肾功能损害对血浆同型半胱氨酸浓度的影响

The effect of renal disfunction on plasma homocysteine

目的研究不同肾功能患者血浆同型半胱氨酸(Hcy)浓度的变化特点及其与血浆肌酐和栓塞性心脑血管疾病(CVD)的关系,探讨其临床意义。方法采用快速高压液相微柱层析法测定中国人民解放军第455医院肾内科98例不同阶段慢性肾衰竭(CRF)患者及40例正常人的血浆Hcy浓度。结果CRF患者高Hcy血症的发生率高达86.7%,为正常对照组的33.3倍,P<0.01;并且血浆Hcy的浓度随着血肌酐浓度的升高或内生肌酐清除率(Ccr)的降低而升高,有明显的相关性,P<0.01。血液透析后(Post-HD)血浆Hcy水平较血液透析前(Pre-HD)下降约34.1%,但仍显著高于正常人,P<0.01。伴有栓塞性CVD组的血浆Hcy较无此病史者明显升高,P<0.01。结论不同阶段的CRF患者普遍存在高Hcy血症,并且肾功能损害的程度与Hcy浓度明显相关,CRF患者的高Hcy血症可能与其CVD有关。

Objective To study the effect of a various degree of renal disfunction on plasma homocysteine （Hcy） and its potential relationship to plasma creatinine concentration and cardiovascular diseases and probe into their clinical significance. Methods Plasma Hcy concentration in 98 patients with the various degree of chronic renal failure （CRF） and 40 healthy controls were measured by rapid microcolumn high pressure liquid chromatography in DS30. Results The incidence of hyperhomocysteinemia in the patients with CRF is 86.7% and 32. 3 times higher than that in healthy individuals, P〈0.01. Linear regression analysis showed a significant correlation between plasma Hcy and creatinine concentration （r=0. 358, P 〈0. 01） or creatinine clearance （r= 0.362, P 〈0.01）. Mean plasma Hcy concentrations in post-HD decreased by 34.1% compared with that in pre HD and significantly higher than controls, P 〈 0.01. Mean plasma Hcy levels in CRF with cardiovascular （CVD） are significantly higher than that in the patients with non-CAD, P 〈0. 01. Conclusions Hyperhomocysteinemia is common in the patients with a various degree of CRF. Plasma Hcy concentration in CRF is significantly related to the degree of renal failure. Increased plasma Hcy may be a risk factor for CAD in the patients with CRF.