慢性肾脏病患者胱抑素C、同型半胱氨酸与动脉硬化指标的相关性  

Correlation among cystatin C,homocysteine and arteriosclerosis indexes in patients with chronic kidney disease

作　　者：陈添儒 李莹[2] 王建刚[2] 王建文[1] CHEN Tianru;LI Ying;WANG Jiangang;WANG Jianwen(Department of Nephrology,Third Xiangya Hospital,Central South University,Changsha 410013;Health Management Center,Third Xiangya Hospital,Central South University,Changsha 410013,China)

机构地区：[1]中南大学湘雅三医院肾内科,长沙410013 [2]中南大学湘雅三医院健康管理中心,长沙410013

出　　处：《中南大学学报（医学版）》2021年第12期1338-1345,共8页Journal of Central South University ：Medical Science

摘　　要：目的:慢性肾脏病(chronic kidney disease,CKD)已日益成为全球重要的公共卫生问题。心血管事件的发生是CKD患者的主要死因,而动脉硬化是心血管疾病发生和发展的重要病理生理基础。肱踝脉搏波传导速度(brachial-ankle pulse wave velocity,baPWV)和踝臂指数(ankle-brachial index,ABI)是临床上常用的反映早期动脉硬化的重要指标。在健康人群、高血压病及糖尿病人群中,半胱氨酸蛋白酶抑制剂C(cystatin C,Cys C)和同型半胱氨酸(homocysteine,Hcy)均与动脉硬化密切相关,而在CKD患者中,Hcy、Cys C与动脉硬化的相关研究报道甚少。本研究旨在探讨CKD患者体内Cys C、Hcy水平与动脉硬化指标的关系。方法:选择2019年6月至2020年6月在中南大学湘雅三医院健康管理中心进行健康体检并符合CKD诊断标准的611名个体作为研究对象。测量并记录受试者的身高、体重、收缩压(systolic pressure,SBP)、舒张压(diastolic pressure,DBP)等,并计算体重指数(body mass index,BMI)。抽取受试者血液样本5 mL并检测Cys C、Hcy、空腹血糖(fasting blood glucose,FBG)、总胆固醇(total cholesterol,TC)、血肌酐(serum creatinine,SCr)等指标。留取受试者尿液,检测尿微量白蛋白、尿肌酐,并计算尿微量白蛋白与尿肌酐比值(albumin/creatinine ratio,UACR)。采用全自动动脉硬化检测仪测定baPWV、ABI。以受试者血中Cys C和Hcy水平的四分位数分组,并比较各组间baPWV和ABI异常的比例。采用Pearson相关分析Cys C、Hcy与baPWV的相关性;采用单因素及多因素logistic回归分析Cys C、Hcy对ABI、baPWV的影响。结果:在611例CKD患者中,435例(71.19%)baPWV异常,48例(7.86%)ABI异常。随着Cys C和Hcy水平的升高,baPWV及ABI异常的比例也逐渐增加。baPWV与Cys C(r=0.32)、Hcy(r=0.20)均呈正相关(均P<0.01)。在校正性别、BMI、FBG等混杂因素后,Cys C(OR=6.54,95%CI:1.93~22.14,P<0.01)及Hcy(OR=1.08,95%CI:1.01~1.16,P=0.02)是baPWV异常的独立危险Objective:Chronic kidney disease(CKD)has become an important public health problem in the world.The occurrence of cardiovascular events is the main cause of death in patients with CKD,and arteriosclerosis is an important pathophysiological basis for cardiovascular diseases.Nowadays,brachial-ankle pulse wave velocity(baPWV)and ankle-brachial index(ABI)are clinically important indicators to reflect early atherosclerosis.Cystatin C(Cys C)and homocysteine(Hcy)are related to arteriosclerosis in healthy,hypertensive,and diabetic people,while there are few studies on the correlation among Hcy,Cys C and arteriosclerosis in patients with CKD.This study aims to investigate the relationship between Cys C,Hcy and atherosclerosis in patients with CKD.Methods:A total of 611 individuals,who met the diagnostic criteria for CKD and underwent physical examination in the Health Management Center of Third Xiangya Hospital,Central South University from June 2019 to June 2020,were selected as the research subjects.Height,weight,systolic blood pressure(SBP),and diastolic blood pressure(DBP)were measured and recorded,and body mass index(BMI)was calculated.Blood samples(5 m L)were collected and Cys C,Hcy,fasting blood glucose(FBG),total cholesterol(TC),serum creatinine(SCr),and other blood indexes were tested.Urine was collected to detect microalbumin and creatinine,and the albumin/creatinine ratio(UACR)was calculated.ba PWV and ABI were measured by automatic arteriosclerosis detector.The quartiles of Cys C and Hcy were divided into groups,and the proportion of ba PWV and ABI abnormalities among groups was compared pairwise.The correlation between Cys C,Hcy,and ba PWV was analyzed by Pearson correlation analysis.Univariate and multivariate logistic regression were used to analyze the effects of Cys C and Hcy on ABI and ba PWV.Results:Among 611 patients with CKD,435(71.19%)had abnormal ba PWV and 48(7.86%)had abnormal ABI.With the increase of Cys C and Hcy levels,the proportion of ba PWV and ABI abnormalities were gradually increased.Ba P

关 键 词：动脉硬化 半胱氨酸蛋白酶抑制剂 同型半胱氨酸 肱踝脉搏波传导速度 踝臂指数 慢性肾脏病 

分 类 号：R692[医药卫生—泌尿科学] R543.5[医药卫生—外科学]