Clinical Analysis of Plasmic Homocysteine, Folate and VitaminB12 in Ulcerative Colitis
|School||Anhui Medical University,|
|Keywords||ulcerative colitis homocysteine folate vitamin B12|
Objective: Hcy is a sulfur-containing amino acid produced as an intermediate product in the metabolism of the essential amino acid methionine. It has been demonstrated that plasma levels of Hcy are mainly influenced by nutrition status of FA, VitB12 ,and by genetic polymorphisms of key enzymes of its metabolism.UC is debilitating illnesses of the bowel characterized by chronic inflammation of unknown etiology.Because of chronic recurrent intestinal inflammation, UC patients often with various degree of malabsorption of nutrients, particularly the absorption of vitamins, which leading to hyperhomocysteinemia.S tudies show that Hcy can occur from the oxidation of thiol to produce oxygen free radicals, by damaging vascular endothelium and promoting thrombosis. Furthermore, Hcy has a pro-inflammatory and immunomodulatory effects, that could induce and promote inflammation and immune response. Those mechanism may be have important implications in the UC pathological mechanism. Through this study to investigate and analyze the clinical characteristics of ulcerative colitis(UC). To investigated the clinical correlation between the level of plasma homocysteine(Hcy), folate(FA), vitamin B12(VitB12) in UC patients and control.Methods: The patients with 112 UC who were diagnosed from Augest 2007 to February 2010 at the first Affiliated Hospital Of Anhui Medical University were collected.The patients were registed and followed up according to case questionnaire of UC, and the complete clinicopathologic features, history, treatment were collected. Using the retrospective analysis of UC clinical features. 112 anticoagulated blood samples were collected from the patients of UC and the control,including 110 healthy volunteers. The level of plasma Hcy in 112 cases of UC patients and 110 controls were detected by HPLC-FD method. The level of plasma FA, VitB12 in UC patients and controls were detected by enzyme-linked immunosorbent assay (ELISA) method. Results:(1) Clinical Analysis of UC: There were 58 male patients and 54 female. The age was 16 to72 years old and the mean duration of the disease was 3.34±2.76 years old. The peak of incidence was 26-40 years old. The cases of chronic relapsing were 61 (54.5%) and first onset were 40(35.7%) were the most common,in all cases, 8.9% were chronic persistent,only 0.9% were acute fluminant type. In the patients who had extra-intestinal manifestations,eight of them(7.1%) have gall-stone,seven of them(6.3%) had canker sore , and two of them(1.8%) had pyoderma gangraenosum. one of them had primary sclerosing cholangitis (0.9%), so as ankylosing spondylitis (0.9%), two of them had cases (1.8%). Routine total colectomy (1.8%). There were nine of remission UC patients (8.0%),but 103 patients with active (92.0%), including 37 patients with mild (33%), 47 cases with moderate (42%),17 cases with severe (17%). According to lesion UC patients were divided into there groups: 34 patients with extensive colonic type (30.4%), 22 cases with left colon type, (19.6%), 56 cases with rectal type (50.0%). There were 33 UC patients of oral sulfasalazine (SASP) treatment (29.5%), oral 5 - aminosalicylic acid preparations (5-ASA) in 31 patients (27.7%), oral or intravenous glucocorticoid therapy were 24 cases (21.4%), six of them (5.4%) were glucocorticoid-depedent or glucocorticoid-resistance, nine of them used immunosuppressive agents azathioprine treatment(8.0%). In the active UC patients,most of the pancolitis and extensive colitis revealed severity diseas(er=0.595, P=0.000), however, the left-side colitis and proctitis or proctosigmoiditis were mostly moderate severity. Disease extent is not correlated with disease clincical types(r=0.164,P=0.084).(2)The level change of plasma Hcy, FA and VitB12 in ulcerative colitis patients:UC patients had significantly higher Hcy(11.27±7.26)umol/L than health control(8.19±4.81)umol/L (P<0.05). The plasma Hcy levels in remission UC patients was (9.68±4.24) umol/L, active patients was (11.41±7.46) umol/L, which light was (11.25±6.49) umol/L, moderate was (12.35±8.52) umol/L, sever was (9.36±6.27) umol/L. UC patients with active disease had similar levels of the serum Hcy in comparison with inactive (P>0.05). The plasma Hcy levels were divided into the rectum was (12.24±7.33) umol/L, left colon was (9.33±5.22) umol/L, extensive colon was (10.91±8.13) umol/L. No association between serum Hcy levels and disease localization in UC patients were found(P >0.05).No directly proportional relationship was found in the UC patiends between Hcy levels and disease duration ,CRP and ESR(duration: r=-0.050、P=0.605; ESR:r=-0.169,P=0.086;CRP:r=0.123,P=0.199). UC patients had significantly lower FA and VitB12 levels(7.64±1.95 nmol/L、108.64±32.22 pmol/L)than health contro(l9.14±1.23 nmol/L、112.64±33.33 pmol/L)(P<0.05). As the critical value of 15.00 umol/L, the level of plasma Hcy were divided into hyperhomocysteinemia and no hyperhomocysteinemia. UC patients with hyperhomocysteinemia had lower FA, VitB12 levels (7.13±1.82 nmol/L, 105.57±36.50 pmol / L) than non- hyperhomocysteinemia UC patients (8.10±1.98 nmol/L, 111.40±27.99pmol/L) and normal control group (P <0.05Conclusions:(1)In the hospitalized cases of UC, the onset is mostly middle-aged, rectum and pancolitis were the most common.The clinical type mostly is chronic relapsing.The disease extent is correlated with the disease severity in active UC.(2) UC patients had significantly higher Hcy than health control. UC patients with active disease had similar levels of the serum Hcy in comparison with inactive. No directly proportional relationship was found in the UC patiends between Hcy levels and disease duration ,CRP and ESR.(3) UC patients had significantly lower FA and VitB12 levels . UC patients with hyperhomocysteinemia had lower FA, VitB12 levels than non- hyperhomocysteinemia and normal control group, which may be related to reduction of FA and VitB12 .