高同型半胱氨酸血症与全科医疗健康问题的研究进展

范天松; 王培栋; 彭艳艳; 杭卫红; 马潇

doi:10.16766/j.cnki.issn.1674-4152.003889

高同型半胱氨酸血症与全科医疗健康问题的研究进展

doi: 10.16766/j.cnki.issn.1674-4152.003889

1.
甘肃中医药大学第一临床医学院，甘肃兰州 730000
2.
甘肃省人民医院全科医学科，甘肃兰州 730000

基金项目:

甘肃省科学技术厅科技计划项目 20CX9ZA029

详细信息

通讯作者:
王培栋，E-mail：sy18919098218@163.com

中图分类号: R589.3 R499
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- 文章访问数: 8
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- 被引次数: 0
出版历程
- 收稿日期: 2024-02-05
- 网络出版日期: 2025-03-27

Research progress of hyperhomocysteinemia and general practice

1.
First School of Clinical Medicine, Gansu University of Chinese Medicine, Lanzhou, Gansu 730000, China

摘要

摘要: 高同型半胱氨酸血症是指血浆中同型半胱氨酸的浓度升高为特征的疾病，高同型半胱氨酸血症可导致人体心脑血管系统、神经系统、内分泌系统等多个系统的损害，同时在妊娠不良结局和胎儿畸形等方面有重要影响。全科医学的研究涵盖了所有人群各个器官系统的各类疾病，要求全科医疗应关注全生命周期各阶段的健康问题。高同型半胱氨酸血症对人体的影响涵盖了各年龄段的不同系统的疾病，与全科医疗健康问题的多个领域有着密不可分的关系。根据2022年中国医师协会印发《住院医师规范化培训内容与标准(2022年版)》中全科医疗实践涉及的主要疾病，包括疾病早期与健康问题、基层常见病与多发病、合并多种疾病的临床情况。本文就高同型半胱氨酸血症与全科医疗健康问题的最新进展进行综述，以提高全科医生和社会对高同型半胱氨酸血症的重视。通过早期预防和干预，可以避免或减少高同型半胱氨酸血症引起相关疾病的发生、发展。同时，针对高危人群进行定期随访，维护居民健康，使全科医生真正成为居民健康的“守门人”。相关部门和社会团体在制定相应政策、指南、共识时，应增加对高同型半胱氨酸血症的重视，倡导高危人群加强健康管理、养成良好的生活方式，重视疾病的预防，积极维护和促进居民健康。同时，高同型半胱氨酸血症的研究价值有待进一步开发，本文为进一步研究高同型半胱氨酸血症提供了新的研究方向。
- 同型半胱氨酸 /
- 高同型半胱氨酸血症 /
- 全科医疗
Abstract: Hyperhomocysteinemia is a disease state defined by elevated plasma concentrations of homocysteine. Hyperhomocysteinemia has the potential to cause damage to numerous systems within the human body, including the cardiovascular, cerebrovascular, nervous and endocrine systems. Additionally, it has been linked to adverse pregnancy outcomes and fetal malformations. The field of general practice encompasses the study of all diseases affecting all organ systems in all populations. Consequently, general practice must address health issues at all stages of the life cycle. The impact of hyperhomocysteinemia on the human body is extensive, encompassing diseases of different systems in all age groups and being inextricably linked to numerous areas of general practice. In accordance with the primary ailments addressed in general medical practice as outlined in the 2022 Edition of the Content and Standards for Standardized Residency Training, published by the Chinese Medical Doctor Association, the following conditions are of particular relevance: the early stages of disease and health issues, prevalent, and recurrent illnesses within primary care, and clinical scenarios involving multiple concurrent diseases. This paper presents a comprehensive overview of the latest developments in the field of hyperhomocysteinemia and their implications for general practice. The objective is to enhance the awareness of hyperhomocysteinemia among General Practitioners and the wider community. This will facilitate the avoidance or reduction of the occurrence and development of diseases caused by hyperhomocysteinemia through the implementation of early prevention and intervention strategies, and the maintenance of population health through the provision of regular follow-up care for high-risk groups, This will enable general practitioners to assume the role of "gatekeepers" of population health. It is recommended that relevant departments and social organizations devote greater attention to hyperhomocysteinemia when formulating corresponding policies, guidelines and consensus. Furthermore, they should advocate for high-risk groups to enhance health management, cultivate positive lifestyles, prioritize disease prevention and proactively maintain and promote residents ' health. In the meantime, the research value of hyperhomocysteinemia must be further developed. This paper provides a new research direction for the continued study of hyperhomocysteinemia.
- Homocysteine /
- Hyperhomocysteinemia /
- General practice

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表 1 HHcy的致病机制

Table 1. Pathogenesis of HHcy

常见致病机制	相关研究结果	参考文献
内皮毒性作用	HHcy通过氧化应激机制诱导活性氧和活性氮的产生增加，影响其舒缩功能；同时，HHcy可诱导内皮细胞凋亡，损伤血管内皮细胞。	^[7]
参与动脉粥样硬化的形成	HHcy可以通过介导内皮细胞凋亡来促进动脉粥样硬化的形成；HHcy可引起脂蛋白代谢紊乱，促进脂质沉积于动脉壁，泡沫细胞增加；HHcy还可以改变动脉壁糖蛋白分子纤维化结构，促进斑块钙化。	^[8-9]
致血栓作用	HHcy可促进血栓调节因子的表达，从而促进血小板的黏附和聚集。	^[7]
刺激血管平滑肌细胞增生	HHcy可直接诱导血管平滑肌增殖。	^[10]
影响体内转甲基反应	HHcy浓度的升高会影响体内多种物质的甲基化过程，如核酸、蛋白质、多糖、胆碱、儿茶酚胺类的甲基化，甲基化能力降低，影响细胞的发育及分化。	^[6]

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