高血压患者同型半胱氨酸与估算肾小球滤过率和尿蛋白肌酐比及载脂蛋白B/A1水平变化及意义

Changes and significances of homocysteine,estimated glomerular filtration rate,urinary protein/creatinine ratio and apolipoprotein B/A_1 in hypertensive patients

目的探讨高血压患者血清同型半胱氨酸(homocysteine,Hcy)、估算肾小球滤过率(estimated glomerular filtration rate,eGFR)、尿蛋白肌酐比(urinary protein/creatinine ratio,UPCR)、载脂蛋白(apolipoprotein,Apo)B/A_1(ApoB/A_1)、叶酸水平变化及在早期肾损伤监测中的价值。方法高血压患者411例,其中1级高血压75例,2级高血压112例,3级高血压224例,同期体检健康者102例为对照组,检测各组血清Hcy、叶酸、ApoB、ApoA1、尿素氮、血肌酐、胱抑素C,尿蛋白、尿微量白蛋白、尿肌酐,计算eGFR、ApoB/A_1、UPCR和尿微量白蛋白肌酐比(urinary microalbumin/creatinine ratio,UmACR),Pearson相关分析血清Hcy水平与eGFR、UPCR、ApoB/A_1、收缩压、舒张压的相关性,多重线性回归分析血清Hcy的影响因素。结果高血压组血清Hcy[(17.55±10.92)μmol/L]、ApoB/A_1(0.88±0.18)、血肌酐[(89.31±37.68)μmol/L]、胱抑素C[(1.04±0.39)mg/L]、UmACR[(46.80±115.20)mg/g·Cr]、UPCR[(171.12±336.94)mg/g·Cr]高于对照组[(13.21±1.70)μmol/L、0.71±0.12、(76.40±10.26)μmol/L、(0.86±0.11)mg/L、(5.64±4.64)mg/g·Cr、(48.81±23.42)mg/g·Cr](P<0.05),叶酸[(6.56±3.11)μg/L]、eGFR[(78.49±18.00)mL/(min·1.73 m2)]低于对照组[(9.48±4.35)μg/L、(92.75±13.41)mL/(min·1.73m2)](P<0.05);3级高血压患者血清Hcy、ApoB/A_1、血肌酐、胱抑素C、UmACR、UPCR水平高于1级高血压患者,叶酸、eGFR低于1级高血压患者(P<0.05);2级高血压患者血清Hcy、ApoB/A_1、胱抑素C、UmACR、UPCR高于1级高血压患者,叶酸、eGFR低于1级高血压患者(P<0.05);3级高血压患者ApoB/A_1、尿素氮、UPCR高于2级高血压患者,eGFR低于2级高血压患者(P<0.05);Pearson相关分析显示,高血压患者血清Hcy与eGFR、叶酸均呈负相关(r=-0.216,P<0.001;r=-0.273,P<0.001),与UPCR、ApoB/A_1、收缩压均呈正相关(r=0.177,P<0.001;r=0.354,P<0.001;r=0.115,P=0.037);多重线性回归分析结果显示,高血压患者eGFR、UPCR、ApoB/A_1、叶酸是血清Hcy水平的主要影响因素(P<0.05)。结论 Hcy与eGFR、ApoB/A_1、UPCR在高血压发生肾损伤中密切相关,对高血压早期肾损伤的诊断、治疗监测提供重要依据。

Objective To investigate the changes of serum homocysteine （Hcy）, estimated glomerular filtration rate （eGFR）, urinary protein/creatinine ratio （UPCR）, apolipoprotein （Apo）B/A1 and folic acid in hypertensive patients and the value of the detection to the monitor of early renal damage. Methods In 411 hypertensive patients, there were 75 cases of grade 1 hypertension, 112 cases of grade 2 hypertension, and 224 cases of grade 3 hypertension. Another 202 healthy volunteers were as controls. The levels of Hcy, folic acid, ApoB, ApoA1, urea nitrogen, serum ereatinine, cystatin C （CysC）, urinary protein, urinary microalhumin and urinary creatinine were detected in all patients, and value of eGFR, ApoB/A1 and urinary microalbumin/creatinine ratio （UmACR） were calculated. The correlation of serum Hcy level with eGFR, UPCR, ApoB/A1, systolic blood pressure and diastolic blood pressure were analyzed by Pearson correlation analysis, and serum Hcy related influencing factors were analyzed by multiple linear regression method.Results The levels of serum Hcy （（17. 55±10. 92） t^mol/L）, ApoB/A1 （0. 88 q-0. 18）, serum creatinine （（89. 31±＋-_ 37.68） t^mol/L）, CysC （（1.04＋0.39） rag/L）, UmACR （（46.80!115.20） mg/g ~ Cr）, UPCR （（171. 12±_336.94） mg/g. Cr） in hypertensive patients were significantly higher than those in health patients （（13. 21±1. 70） μmol/L, 0.71＋0.12, （76.40±10.26） μmol/L, （0.86±0.11） mg/L, （5.64±4.64） mg/g- Cr, （48.81±23.42） mg/g. Cr） （P＇Q0.05）, and the levels of folic acid （ （6, 56 ± 3.11 ） μg/L） and eGFR （ （ 78.49 ± 18.00） mL/（min· 1.73 m^2 ） ） were significantly lower than those in control group （（9.48 ± 4. 35） μg/L, （92. 75± 13. 41） mL/（min · 1. 73 m2）） （P〈 0.05）. The levels of serum Hcy, ApoB/A1 , serum creatinine, CysC, UmACR and UPCR were significantly higher and the levels of folic acid and eGFR were significantly lower in grade 3 hypertensive patients than those in grade 1 hypertensive patients （P%0.05）. The levels of serum Hcy, ApoB/A1, CysC, UmACR and UPCR were significantly higher and the levels of folic acid and eGFR were significantly lower in grade 2 hypertensive patients than those in grade 1 hypertensive patients （P%0.05）. The levels of ApoB/A1, urea nitrogen and UPCR were significantly higher and eGFR level was significantly lower in grade 3 hypertensive patients than those in grade 2 hypertensive patients （P% 0.05）. Pearson correlation analysis showed H cy was negatively correlated with eGFR （r=- 0. 216, P%0. 001） and folie acid （r= ±0. 273, P〈0. 001）, and positively correlated with UPCR （r= 0. 177, P〈0. 001）, ApoB/A1 （r= 0. 354, P〈 0. 001） and systolic blood pressure （r= 0. 115, P= 0. 037） in hypertensive patients. Multiple linear regression analysis indicated eGFR, UPCR, ApoB/A1 and folic acid were the main influencing factors for Hcy （P〈0.05）. Conclusion Hcy is closely correlated with eGFR, ApoB/A1 and UPCR in hypertensive patients with renal damage, which provides an important basis for the diagnosis and treatment of early renal damage.