慢性肾脏病患者血清同型半胱氨酸的变化及影响因素  

Change and influential factors of homocysteine level in patients with chronic kidney diseases

作　　者：黄业华[1] 任伟[1] 杨沐[1] 黄珍珍[1] 倪力军[1] 

机构地区：[1]安徽医科大学附属省立医院、安徽省立医院肾内科,合肥230001

出　　处：《中国临床保健杂志》2011年第1期11-13,共3页Chinese Journal of Clinical Healthcare

摘　　要：目的探讨慢性肾脏病(CKD)患者血清同型半胱氨酸(Hcy)的变化及其影响因素。方法选择住院的CKD患者165例,于治疗前采空腹静脉血用酶法检测血清Hcy。根据肾小球滤过率(eGFR)将CKD患者分为3组:A组eGFR≥60 ml.min-1.(1.73 m2)-1,52例;B组eGFR 15～59 ml.min-1.(1.73 m2)-1,47例;C组eGFR<15 ml.min-1.(1.73 m2)-1,66例;比较三组患者血清Hcy的变化。并对165例患者的血清Hcy与肾小球滤过率(eGFR)、胱抑素C(Cys C)、血管内皮生长因子(VEGF)、血常规、生化、叶酸、VitB12、收缩压、舒张压、年龄等因素的相关性进行分析。结果随着eGFR的下降,Hcy逐渐升高,B组Hcy高于A组Hcy水平,C组Hcy高于A组和B组Hcy水平(均P<0.01)。165例CKD患者的Hcy与eGFR、血红蛋白、二氧化碳结合力呈负相关(均P<0.01),与Cys C、渗透压、阴离子间隙、收缩压、舒张压呈正相关(均P<0.01),与VEGF也呈正相关(P<0.05)。结论慢性肾脏病患者肾功能下降可影响血清同型半胱氨酸清除,同时贫血和机体内环境的改变对血清同型半胱氨酸的代谢产生影响,导致高同型半胱氨酸血症。Objective To study influential factors of homocysteine（Hcy）change in patients with chronic kidney diseases（CKD）.Methods 165 hospitalized cases with CKD were chosen,and serum Hcy was determined by enzymic method before treatment.The patients were grouped according to the estimated glomerular filtration rate（eGFR）：group A,eGFR≥60 ml·min-1·（1.73 m2）-1,52 cases;group B,eGFR 15～59 ml · min-1·（1.73 m2）-1,47cases;group C,eGFR15 ml·min-1·（1.73 m2）-1,66 cases.Serum Hcy was compared between three groups.The relationship between serum Hcy and eGFR,cystatin C（Cys C）,plasma vascular endothelial growth factor（VEGF）,blood routine,biochemical indexes,folic acid,vitamin B12,blood pressure and age were analyzed.Results Serum Hcy increased along with eGFR decreasing.Serum Hcy in group B was higher than that in group A;and serum Hcy in group C was the highest in three groups（P〈0.01）.There was a negative correlation between serum Hcy and eGFR,hemoglobin,carbon dioxide combining power（P〈0.01）.In contrast,there was a positive correlation between serum Hcy and Cys C,osmotic pressure,anion gap,systolic pressure and diastolic pressure（P〈0.01）.The serum Hcy had positive relationship with serum VEGF（P〈0.05）.Conclusions Decrease of renal function may decrease the clearance of serum Hcy.In addition,anemia and the change of internal milieu in the body may influence the metabolism of Hcy,which leads to hyperhomocysteinaemia.

关 键 词：肾疾病 半胱氨酸 危险因素 

分 类 号：R692[医药卫生—泌尿科学]