原发性肾小球肾炎患者高同型半胱氨酸血症的发生率及与靶器官损害之间的关系  

Prevalence of Hyperhomocysteinemia in Patients with Primary Glomerulonephritis and Its Relationship with Target-organ Damages

作　　者：叶增纯[1] 黎燕[1] 张俊[1] 马欣欣[1] 彭晖[1] 王成[1] 娄探奇[1] YE Zeng-chun LI Yan ZHANG Jun MA Xin-xin PENG Hui WANG Cheng LOU Tan-qi(Division of Nephrology, Department of Medicine, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630,China)

机构地区：[1]中山大学附属第三医院肾内科,广东广州510630

出　　处：《中山大学学报（医学科学版）》2016年第6期869-874,880,共7页Journal of Sun Yat-Sen University:Medical Sciences

摘　　要：【目的】探讨高同型半胱氨酸血症在原发性肾小球肾炎患者中的发生率及其与靶器官损害的关系。【方法】本研究纳入2010年5月-2015年3月在中山大学附属第三医院就诊的601名原发性肾小球肾炎的患者进入研究队列。收集人口学及实验室数据,检测血浆同型半胱氨酸,计算估算肾小球滤过率,采用彩超评价心脏结构和功能改变。采用多因素线性回归分析血浆同型半胱氨酸水平的相关因素,多因素线性回归分析其与靶器官损伤的有关因素。【结果】在601名患者中,高同型半胱氨酸血症的发生率为45.92%,CKD 1期、2期、3期、4期和5期的患者高同型半胱氨酸血症发生率分别为10.34%、24.53%、57.58%、72.55%和89.53%。肾功能受损严重的患者高同型半胱氨酸血症发生率高于肾功能较好的患者(P﹤0.05)。与正常同型半胱氨酸血症患者相比,合并高同型半胱氨酸血症的患者肾功能受损、左心室肥厚、左心室舒张功能减退及异常颈动脉内中膜厚度的发生率增高(P﹤0.05)。多重线性回归分析结果显示同型半胱氨酸与e GFR相关。血浆同型半胱氨酸浓度与eGFR、钙磷乘积、血尿酸、LDL-C、性别和血红蛋白密切相关。【结论】原发性肾小球肾炎患者高同型半胱氨酸血症的发生率高,同型半胱氨酸血症与患者肾功能受损相关。[Objective] To investigate the prevalence of hyperhomocysteinemia in patients with primary glomerulonephritis and its relationship with target-organ damages. [ Methods ] This study included 601 patients with primary glomerulonephritis who were enrolled in the Third Affiliated Hospital of Sun Yat-sen University from May 2010 to March 2015. Demographic and laboratory data were collected. Plasma homocysteine was detected and estimated glomerular filtration rate （eGFR） was calculated. Doppler ultrasound was used to evaluate the changes of cardiac structure and function. Multiple linear regression analyses were used to evaluate the correlation between plasma homocysteine and target-organ damages. [ Results ] The prevalence of hyperhomocysteinemia was 45.92% （276/601 ） in patients with primary glomerulonephritis. And the incidence of hyperhomocysteinemia in CKD stage 1, stage 2, stage 3, stage 4, and stage5 was 10.34%, 24.53%, 57.58%, 72.55% and 89.53%, respectively. With the deterioration of renal function, the incidence of hyperhomocysteinemia increased significantly, eGFR in patients with hyperhomocysteinemia was significantly lower than those of normal homocysteine, and the left ventricular mass index and carotid artery intima media thickness were significantly increased. Multiple linear regression analysis showed that homocysteine was associated with impaired renal function. Plasma homocysteine concentration is related to eGFR, calcium ＊ phosphorus, serum uric acid, LDL-C, gender and hemoglobin. [Conclusions] The prevalence of hyperhomocysteinemia in patients with primary glomerulonephritis was 45.92%. Hyperhomocysteinemia was associated with impaired renal function in these patients.

关 键 词：原发性肾小球肾炎 同型半胱氨酸 靶器官损伤 EGFR 

分 类 号：R69[医药卫生—泌尿科学]