尿液早期肾损伤标志物与血清同型半胱氨酸升高的相关性

Correlation between markers of early renal injury in urine and serum homocysteine elevation

目的探讨尿液早期肾功能损伤标志物与血清同型半胱氨酸(Hcy)升高的相关性。方法对2019年1月至2020年5月于北京大学第三医院体检中心同时完成血清Hcy和尿液早期肾损伤标志物检测的1133例体检资料进行回顾性分析。收集受检者既往病史、年龄、性别、血压、体质指数,尿液早期肾损伤标志物包括尿微量白蛋白(U-mALB)、尿N-乙酰-β-氨基葡萄糖苷酶(NAG)、微量白蛋白/肌酐比值(UACR),以及血清肾功、肝功、血脂、心肌酶和全血糖化血红蛋白(HbA1C)等。排除既往史、基本信息、生化指标不完整以及估算肾小球滤过率(eGFR)下降者,最终纳入969例。根据Hcy水平分为正常组(˂15μmol/L)和升高组(≥15μmol/L),以组间对比存在显著差异的指标为自变量,采用多因素logistic回归探讨Hcy升高的影响因素。结果Hcy升高组受检者男性比率、U-mALB、NAG、UACR升高发生率均显著高于正常组(93.4%比50.6%、16.4%比8.0%、23.0%比14.0%、13.9%比7.9%)(均P<0.05)。Hcy升高组收缩压、舒张压、血清尿酸、钙、丙氨酸氨基转移酶(ALT)、乳酸脱氢酶均显著高于正常组[(127.5±15.4)比(121.9±16.2)mmHg(1 mmHg=0.133 kPa)、(78.6±9.3)比(76.0±11.0)mmHg、(385.9±86.0)比(335.7±88.2)μmol/L、(2.392±0.086)比(2.366±0.092)mmol/L、(27.8±21.0)比(23.8±20.2)U/L、(198.3±28.4)比(192.2±31.2)U/L](均P<0.05),而高密度脂蛋白胆固醇(HDL-C)、磷均显著低于正常组[(1.21±0.25)比(1.31±0.30)mmol/L、(1.107±0.154)比(1.158±0.159)mmol/L](均P<0.05)。收缩压升高、男性、尿酸、U-mALB、NAG是Hcy升高的独立相关因素(均P<0.05)。结论Hcy升高与尿液U-mALB和NAG升高独立相关,提示对早期肾损伤标志物升高者应及早检测Hcy水平。

Objective To investigate the correlation between early renal impairment markers in urine and elevated serum homocysteine.Methods Clinical data of serum homocysteine(Hcy)and early renal injury markers in urine of the health examination population from the Physical Examination Center of Peking University Third Hospital from January 2019 to May 2020 were retrospectively analyzed(1133 cases).The previous medical history,age,sex,blood pressure,body mass index(BMI)of the subjects were collected.Early urine kidney injury markers,including urine microalbumin(U-mALB),urinary N-acetyl-β-D-glucosaminidase(NAG),urinary albumin to creatinine ratio(UACR),and serum renal function,liver function,blood lipid,myocardial enzyme and glycosylated hemoglobin(HbA1C),etc.were also collected.Those with incomplete previous history,general information,biochemical indexes and decreased estimated glomerular filtration rate(eGFR)were excluded,and 969 cases were included.The included subjects were divided into the normal group(˂15μmol/L)and the elevated group(≥15μmol/L)according to Hcy levels,the indexes with significant difference between the two groups were included as independent variables,and the multivariate logistic regression was used to explore the influence factors of Hcy elevation.Results The male ratio,the incidence of increased U-mALB,NAG and UACR were significantly higher in the elevated group than those in the normal Hcy group(93.4%vs 50.6%,16.4%vs 8.0%,23.0%vs 14.0%,13.9%vs 7.9%)(all P<0.05).Systolic blood pressure,diastolic blood pressure,serum uric acid,calcium,alanine aminotransferase(ALT)and lactate dehydrogenase in the elevated group were higher than those in the normal group[(127.5±15.4)vs(121.9±16.2)mmHg(1 mmHg=0.133 kPa),(78.6±9.3)vs(76.0±11.0)mmHg,(385.9±86.0)vs(335.7±88.2)μmol/L,(2.392±0.086)vs(2.366±0.092)mmol/L,(27.8±21.0)vs(23.8±20.2)U/L,(198.3±28.4)vs(192.2±31.2)U/L](all P<0.05),while high density lipoprotein cholesterol(HDL-C),serum phosphorus were lower than those in the normal group[(1.21±0.25)vs(1.31±0.30)mmol/L,(1.107±0.154)vs(1.158±0.159)mmol/L](all P<0.05).The increased systolic blood pressure,male,uric acid,U-mALB,NAG were independent correlative factors of Hcy elevation.Conclusion The increase of Hcy is independently correlated with urine U-mALB and NAG,which suggests that the level of Hcy should be detected as soon as possible in patients with elevated early renal injury markers.