血同型半胱氨酸水平与原发性高血压及肾功能相关性研究

Research on Correlation Among Level of Homocysteine,Essential Hypertension and Kidney Function

目的:探讨脑梗死患者同型半胱氨酸(Hcy)与高血压及肾功能三者之间的相关性。方法:将122例血清肌酐(SCr)在正常值范围的脑梗死患者按Hcy值分为Hcy升高组(Hcy>15μmmol/L)68例和正常组(Hcy≤15μmmol/L)54例。首先采用Spearman法对患者年龄、性别、Hcy、高血压、糖尿病及反映肾功能的4项指标胱氨酸蛋白酶抑制剂C(CystatinC,Cys-C)、血清肌酐(SCr)、尿素氮(BUN)和尿酸(UA)进行相关分析,再采用偏相关分析纠正年龄和性别的影响,确定各项变量间的相关关系;然后采用秩和检验对Hcy升高组与正常组间高血压、糖尿病的分布及Cys-C、SCr、BUN和UA数值进行差异性分析。结果:Hcy与高血压分布呈正相关(γ=0.309,P=0.001),与Cys-C、SCr分别呈正相关,(γ分别为0.224、0.240,P<0.05),与BUN(γ=-0.026,P=0.777)和UA(γ=0.161,P=0.080)无显著相关;Hcy升高组高血压分布显著多于Hcy正常组,且该组病例Cys-C和SCr值显著高于Hcy正常组。结论:脑梗死患者高Hcy与高血压及肾功能受损之间存在内在联系;Hcy与高血压可能导致肾功能储备能力下降,而肾功能早期轻度受损(储备能力下降)可能导致Hcy升高;高Hcy可能在高血压发病机制中起一定作用。Cys-C比SCr更能反映肾功能早期损害。

Objective： To investigate the correlation among homocysteine （Hcy）, essential hypertension and kidney function in patients with cerebral infarction. Methods： One hundred and twenty-two cerebral infarction patients with normal ranged serum creatinine （SCr） were divided into Hcy elevated groups （Hcy〉15μmmol/L, 68 cases） and normal Hcy group （Hcy 415μmmol/L, 54 cases）. Patients＇age, sex, Hcy concentration, and history of essential hypertension or diabetes, Cystatin C （Cys C）, serum creatinine （SCr）, blood urea nitrogen （BUN）, and uric acid （UA） were correlated analyzed by the method of spearman. Partial correlation analysis was used to correct the effects of age and sex to determine the correlation between the variables; and distribution of hypertension or diabetes, the values of Cys-C, SCr, BUN, and UA were analyzed for the differences between Hcy elevated group and the normal Hcy group by rank-sum test. Results： Level of Hcy were positively correlated with distribution of hypertension （γ= 0. 309, P= 0. 001）, and also positively correlated with Cys-C （γ= 0. 224, P〈0. 05）, SCr （7= 0. 240, P 〈0. 05）. No significant correlation was found between Hcy and BUN （γ = - 0. 026, P = 0. 777） and UA （γ= 0. 161, P = 0. 080）. The distribution of hypertension in Hcy elevated group is significantly more than that in normal Hcy group, and the level of Cys-C and SCr in former was significantly higher than the latter. Conclusions： Elevated Hcy, hypertension and impaired kidney function in patients with cerebral infarction were intrinsically linked. Hcy and hypertension may lead to declined kidney function in reserve capacity, while the early mild kidney function im pairment （decreased reserve capacity） may lead to elevated level of Hcy, which may play a role in the pathogenesis of hypertension. Cys-C can better reflect early kidney function impairment than SCr.