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Prevalence of hyperhomocysteinaemia, activated protein C resistance and prothrombin gene mutation in inflammatory bowel disease.

Abstract

BACKGROUND

Thromboembolic disease is a significant cause of morbidity and mortality in patients with inflammatory bowel disease (IBD). A hypercoagulable state exists in IBD that may involve many components of haemostasis and is closely linked to the disease pathogenesis. It has been proposed that microvascular thrombosis and infarction may trigger the underlying inflammatory process.

AIM

To determine the prevalence of prothrombotic factors including hyperhomocysteinaemia, activated protein C (APC) resistance and prothrombin gene mutations as well as vitamin levels in the local IBD population.

METHOD

A total of 68 patients (37 men and 31 women) attending the IBD clinic were enrolled into the study. Citrated and ethylenediamine tetraacetic acid blood samples were collected from all patients as well as from 30 controls. Homocysteine levels were measured using the IMX immunoassay. APC resistance was measured using an unmodified activated partial thromboplastin time-based clotting assay. Prothrombin mutations were determined using polymerase chain reaction with the HB-gene factor II detection system.

RESULTS

Mean homocysteine levels were significantly higher and APC resistance ratios significantly lower in IBD patients compared with controls. No significant difference was detected between patients with ulcerative colitis or Crohn's disease. There was no significant increase in the incidence of prothrombin mutation in IBD patients. IBD patients had lower vitamin B12 and higher serum folate levels than controls.

CONCLUSION

High homocysteine and high serum folate may be associated with low vitamin B12 levels in IBD patients. We did not find any association between a low APC ratio and the factor V Leiden mutation or high factor VIII levels. Both hyperhomocysteinaemia and a low APC ratio may contribute to an increased risk of thromboembolic disease in IBD patients.

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  • Authors+Show Affiliations

    ,

    North Hampshire Hospital, Basingstoke, UK.

    , , , , ,

    Source

    MeSH

    Activated Protein C Resistance
    Adult
    Colitis, Ulcerative
    Crohn Disease
    Factor V
    Factor VIII
    Female
    Folic Acid
    Homocysteine
    Humans
    Hyperhomocysteinemia
    Inflammatory Bowel Diseases
    Male
    Middle Aged
    Mutation
    Protein C
    Prothrombin
    Vitamin B 12

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    15947551

    Citation

    Mahmood, Asif, et al. "Prevalence of Hyperhomocysteinaemia, Activated Protein C Resistance and Prothrombin Gene Mutation in Inflammatory Bowel Disease." European Journal of Gastroenterology & Hepatology, vol. 17, no. 7, 2005, pp. 739-44.
    Mahmood A, Needham J, Prosser J, et al. Prevalence of hyperhomocysteinaemia, activated protein C resistance and prothrombin gene mutation in inflammatory bowel disease. Eur J Gastroenterol Hepatol. 2005;17(7):739-44.
    Mahmood, A., Needham, J., Prosser, J., Mainwaring, J., Trebble, T., Mahy, G., & Ramage, J. (2005). Prevalence of hyperhomocysteinaemia, activated protein C resistance and prothrombin gene mutation in inflammatory bowel disease. European Journal of Gastroenterology & Hepatology, 17(7), pp. 739-44.
    Mahmood A, et al. Prevalence of Hyperhomocysteinaemia, Activated Protein C Resistance and Prothrombin Gene Mutation in Inflammatory Bowel Disease. Eur J Gastroenterol Hepatol. 2005;17(7):739-44. PubMed PMID: 15947551.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Prevalence of hyperhomocysteinaemia, activated protein C resistance and prothrombin gene mutation in inflammatory bowel disease. AU - Mahmood,Asif, AU - Needham,Jane, AU - Prosser,Jeanne, AU - Mainwaring,Jason, AU - Trebble,Tim, AU - Mahy,Gillian, AU - Ramage,John, PY - 2005/6/11/pubmed PY - 2006/1/10/medline PY - 2005/6/11/entrez SP - 739 EP - 44 JF - European journal of gastroenterology & hepatology JO - Eur J Gastroenterol Hepatol VL - 17 IS - 7 N2 - BACKGROUND: Thromboembolic disease is a significant cause of morbidity and mortality in patients with inflammatory bowel disease (IBD). A hypercoagulable state exists in IBD that may involve many components of haemostasis and is closely linked to the disease pathogenesis. It has been proposed that microvascular thrombosis and infarction may trigger the underlying inflammatory process. AIM: To determine the prevalence of prothrombotic factors including hyperhomocysteinaemia, activated protein C (APC) resistance and prothrombin gene mutations as well as vitamin levels in the local IBD population. METHOD: A total of 68 patients (37 men and 31 women) attending the IBD clinic were enrolled into the study. Citrated and ethylenediamine tetraacetic acid blood samples were collected from all patients as well as from 30 controls. Homocysteine levels were measured using the IMX immunoassay. APC resistance was measured using an unmodified activated partial thromboplastin time-based clotting assay. Prothrombin mutations were determined using polymerase chain reaction with the HB-gene factor II detection system. RESULTS: Mean homocysteine levels were significantly higher and APC resistance ratios significantly lower in IBD patients compared with controls. No significant difference was detected between patients with ulcerative colitis or Crohn's disease. There was no significant increase in the incidence of prothrombin mutation in IBD patients. IBD patients had lower vitamin B12 and higher serum folate levels than controls. CONCLUSION: High homocysteine and high serum folate may be associated with low vitamin B12 levels in IBD patients. We did not find any association between a low APC ratio and the factor V Leiden mutation or high factor VIII levels. Both hyperhomocysteinaemia and a low APC ratio may contribute to an increased risk of thromboembolic disease in IBD patients. SN - 0954-691X UR - https://www.unboundmedicine.com/medline/citation/15947551/full_citation L2 - http://Insights.ovid.com/pubmed?pmid=15947551 DB - PRIME DP - Unbound Medicine ER -