------------------1
Abstract-----------------------------------------------------------------------------------------------------2
Literature review-------------------------------------------------------------------------------------------3
Purposes---------------------------------------------------------------------------------------------------23
PART 1:
Methylenetetrahydrofolate reductase 677C->T gene polymorphism is associated with high plasma homocysteine but not the risk of coronary artery disease ---------------------------25
1-1. Abstract----------------------------------------------------------------------------------------26
1-2. Introduction------------------------------------------------------------------------------------27
1-3. Materials and methods ----------------------------------------------------------------------27
1-4. Results------------------------------------------------------------------------------------------29
1-5. Discussion-------------------------------------------------------------------------------------31
1-6. Conclusion-------------------------------------------------------------------------------------32
1-7. References-------------------------------------------------------------------------------------33
1-8. Tables-------------------------------------------------------------------------------------------37
PART 2:
Low-dose folic acid supplementation reduces homocysteine concentration in hyperhomocysteinemic coronary artery disease patients--------------------------------------41
2-1. Abstract----------------------------------------------------------------------------------------42
2-2. Introduction------------------------------------------------------------------------------------43
2-3. Materials and methods ----------------------------------------------------------------------44
2-4. Results------------------------------------------------------------------------------------------46
2-5. Discussion-------------------------------------------------------------------------------------47
2-6. Conclusion-------------------------------------------------------------------------------------50
2-7. References-------------------------------------------------------------------------------------51
2-8. Tables and figures-----------------------------------------------------------------------------55
PART 3:
Low pyridoxal 5’-phosphate is associated with increased risk of coronary artery disease------------------------------------------------------------------------------------------------61
3-1. Abstract----------------------------------------------------------------------------------------62
3-2. Introduction------------------------------------------------------------------------------------63
3-3. Materials and methods ----------------------------------------------------------------------64
3-4. Results------------------------------------------------------------------------------------------66
3-5. Discussion-------------------------------------------------------------------------------------67
3-6. Conclusion-------------------------------------------------------------------------------------68
3-7. References-------------------------------------------------------------------------------------69
3-8. Tables-------------------------------------------------------------------------------------------72
PART 4:
Low plasma pyridoxal 5’-phosphate concentration and MTHFR C677→T genotypes are associated with increased risk of hypertension-------------------------------------------------76
4-1. Abstract----------------------------------------------------------------------------------------77
4-2. Introduction------------------------------------------------------------------------------------78
4-3. Materials and methods ----------------------------------------------------------------------79
4-4. Results-----------------------------------------------------------------------------------------80
4-5. Discussion-------------------------------------------------------------------------------------81
4-6. Conclusion------------------------------------------------------------------------------------83
4-7. References-------------------------------------------------------------------------------------84
4-8. Tables------------------------------------------------------------------------------------------88
Anticipation and foresight------------------------------------------------------------------------------91
Appendixes-----------------------------------------------------------------------------------------------93
Appendix 1. Informed consent (baseline)--------------------------------------------------------94
Appendix 2. Approval Institutional Review Board of Chung Shan Medical Hospital (baseline)------------------------------------------------------------------------------96
Appendix 3. Informed consent (intervention) --------------------------------------------------97
Appendix 4. Approval Institutional Review Board of Chung Shan Medical Hospital (intervention)------------------------------------------------------------------------99
Appendix 5. Questionnaire of subject’s characteristics --------------------------------------100
Appendix 6. Twenty-four hour diet recall form-----------------------------------------------103
Appendix 7. Concentration curve of plasma homocysteine----------------------------------104
Appendix 8. Concentration curve of plasma pyridoxal 5’-phosphate-----------------------106
Appendix 9. Serum folate assay------------------------------------------------------------------108
Appendix 10. Serum vitamin B-12 assay ------------------------------------------------------109
Appendix 11. Methylenetetrahydrofolate gene polymorphism analyses-------------------110
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