血清同型半胱氨酸水平与肾功能下降:一项基于健康人群的队列研究

Serum homocysteine levels and decreased renal function:a cohort study in a healthy population

目的探讨健康人群中血清同型半胱氨酸(homocysteine,Hcy)浓度与肾损伤之间的因果关系。方法使用2015年华东疗养院体检数据库进行回顾性队列研究,共4021例健康人纳入分析,随访时间为3年。研究对象按血清Hcy水平四分位化分组,分析比较各组之间肾小球滤过率(eGFR)变化,使用Logistic回归分析血清Hcy与肾脏终点的关系。结果4组人群的基线eGFR随着血清Hcy水平升高而降低[Ⅰ:(108.96±10.34)μmol/L,Ⅱ:(104.30±11.23)μmol/L,Ⅲ:(100.71±11.27)μmol/L,Ⅳ:(98.49±12.44)μmol/L,P<0.05];Logistic回归分析表明,与Hcy最低四分位数组(Ⅰ组Hcy<8.93μmol/L)相比,Ⅱ、Ⅲ、Ⅳ组出现联合肾脏终点事件的风险显著增加[OR(95%CI):Ⅱ1.32(1.08,1.61),Ⅲ1.71(1.41,2.08),Ⅳ2.37(1.96,2.87),P<0.05],校正多因素后,差异有统计学意义(P<0.05)。结论健康人群的血清Hcy升高与eGFR降低相关。血清Hcy水平是健康人群肾脏病变发生发展的独立危险因素。

Objective To explore the causal relationship between serum homocysteine(Hcy)levels and renal injury in healthy population.Methods A retrospective cohort study was conducted using the physical examination database of East China Sanatorium in 2015.A total of 4021 healthy people were included in the analysis and followed up for 3 years.The subjects were divided into four groups according to the serum Hcy level,and eGFR changes among each group were analyzed and compared.Logistic regression was used to analyze the relationship between serum Hcy and renal end points.Results Baseline eGFR in the 4 groups decreased with the increase of serum Hcy level[Ⅰ:(108.96±10.34)μmol/L,Ⅱ:(104.30±11.23)μmol/L,Ⅲ:(100.71±11.27)μmol/L,Ⅳ:(98.49±12.44)μmol/L,P<0.05].Logistic regression analysis showed that compared with the lowest Hcy quartile array(groupⅠ,Hcy<8.93μmol/L),groupsⅡ,Ⅲ,andⅣhad a significantly increased risk of combined renal end events[OR(95%CI):Ⅱ1.32(1.08,1.61),Ⅲ1.71(1.41,2.08),Ⅳ2.37(1.96,2.87),P<0.05],the differences were still statistically significant after adjustment for multiple factors(P<0.05).Conclusion Elevated serum Hcy was associated with decreased eGFR in healthy subjects.Serum Hcy level is an independent risk factor for the occurrence and development of renal lesions in healthy people.