脑血管病患者血总同型半胱氨酸水平与肾小管损伤相关性分析

Association between tubulus renalis injury and total homocysteine levels in patients with cerebrovascular diseases

目的探讨正常血肌酐(Scr)水平脑血管病患者肾小管损伤对血总同型半胱氨酸(tHcy)水平的影响及其相关性。方法测定脑血管病患者(脑梗死63例、脑出血10例、短暂性脑缺血发作53例,共126例)空腹血清tHcy、Scr及晨尿中微量白蛋白(u-ALB)、α1-微球蛋白(α1-MG)。以u-ALB和α1-MG作为肾小球和肾小管损伤的分类依据,共分为4组:①肾小球和肾小管同时损伤组(组1,32例)。②单纯性肾小管损伤组(组2,18例)。③单纯肾小球损伤组(组3,22例)。④肾小球、肾小管无损伤组(组4,54例)。结果组间比较:血tHcy4组间比较有显著性差异(P=0.003),两两比较显示组1、组2明显高于组4(15.5μmol/L,14.2μmol/L vs12.1μmol/L,中位数,P<0.01),组3与组4之间无显著性差异(P>0.05)。组1高同型半胱氨酸血症发生率(53.1%)明显高于组3(22.7%)和组4(22.2%)(P<0.05,P<0.01),与组2(38.9%)无显著性差异。合并组(包括4组,126例)相关分析:①Pearson相关分析显示血LgtHcy与Scr显著相关(r=0.342,P<0.001),与Lg(α1-MG)显著相关(r=0.228,P=0.01),与Lg(u-ALB)无相关性(r=0.168,P=0.61)。②控制Scr后,偏相关分析显示LgtHcy与Lg(α1-MG)不再具有相关性(r=0.1318,P=0.143)。③控制Lg(u-ALB)和Lg(α1-MG)后,偏相关分析显示LgtHcy与Scr依然具有相关性(r=0.2961,P=0.001)。结论①单纯u-ALB升高,即早期肾小球损伤对血tHcy影响不显著。②早期单纯肾小管损伤可明显引起血tHcy升高。③与肾小球滤过功能相比,肾小管损伤不是血tHcy的独立影响因素。肾脏各部分的损伤中,肾小球滤过功能对血tHcy水平的影响起决定作用。

Objective To investigate the relationship between tubulus renalis injury and total homocysteine levels in patients with cerebrovascular diseases within normal serum creatinine concentrations. Methods The levels of urine albumin （u-ALB）. alpha- 1 -microglobulin （α1-MG）, and fasting serum total homocysteine （tHcy ）, serum creatinine （Scr） were measured in 126 cerebrovascular diseases patients （including 63 cerebral infarction, 10 cerebral hemorrhage and 53 transient ischemic attacks patients ） .According to the levels of u-ALB and α1-MG,patients were divided into four subgroups ,①group 1 （32 cases） ,both glomerulus and tubulus renelis were impaired .②group 2 （18 cases）, simply tubulus renelis injured.③group 3 （22 cases） ,only glomerulus renelis injured. ④group 4（54 cases）, both glomerulus and tubulus renelis were normal. Results Comparison in subgroups：there were significantly different in four subgroups （P=0.003）. The tHcy levels in groupl and group 2 were significantly higher than that in group 4 （15.5μmol/L, 14.2μmol/L vs 12.1μmol/L,median. P〈0.01 ）.No significant differences were observed between group 3 and group 4（P〉0.05）. The percentage of hyperhomocysteinemia in gorup 1 （53.1%）was significantly higher than that in group 3 （22.7%）and group 4（22.2%）,and there were no significant differences compared with group 2 （38.9%）.Correlation analysis of combined groups （including four subgroups, 126 cases）： ①According to the Pearson＇s correlation analysis, LgtHcy were significantly correlated with Scr （r=0.342, P〈0.001 ）, Lg （α1-MG） （r=0.228, P=0.01 ）, and not related with Lg （u-ALB） （r=0.168,P=0.61）. ②When adjusted for Scr, no correlation existed between LgtHcy and Lg （α1-MG）（r= 0.1318,P=0.143）. ③Whereas,after adjusted for Lg（u-ALB）and Lg （α1-MG）, LgtHcy were also correlated with Scr（r=0.2961, P=0.001 ）. Conclusion ①The tHcy levels are not significantly effected by simple glomerulus renelis injury defined as elevated u-ALB levels. ②Simple tubulus renelis injury obviously increases serum tHey levels. ③Compared with glomerular filtration function.the simple tubulus renelis injury don＇t independently effect serum tHcy levels .In terms of the renal failure,the glomerular filtration rate independently determined serum tHcy levels.