肾移植后高同型半胱氨酸血症的发生率及其与心脑血管疾病风险因素的关系

目的 心脑血管并发症是肾移植受者(renal transplantation recipients,RTRs)的重要死亡原因,近来证实同型半胱氨酸与脑卒中有密切关系,本研究旨在探讨肾移植受者高同型半胱氨酸的发生率及其与传统心脑血管疾病风险因素的关系.方法 测定120例连续随访肾移植受者的同型半胱氨酸水平,其中男82例,平均年龄(42.5±8.7)岁;女38例,平均年龄(40.2±3.4)岁.同时监测空腹血糖、总胆固醇、甘油三酯、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、脂蛋白a、尿酸、肌酐、C反应蛋白的数值.结果 高同型半胱氨酸血症的总体发生率为95％,其中男性97.6％,女性89.5％,男女之间无显著差异(P＞0.05);高同型半胱氨酸血症组中脂蛋白a、尿酸、肌酐显著高于正常同型半胱氨酸组,分别为(305±132)mg/L、(406±34.6)μmol/L、(135±14)μmol/L和(221±129)mg/L、(320±51.1)μmol/L、(127±38.2) μmol/L(P＜0.05).Pearson相关分析结果显示,同型半胱氨酸与同时期的肌酐(r=0.832,P=0.013)、尿酸(r=0.263,P=0.005)、脂蛋白a(r=0.754,P=0.003)呈正相关,与总胆固醇(r=-0.197,P=0.036)呈负相关.结论 肾移植受者的高同型半胱氨酸血症发生率高,尤其是男性肾移植受者,与影响移植后心脑血管疾病的传统风险因素并存,可能增加肾移植受者发生心脑血管疾病的风险,提示应在肾移植受者中筛查同型半胱氨酸,及对高同型胱氨酸血症患者进行降同型半胱氨酸治疗的必要性.

Hyperhomocysteinemia in renal transplant recipients

Objective Cardiovascular complications is one of the important causes of death in renal transplant recipients(RTRs).This research was to explore the correlation of plasma homocysteine (Hcy) to traditional cardiovascular risk factors.Methods Hcy was mearsured in 120 continuous RTRs,among which 82 were males (average age (43.5 ± 8.7) years) and 38 were females (average age (40.15 ± 3.45) years).Fasting blood glucose (FBG),total cholesterol (TC),triglyceride (TG),high-density lipoprotein cholesterol (HDL-C),low-density lipoprotein cholesterol (LDL-C),lipoprotein a (Lp (a)),uric acid (UA),creatinine (Scr),C-reactive protein (CRP) were measured.Results The overall incidence of hyperhomocysteinemia was 97.5 ％,and among them 89.4％ in males and 28 ％ in females,respectively.There was no significant difference between males and females (P ＞ 0.05).The levels of Lp(a) ((305 ± 132)mg/L),UA((406± 34.6)μmol/L) and Scr((135 ± 14)μmol/L) in the hyperhomocyteinemia group were significantly higher than those ((221 ± 129)mg/L,(320 ± 51.1)μmol/L and (127 ± 38.2)μmol/L) in nomal Hcy group(P ＜0.05).In Pearson correlation analysis,HHcy and Scr (r =0.832,P =0.013),UA (r =0.263,P =0.005) and Lp(a) (r =0.754,P=0.003)were positively correlated,although Hcy and TC (r =0.197,P =0.197) showed a negative correlation.Conclusion The incidence of hyperhomocysteinemia in RTRs is very high.Coexisting with traditional risk factor of cardiovascular and cerebrovascular disease may increase the incidence of cardiovascular and cerebrovascular disease in RTRs.The results suggest the necessity of screening Hcy in RTRs.