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Plasma total homocysteine in the active stage of ulcerative colitis
Józef Drzewoski1, Anita Gasiorowska, Ewa Małecka-Panas
1Department of Gastroenterology and Metabolic Diseases, Medical University of Lodz, Lodz, Poland.
Insights
Elevated total plasma homocysteine (tHcy) is linked to active ulcerative colitis (UC) and disease recurrence. This increase, observed even with normal folate levels, may enhance blood clotting in UC patients.
Area of Science:
- Gastroenterology
- Clinical Biochemistry
- Hematology
Background:
- Ulcerative colitis (UC) is associated with an increased risk of thromboembolism.
- Elevated total plasma homocysteine (tHcy) has been observed in UC patients, but its correlation with disease activity was unclear.
Purpose of the Study:
- To investigate the relationship between total plasma homocysteine (tHcy) levels and the activity and recurrence of ulcerative colitis (UC).
- To assess the influence of folate and vitamin B12 status on tHcy levels in UC patients.
- To examine the association between tHcy and coagulation parameters in UC.
Main Methods:
- A case-control study involving 30 UC patients (15 active, 15 remission) and 21 healthy controls.
- Measurement of total plasma homocysteine (tHcy), serum folate, and vitamin B12 levels.
- Assessment of selected coagulation parameters including platelet count, fibrinogen, and D-dimer.
Main Results:
- Mean tHcy was significantly higher in UC patients (10.8 +/- 3.1 mmol/L) compared to controls (6.8 +/- 2.5 mmol/L).
- Patients with active UC exhibited higher tHcy (11.2 +/- 3.5 mmol/L) than those in remission (9.0 +/- 2.3 mmol/L).
- Higher tHcy levels correlated with disease duration and recurrence frequency (> or =4 recurrences). Active disease also showed elevated platelet count, fibrinogen, and D-dimer.
Conclusions:
- Ulcerative colitis is associated with elevated tHcy, particularly in active and recurrent disease stages.
- Normal folate status does not prevent tHcy elevation in UC.
- Elevated tHcy may contribute to a procoagulant state in UC patients.
Background:
Homocysteine, an independent risk factor for thromboembolism, has been recently shown to be elevated in ulcerative colitis (UC). However, its relation to the activity of the disease remain unclear.
Methods:
Two groups were studied: group consisted of 1-30 patients with UC (17 men, 13 women, mean age 50.3 +/- 14.7 years), including 15 patients with active disease. Group 2 (controls) consisted of 21 age-, sex-, bodyweight-matched healthy persons (12 men, nine women, mean age 53.1 +/- 12.8 years). Total plasma homocysteine (tHcy) and serum folate and vitamin B12 as well as selected coagulation parameters were assessed.
Results:
Mean tHcy in UC patients was significantly higher than in healthy controls: 10.8 +/- 3.1 mmol/L versus 6.8 +/- 2.5 mmol/L (P < 0.001). Patients with active disease had higher tHcy than patients in remission: 11.2 +/- 3.5 mmol/L versus 9.0 +/- 2.3 mmol/L (P = 0.048). Patients with > or =4 recurrences of the disease had also higher tHcy than the others: 11.5 +/- 3.6 mmol/L versus 9.0 +/- 2.1 mmol/L (P = 0.035). The tHcy correlated with duration of disease: r = 0.6632 (P < 0.05). Folate and B12 levels were within their reference ranges in all subjects. However, in the patients with active disease the platelet count, fibrinogen and D-dimer were significantly higher than in the patients in remission and the controls.
Conclusions:
Ulcerative colitis is associated with elevated tHcy concentration, particularly in the active stage, and in more recurrent types of the disease; this elevation does not seem to be prevented by a normal folate status and might have an enhancing effect on the procoagulation blood profile.
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