血清同型半胱氨酸与IgA肾病临床病理的相关性分析  

Correlation between serum homocysteine level and clinicopathological factors of IgA nephropathy

作　　者：蔡小凡[1] 黄洁波 邢玥 蔡秀峰 李雪玲[1] 钟逸斐[1] Cai Xiao-fan;Huang Jie-bo;Xing Yue;Cai Xiu-feng;Li Xue-ling;Zhong Yi-fei(First Department of Nephrology,Longhua Hospital,Shanghai University of Traditional Chinese Medi-cine,Shanghai 200032,China;Department of Nephrology,Shanghai Putuo District Central Hospital(Putuo Affiliated Hospital of Shanghai University of Traditional Chinese Medicine),Shanghai 200062,China)

机构地区：[1]上海中医药大学附属龙华医院肾病一科,上海200032 [2]上海中药大学附属普陀区中心医院肾病科,上海200062

出　　处：《临床肾脏病杂志》2025年第1期13-18,共6页Journal Of Clinical Nephrology

基　　金：上海申康医院发展中心研究型创新转化能力培训项目(SHDC2022CRD003);龙华医院爱建基金资助项目(AJ069);龙华医院龙医学者项目(KC2022013)。

摘　　要：目的探讨血清同型半胱氨酸(homocysteine,Hcy)与IgA肾病临床病理因素的相关性。方法回顾性分析2014年1月1日至2023年10月31日在上海中医药大学附属龙华医院肾病一科行肾穿刺活检确诊为IgA肾病的患者349例。按Hcy正常组和高同型半胱氨酸血症(hyperhomocysteinemia,HHcy)组对患者的临床病理指标进行比较。Spearman法分析估算肾小球滤过率(estimated glomerular filtration rate,eGFR)和病理指标与Hcy的相关性,Logistic回归分析与HHcy相关的临床病理因素,受试者工作特征曲线下面积(area under curve,AUC)评估Hcy预测相关病理损伤的能力。结果HHcy组患者男性比例(63.1%比32.7%)、年龄[(40.44±12.85)岁比(36.83±11.56)岁]、白蛋白[(38.14±4.71)g/L比(36.28±6.65)g/L]、血肌酐[(125.90±75.89)μmol/L比(75.39±29.16)μmol/L]、尿素[(7.61±4.01)mmol/L比(5.29±1.78)mmol/L]、尿酸[(427.04±101.99)μmol/L比(351.56±93.45)μmol/L]、胱抑素C(cystatin C,Cys C)[(1.61±0.66)mg/L比(1.05±0.36)mg/L]水平均高于Hcy正常组,eGFR水平[(70.50±30.90)mL·min^(-1)·(1.73 m^(2))^(-1)比(100.35±27.08)mL·min^(-1)·(1.73 m^(2))^(-1)]低于Hcy正常组,而肾小管萎缩与肾间质纤维化(T)(T1/2:42.5%比16.3%)以及肾小动脉管壁增厚(A)(A1/2:73.8%比49.5%)的程度较Hcy正常组重(P均<0.05)。Spearman分析显示Hcy水平与eGFR呈负相关,与T和A呈正相关(P均<0.05)。Logistic回归显示性别、白蛋白、血肌酐、Cys C、T和A与HHcy存在相关性(P均<0.05)。Hcy预测T和A的AUC分别为0.751(95%CI:0.699~0.803)和0.625(95%CI:0.565~0.685)(P均<0.05),最佳临界点分别为15.04μmol/L和13.11μmol/L。结论肾活检时Hcy水平与IgA肾病患者性别、白蛋白、血肌酐、Cys C、T和A相关。Hcy可从一定程度上判断上述病理损伤的严重程度。Objective To investigate the correlation between serum homocysteine(Hcy)and clinicopathologic factors of immunoglobulin A nephropathy(IgAN).Methods A total of 349 patients with IgAN diagnosed by renal biopsy in the Nephrology Department of Longhua Hospital,Shanghai Uni-versity of Traditional Chinese Medicine from January 1,2014 to October 31,2023 were retrospectively analyzed.The patients were divided into the Hcy normal group and hyperhomocysteinemia(HHcy)group according to Hcy level at the time of renal biopsy.Clinical observation data and pathological injury indices were compared between groups.The correlation of estimated glomerular filtration rate(eGFR)and pathological injury indices with Hcy was analyzed by Spearman's correlation analysis.The clinico-pathological factors associated with HHcy were analyzed by logistic regression,and area under the re-ceiver operator characteristic curve(AUC)was used to assess the ability of Hcy in predicting pathologic injuries associated with IgAN.Results Patients in the HHcy group had significantly higher male ratio(63.1%vs 32.7%),age[(40.44±12.85)years vs(36.83±11.56)years],albumin[Alb,(38.14±4.71)g/L vs(36.28±6.65)g/L],serum creatinine[Scr,(125.90±75.89)μmol/L vs(75.39±29.16)μmol/L],blood uric urea[BUN,(7.61±4.01)mmol/L vs(5.29±1.78)mmol/L],uric acid[UA,(427.04±101.99)μmol/L vs(351.56±93.45)μmol/L],and cystatin C[Cys C,(1.61±0.66)mg/L vs(1.05±0.36)mg/L],but lower eGFR[(70.50±30.90)mL·min^(-1)·(1.73 m^(2))^(-1) vs(100.35±27.08)mL·min^(-1)·(1.73 m^(2))^(-1)]than the Hcy normal group(all P<0.05).Renal tubular atrophy and re-nal interstitial fibrosis(T,42.5%vs 16.3%)and thickening of renal arteriolar wall(A,73.8%vs 49.5%)were significantly larger in the HHcy group than the Hcy normal group(all P<0.05).Spearman correla-tion showed that Hcy was negatively correlated with eGFR,but positively correlated with T and A(all P<0.05).Logistic regression showed that sex,Alb,Scr,Cys C,T and A was significantly correlated with HHcy(all P<0.05).The AUC of Hcy in pred

关 键 词：IGA肾病 肾小球肾炎 同型半胱氨酸 半胱氨酸蛋白酶抑制剂 

分 类 号：R692.31[医药卫生—泌尿科学]