Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
권호 표지

A Case of Pulmonary Thromboembolism in a Patient with Hyperhomocysteinemia

과호모시스테인혈증 환자에서 발생된 폐색전증 1예

  • Oh, Sook Eui (Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University Medical Center) ;
  • Jung, Jae-Hun (Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University Medical Center) ;
  • Yoon, Seong Bo (Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University Medical Center) ;
  • Yoon, Hyeon Young (Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University Medical Center) ;
  • Park, Jong Kyu (Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University Medical Center) ;
  • Lee, Dong Hun (Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University Medical Center) ;
  • Hong, Sung Ho (Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University Medical Center) ;
  • Woo, Kung Hee (Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University Medical Center) ;
  • Choi, Seonghoon (Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University Medical Center) ;
  • Lee, Sang Hak (Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University Medical Center) ;
  • Lee, Namho (Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University Medical Center)
  • 오숙의 (한림대학교 의과대학 강남성심병원 내과학교실) ;
  • 정재헌 (한림대학교 의과대학 강남성심병원 내과학교실) ;
  • 윤성보 (한림대학교 의과대학 강남성심병원 내과학교실) ;
  • 윤현영 (한림대학교 의과대학 강남성심병원 내과학교실) ;
  • 박종규 (한림대학교 의과대학 강남성심병원 내과학교실) ;
  • 이동훈 (한림대학교 의과대학 강남성심병원 내과학교실) ;
  • 홍성호 (한림대학교 의과대학 강남성심병원 내과학교실) ;
  • 우경희 (한림대학교 의과대학 강남성심병원 내과학교실) ;
  • 최성훈 (한림대학교 의과대학 강남성심병원 내과학교실) ;
  • 이상학 (한림대학교 의과대학 강남성심병원 내과학교실) ;
  • 이남호 (한림대학교 의과대학 강남성심병원 내과학교실)
  • Received : 2007.01.23
  • Accepted : 2007.02.15
  • Published : 2007.03.30
Download PDF
⟨ Previous Next ⟩

Abstract

Hyperhomocysteinemia is an independent risk factor for cardiovascular, cerebrovascular and peripheral vascular diseases that are complicated by atherosclerosis and a thromboembolism. An increased level of plasma homocysteine develops from a genetic defect in the of enzyme for the homocysteine metabolism or a vitamin deficiency. Hyperhomocysteinemia has direct toxic effect on the vascular endothelium and causes damages to the antithrombotic action of vascular endothelial cells. Most cases of hyperhomocysteinemia are asymptomatic, but cardiopulmonary or cerebrovascular incidents developin rare cases. In the case of a thromboembolism with an unknown cause, hyperhomocysteinemia should be considered in a differential diagnosis. The authors report a case of pulmonary thromboembolism in a patient with hyperhomocysteinemia with a review of the relevant literature.

저자들은 평소 건강하게 지내던62세 남자 환자에게서 발생한 우하지 심부정맥혈전증과 폐색전증의 원인으로 과호모시스테인혈증이 독립적인 위험인자로 작용한 것으로 생각되는 1예를 경험하였기에 문헌고찰과 함께 보고한다.

Keywords

References

  1. Rudoni RR, Jackson RE, Godfrey GW, Bonfiglio AX, Hussey ME, Hauser AM. Use of two-dimensional echocardiography for the diagnosis of pulmonary embolus. J Emerg Med 1998;16:5-8 https://doi.org/10.1016/S0736-4679(97)00226-6
  2. Kasper W, Meinertz T, Henkel B, Eissner D, Hahn K, Hofmann T, et al. Echocardiographic findings in patients with proved pulmonary embolism. Am Heart J 1986;112:1284-90 https://doi.org/10.1016/0002-8703(86)90361-3
  3. Chang J. Acute pulmonary embolism. Tuberc Respir Dis 2000;48:123-48 https://doi.org/10.4046/trd.2000.48.2.123
  4. Welch GN, Loscalzo J. Homocysteine and ather othrombosis. N Engl J Med 1998;338:1042-50 https://doi.org/10.1056/NEJM199804093381507
  5. Dennis VW, Nurko S, Robinson K. Hyperhomocysteinemia; detection, risk assessment, and treatment. Curr Opin Nephrol Hypertens 1997;6:483-8 https://doi.org/10.1097/00041552-199709000-00013
  6. Park JS, Bae WK, Lee SJ, Chung RI, Jin SL, Lee HP, et al. A case of multiple thromboembolism in hyperhomocysteinemia. Tuberc Respir Dis 1999;47:239-46 https://doi.org/10.4046/trd.1999.47.2.239
  7. McCully KS. Vascular pathology of homocysteinemia: implication for the pathogenesis of arteriosclerosis. Am J Pathol 1969;56:111-28
  8. Franken DG, Boers GH, Blom HJ, Trijbels FJ, Kloppenborg PW. Treatment of mild hyperhomocysteinemia in vascular disease patients. Arterioscler Thromb 1994;14:465-70 https://doi.org/10.1161/01.ATV.14.3.465
  9. Kim YJ, Park JS, Park MH, Chang NS. The interaction of methylenetetrahydrofolate reductase polymorphism with homocysteine in pregnant women. Korean J Obstet Gynecol 2003;46:1525-30
  10. Brattstrom L, Wilcken DE, Ohrvik J, Brudin L. Common methylenetetrahydrofolate reductase gene mutation leads to hyperhomocysteinemia but not to vascular disease: the result of a meta-analysis. Circulation 1998;98:2520-6 https://doi.org/10.1161/01.CIR.98.23.2520
  11. Ou T, Yamakawa-Kobayahi K, Arinami T, Amemiya H, Fujiwara H, Kawata K, et al. Methylenetetrahydrofolate reductase and apolipoprotein E polymorphisms are independent risk factors for coronary heart disease in Japanese: a case-control study. Atherosclerosis 1998;137:23-8 https://doi.org/10.1016/S0021-9150(97)00244-X
  12. Oh KW, Lee WY, Ahn YB, Song KH, Yoo SJ, Yoon KH, et al. Homocysteine, folate, and methylenetetrahydrofolate reductase polymorphism in Korean normal subjects. Korean J Intern Med 1999;57:1030-6
  13. Eikelboom JW, Lonn E, Genest J Jr, Hankey G, Yusuf S. Homocysteine and cardiovascular disease: a critical review of the epidemiologic evidence. Ann Intern Med 1999;131:363-75 https://doi.org/10.7326/0003-4819-131-5-199909070-00008
  14. Kim SG, Kim YD, Kim SG, Jang SJ, Choi HJ, Kim BK, et al. Plasma homocysteine concentration and genotype variation of enzyme as risk factors in patients with coronary artery disease. Korean Circ J 2001;31:757-66 https://doi.org/10.4070/kcj.2001.31.8.757
  15. Jeong CH, Park Kh, Jung SJ, Choi DR, Joo DH, Lee HI, et al. Acute arterial thrombosis in leg associated with hyperhomocysteinemia. J Korean Surg Soc 2005;68:78-82