Homocysteine, Liver Function Derangement and Brain Atrophy in Alcoholics.
OBJECTIVE
Hyperhomocysteinemia may be involved in the development of brain atrophy in alcoholics. Its pathogenesis is multifactorial. In the present study, we analyse the relationship between homocysteine levels and brain atrophy, and the relative weight of co-existing factors such as liver function impairment, the amount of ethanol consumed, serum vitamin B12, B6, and folic acid levels on homocysteine levels and brain alterations in alcoholic patients.


METHODS
We included 59 patients admitted to this hospital for major withdrawal symptoms and 24 controls. The mini-mental state examination test and a brain computed tomography (CT) scan were performed and several indices were calculated. Serum levels of homocysteine, folic acid, vitamin B6 and vitamin B12 were determined. Liver function was assessed by Child-Pugh score. The daily consumption of ethanol in grams per day and years of addiction were recorded.


RESULTS
A total of 83.6% and 80% of the patients showed cerebellar or frontal atrophy, respectively. Patients showed altered values of brain indices, higher levels of homocysteine and vitamin B12, but lower levels of folic acid, compared with controls. Homocysteine, B12 and liver function variables showed significant correlations with brain CT indices. Multivariate analyses disclosed that Pugh's score, albumin and bilirubin were independently related to cerebellar atrophy, frontal atrophy, cella index or ventricular index. Serum vitamin B12 was the only factor independently related to Evans index. It was also related to cella index, but after bilirubin. Homocysteine levels were independently related to ventricular index, but after bilirubin.


CONCLUSIONS
Vitamin B12 and homocysteine levels are higher among alcoholics. Liver function derangement, vitamin B12 and homocysteine are all independently related to brain atrophy, although not to cognitive alterations.


OBJECTIVE
Hyperhomocysteinemia has been described in alcoholics and may be related to brain atrophy, a reversible condition with an obscure pathogenesis. We studied 59 patients and found that liver function derangement, vitamin B12 and homocysteine levels are all independently related to brain atrophy assessed by computed tomography, although we found no association between these parameters and cognitive alterations.
Servicio de Medicina Interna, Hospital Universitario de Canarias, Universidad de La Laguna, Tenerife 38320, Canary Islands, Spain.
Camino
C
Fernández-Rodríguez
Servicio de Medicina Interna, Hospital Universitario de Canarias, Universidad de La Laguna, Tenerife 38320, Canary Islands, Spain egonrey@ull.es.
Emilio
E
González-Reimers
Servicio de Medicina Interna, Hospital Universitario de Canarias, Universidad de La Laguna, Tenerife 38320, Canary Islands, Spain.
Geraldine
G
Quintero-Platt
Laboratorio Central, Hospital Universitario de Canarias, Universidad de La Laguna, Tenerife 38320, Canary Islands, Spain.
María José
MJ
de la Vega-Prieto
Servicio de Medicina Interna, Hospital Universitario de Canarias, Universidad de La Laguna, Tenerife 38320, Canary Islands, Spain.
Onán
O
Pérez-Hernández
Servicio de Medicina Interna, Hospital Universitario de Canarias, Universidad de La Laguna, Tenerife 38320, Canary Islands, Spain.
Candelaria
C
Martín-González
Laboratorio Central, Hospital Universitario de Canarias, Universidad de La Laguna, Tenerife 38320, Canary Islands, Spain.
Elisa
E
Espelosín-Ortega
Servicio de Medicina Interna, Hospital Universitario de Canarias, Universidad de La Laguna, Tenerife 38320, Canary Islands, Spain.
Lucía
L
Romero-Acevedo
Servicio de Medicina Interna, Hospital Universitario de Canarias, Universidad de La Laguna, Tenerife 38320, Canary Islands, Spain.
Francisco
F
Santolaria-Fernández
D000437:Alcoholism / Q000097:blood / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology*; D001284:Atrophy / Q000139:chemically induced / Q000473:pathology; D001921:Brain / Q000000981:diagnostic imaging / Q000187:drug effects / Q000473:pathology*; D016022:Case-Control Studies; D005260:Female; D005492:Folic Acid / Q000097:blood; D006710:Homocysteine / Q000009:adverse effects / Q000097:blood*; D006801:Humans; D008099:Liver / Q000187:drug effects / Q000473:pathology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed; D014805:Vitamin B 12 / Q000097:blood; D025101:Vitamin B 6 / Q000097:blood
D006710:Homocysteine; D025101:Vitamin B 6; D005492:Folic Acid; D014805:Vitamin B 12