慢性肾功能衰竭病人高同型半胱氨酸血症及其影响因素

Hyperhomocysteinema level in patients with chronic renal failure and its influencing factors

目的 :研究慢性肾衰 (CRF)病人血浆同型半胱氨酸 (Hcy)水平及其影响因素。方法 :采用荧光偏振免疫分析法测定 16 0例CRF病人血浆总同型半胱氨酸 (tHcy)水平 ,同时用离子夺获分析法和微离子酶免疫分析法分别检测血浆叶酸(FA)和维生素B12 (VB12 )浓度。结果 :CRF病人血浆tHcy水平 (2 2 6 9± 12 16 ) μmol/ )明显高于正常对照组 (7 97±2 6 5 ) μmol/L ,CRF病人高同型半胱氨酸血症的发生率为 82 5 0 % ,其中血液透析组血浆tHcy水平 (2 4 13± 12 6 8μmol/L ,n =73)明显高于持续性非卧床腹膜透析 (CAPD)组 (16 4 3± 5 5 8μmol/L ,n =19)和非透析治疗组 (19 79± 10 5 7)μmol/L ,(n =6 8) ,但血浆FA和VB12 与正常对照组均无明显差别 (P >0 0 5 )。CRF病人血浆tHcy水平与血浆FA浓度均呈负相关关系 ,未经透析的CRF病人血浆tHcy水平与内生肌酐清除率和血浆FA水平呈负相关 ;透析治疗组血浆tHcy水平与血浆FA浓度呈负相关。血透 4h使血浆tHcy下降约 4 0 0 % ,透析后 2 0h回复到透析前水平的 76 0 %～86 0 % ,但在采用血仿膜和聚砜膜透析的病人之间 ,血浆tHcy水平无明显差异。结论 :CRF病人普遍存在高同型半胱氨酸血症 ,但没有明显的FA和VB12 缺乏 ,CRF时肾脏损害削弱了对Hcy的代谢或清除能力 ,

Objective: To investigate hyperhomocysteinema level in patients with chronic renal failure(CRF) and its epidemiology, etiology and influencing factors. Methods: 160 CRF patients and 45 healthy volunteers were enrolled in this study. The levels of their plasma total homocysteine(tHcy) were measured by fluorescence polarization immunoassay, folic acid(FA) by ion capture assay and cyanocobalamin(VB12) by microparticle enzyme immunoassay. Results: 82% of CRF patients suffered from hyperhomocysteinemia. The mean plasma tHcy level of CRF patients (22.69±12.16μmol/L) was higher significantly than that of the healthy subjects(7.07±2.65μmol/L,P<0.01). The plasma tHcy level in hemodialysis patients (24.13±12.68μmol/L, n=73) was higher markedly than that in continuous ambulatory peritoneal dialysis(CAPD) patients(16.43±5.58μmol/L, n=19) and that in non - dialysis patients(19.79±10.57μmol/L, n=68), whereas, there was not any significant difference of FA and VB12 between CRF patients and the healthy. The level of tHcy was correlated negatively with the concentration of FA in the normal subjects(r= - 0.512, P<0.05, n=45) and CRF patients(r= - 0.356, P<0.01, n=155). In non - dialysis patients, the level of tHcy had inverse correlations with the level of Ccr(r= - 0.374, P<0.01, n=68) and FA(r= - 0.402, P<0.05, n=63), but not correlation with age, blood glucose, cholesterol, triglyceride, high density lipoproteins, low density lipoproteins, albumin and VB12. Similarly, there were inverse association between tHcy and FA in dialysis patients(r= - 0.341, P<0.01, n=92), but without correlation with duration of dialysis and other indexes as above. The level of plasma tHcy declined by 40% after 4 h hemodialysis, and then returned by 76% - 86% within 20 hours after stopping hemodialysis. There was not difference in clearance of tHcy between hemophan and polysulfone dialyzer. Conclusion: hyperhomocysteinemia is more prevalent in patients with CRF, but the level of their FA and VB12 are normal. It is considered that the renal dysfunction in CRF patients results in damage to clearance, which may be one cause of tHcy elevation in CRF patients.