高同型半胱氨酸血症与慢性肾脏病的相关性研究

Correlation between hyperhomocysteinemia and chronic kidney diseases

目的探讨高同型半胱氨酸(Hcy)血症与慢性肾脏病(CKD)的相关性。方法选择经该院临床确诊的446例CKD患者为观察组,另选择该院152例健康体检者为对照组。应用化学发光法测定血清Hcy水平,比较各组患者的血清Hcy水平并分析血清高Hcy水平对患者左心室结构功能的影响,以及血清高Hcy检测在慢性肾病预测中的应用价值。结果血清高Hcy水平与CKD明显相关,CKD患者的血清高Hcy水平高于健康体检者,随着CKD分期的进展,患者血清Hcy水平升高。高Hcy是CKD发病的危险因素[Waldχ2=9.773,RR=2.245(95%CI:1.275,4.938),P=0.007]。患者血清Hcy水平对左心室结构功能有很大影响,高Hcy、正常Hcy患者左心室结构功能指标与对照组比较,差异有统计学意义(P<0.05)。以11.52μmol/L为截断点,血清Hcy检测对预测CKD具有一定的价值[AUC=0.874(95%CI:0.673,0.954)]。结论血清Hcy水平与CKD有明显的相关性,是CKD发病的危险因素,高Hcy对患者的左心室结构功能有较大影响,血清Hcy检测联合具体肾脏病特定指标检查对预测各类肾脏病具有较高的应用价值。

Objective To study the relationship between hyperhomocysteinemia and chronic kidney diseases （CKD）. Methods Clinically diagnosed 446 CKD patients were chosen as observation group, 152 healthy people having physical examination in the hospital as control group. Serum homocysteine （Hcy） level was evaluated using chemiluminescence method. The patient＇s serum Hcy levels were compared between both groups, and the effect of serum Hcy level on left ventricular structure and function was analyzed and the value of hyperhomocysteinemia in prediction of chronic kidney diseases was investigated. Results Serum Hcy level had obvious correlation with chronic kidney diseases. Serum Hcy level of the CKD patients was higher than that of the healthy people. With the progress of CKD stage, the patients＇ serum Hcy level increased. High Hcy is a risk factor for the onset of chronic kidney diseases （Wald χ2 = 9.773, P = 0.007; RR = 2.245, 95% CI： 1.275, 4.938）. Serum Hcy level had a great influence in patients＇ left ventricular structure and function, The left ventricular structure and function indexes of the patients with normal or high Hcy were significantly different from those of the control group （P 〈 0.05）. Taking 11.52 μmol/L as the cut-off point, serum Hcy testing had a certain value in prediction of chronic kidney diseases （AUC = 0.874, 95% CI of AUC： 0.673, 0.954）. Conclusions Serum Hcy level has an obvious correlation with chronic kidney diseases, is a risk factor for the onset of chronic kidney diseases. High Hcy has a great influence in left ventricular structure and function of the patients. Serum Hcy test combined with specific indicators of concrete kidney disease has high application value in prediction of all kinds of kidney diseases.