Neizvesna pouzdanost homocisteina kao metaboličkog markera za nedostatak folata i vitamina B12 kod pacijenata sa hroničnom opstruktivnom bolešću pluća

Abstract

Uvod: Povišena koncentracija homocisteina (Hey) može predstavljati metabolički marker nedostatka folata i vitamina B12, značajnih problema javnog zdravlja. Bolesnici sa hroničnom opstruktivnom bolešću pluća (HOBP) skloni su nedostatku ovih vitamina usled različitih razloga. Prikazana studija procenjuje pouzdanost koncentracije Hcy kao prediktora nedostatka folata i vitamina B12 kod ovih bolesnika. Metode: Studija je sprovedena u grupi od 50 osoba obolelih od HOBP (28 muškaraca/22 žene, starosti (x±SD = 49,0±14,5) godina. Koncentracije Hcy, folata i vitamina B12 su određivane hemiluminiscentnim imunoodređivanjem na mikročesticama. Statistička analiza je uključila testove Kolmogorov-Smirnov, Mann-Whitney U and x2, Spearman-ovu korelaciju i ROC analizu, uz nivo značajnosti od 0,05. Rezultati: Prosečne (SD) koncentracije folata i vitamina B-12 su iznosile 4,15 (2,16) pg/L i 465,6 (271,0) ng/L, pri čemu je samo kod vitamina B12 uočena korelacija sa nivoom Hcy (R =-0,510 (P=0,029)). Koncentracije vitamina se nisu razlikovale između polova, a starost je bila u korelaciji samo sa nivoom folata (R= 0,279 (P=0,047)). Incidenca nedostatka vitamina značajno se razlikovala (P=0,000 i P lt 0,000 za folat odn. vitamin B12) u zavisnosti od cut-off vrednosti u odnosu na koju je definisana (4,4; 6,6 i 8,0 pg/L - folat; 203 i 473 ng/L - vitamin B-12)-ROC analizom nije bilo moguće dokazati značaj hiperhomocisteinemije kao prediktora deficijencije. Zaključak: Pouzdanost koncentracije Hey kao markera nedostatka folata ili vitamina B12 kod bolesnika sa HOBP nije zadovoljavajuća, pa se deficijencija ovih vitamina ne može predvideti na osnovu pojave hiperhomocisteinemije.

Background: An increased homocysteine (Hey) concentration may represent a metabolic marker of folate and vitamin Bi2 deficiency, both significant public health problems. For different reasons, patients with chronic obstructive pulmonary disease (COPD) are prone to these deficiencies. The study evaluates the reliability of Hey concentration in predicting folate or vitamin B12 deficiency in these patients. Methods: A group of 50 COPD patients (28 males/22 females, age (x±S D = 49.0±14.5) years was enrolled. A chemiluminescent microparticle immunoassay was applied for homocysteine, folate and vitamin B12 concentration. Kolmogorov-Smirnov, Mann-Whitney U and x2 tests, Spearman's correlation and ROC analysis were included in the statistical analysis, with the level of significance set at 0.05. Results: Average (SD) concentrations of folate and vitamin B12 were 4.15 (2.16) pg/L and 465.6 (271.0) ng/L, whereas only vitamin B12 correlated with the Hey level (P =-0.510 (R=0.029)). Gender related differences were not significant and only a borderline significant correlation between age and folate was confirmed (R = 0.279 (P=0.047)). The incidence of folate and vitamin B12 deficiency differed significantly (P=0.000 and PcO.OOO for folate and vitamin B12 respectively), depending on the cutoff used for classification (4.4, 6.6 and 8.0 pg/L - folate; 203 and 473 ng/L - vitamin B12)-ROC analyses failed to show any significance of hyperhomocysteinemia as a predictor of folate or vitamin B12 deficiency. Conclusion: Reliability of the Hey concentration as a biomarker of folate or vitamin B12 depletion in COPD patients is not satisfactory, so their deficiency cannot be predicted by the occurrence of HHcy.