Pathological clarification of thrombosis risk related to homocysteine interacted with lipoprotein vitamin E and lipoprotein (a)

2020 Fiscal Year Final Research Report

• Project/Area Number: 17K09560
• Research Category: Grant-in-Aid for Scientific Research (C)
• Allocation Type: Multi-year Fund
• Section: 一般
• Research Field: Cardiovascular medicine
• Research Institution: Jikei University School of Medicine
• Principal Investigator: Yoshida Hiroshi 東京慈恵会医科大学, 医学部, 教授 (30333529)
• Project Period (FY): 2017-04-01 – 2021-03-31
• Keywords: Lp(a) / ホモシステイン / 腎機能 / 2型糖尿病

Outline of Final Research Achievements

To address the research subject, "Pathological clarification of thrombosis risk related to homocysteine interacted with lipoprotein vitamin E and lipoprotein (a) [Lp(a)]", the association between homocysteine and Lp(a), both of which may be involved in the thrombosis risk, was investigated at first in patients with type 2 diabetes. But, the association between the two was not found at all.
However, eGFR, kidney function, folic acid, and vitamin B12 significantly correlated with homocysteine independently of gender, age, BMI, and glucose control status (HbA1c). Furthermore, multivariate regression analyses showed the significant association of Lp(a) with eGFR and BMI. This association was found markedly in the study subjects without statin therapy.
Therefore, serum levels of homocysteine and Lp(a) for the atherothrombotic risk should be presumably investigated in diabetic patients with renal dysfunction especially in terms of nutritional status and statin therapy.

Free Research Field

循環器内科、動脈硬化脂質代謝、臨床検査医学

Academic Significance and Societal Importance of the Research Achievements

2型糖尿病患者では、非糖尿病患者に比べて血中ホモシステイン濃度が高いことが認められているほか、糖尿病腎症患者では、CKDを合併していない糖尿病患者よりも血中ホモシステイン濃度が高いこと、血清ホモシステイン濃度は糖尿病腎症のリスクと重症度に関連することが報告されているが、ビタミンB12や葉酸の栄養管理により、腎症を有する2型糖尿病患者にいおいても動脈硬化・血栓疾患と関連するホモシステインをコントロールできる可能性が示唆された。また動脈硬化危険因子であるLp(a)とeGFRに独立した負の相関がみられるが、スタチンの使用と不使用で違いがあることは2型糖尿病の診療のなかで留意すべきある。