初诊糖尿病患者高同型半胱氨酸血症与慢性肾脏病相关性研究

目的 探讨初诊糖尿病患者高同型半胱氨酸血症(HHcy)患病情况及其与慢性肾脏病(CKD)的相关性.方法 对来本院健康体检的成年人进行横断面研究,收集体检者临床资料包括年龄、性别、吸烟史等,进行人体测量(身高、体重、血压等),空腹8～10 h测定血糖、血脂、血肌酐、血尿酸、糖化血红蛋白等生化指标检测.初诊糖尿病定义为空腹血糖＞ 7.0 mmol/L和或糖化血红蛋白＞6.5％并排除既往诊断糖尿病及服用降糖药物者.HHcy定义为Hcy≥15μmol/L.CKD定义为肾功能下降估测的肾小球滤过率(eGFR) ＜60 mL·(min·1.73m2)-1]或蛋白尿尿常规蛋白≥1+].应用多因素logistic回归模型探讨HHcy与CKD的相关性.结果 共有1801例初诊成年糖尿病患者纳入该研究,年龄(61.3±10.1)岁,男性占83.9％,eG-FR(119.2±30.9)(范围36.4～155.9)mL· (min· 1.73m2)-1,HHcy的患病率高达28.0％.肾功能下降、蛋白尿及CKD的患病率分别为2.3％、8.1％及10.0％.其中Hcy最高四分位数组年龄、男性比例、高血压、肾功能下降及CKD患病明显大于其他三组(P＜O.001).多因素Logistic回归分析显示,HHcy与肾功能下降及CKD正相关,测定OR值分别为3.32(95％ CI:1.63～6.78)及1.45(95％ CI:1.01 ～2.08).在771例无高血压的亚组人群中分析,同样显示HHcy与CKD正相关,OR值为2.34(95％ CI:1.18 ～4.61).结论 初诊糖尿病患者HHcy患病率较高,且HHcy与CKD正相关,应在初诊糖尿病患者尤其是合并HHcy患者中加强CKD的筛查.

Association of hyperhomocysteinemia with chronic kidney disease in patients with newly diagnosed diabetes

Objectives To explore the association of hyperhomocysteinemia(HHcy) with chronic kidney disease (CKD) in patients with newly diagnosed diabetes.Methods Adults who visited the health checkup clinic consecutively were included in the study.Questionnaires including the following questions,such as age,gender and smoking were fulfilled.Height,weight,blood pressure,blood sugar,serum lipid,serum creatinine,blood uric acid and glycosylated hemoglobin were measured.Newly diagnosed diabetes were defined as fasting plasma glucose levels of 7.0 mmol/L or higher and/or glycosylated hemoglobin of 6.5％ or more.CKD was defined as decreased kidney function (estimated glomerular filtration (eGFR) ＜ 60 mL · (min · 1.73m2)-1] or (proteinuria ≥ 1 +).Multivariable logistic regression analysis were used to study the association of hyperhomocysteinemia with CKD.Results In the study,1801 adults with the average age(61.3 ± 10.1) years were enrolled,of which 83.9％ were males.The estimated glomerular filtration rate was (119.2 ± 30.9) mL · (min · 1.73m2)-1.The total prevalence of hyperhomocysteinemia reached up to 28.0％.The total prevalence of decreased kidney function,proteinuria and CKD was 2.3％,8.1％ and 10.0％,respectively.As a categorical outcome,age,male,and the prevalence of hypertension,decreased eGFR and CKD in the highest homocysteine quartile were higher than in the lower three quartiles (P ＜ 0.001).Multivariable logistic regression analysis indicated that hyperhomocysteinemia were independently associated with decreased kidney function (3.32,95％ CI:1.63 ～ 6.78) and CKD (1.45,95 ％ CI:1.01 ～2.08).The results were robust among 771 hypertension-free participants,the adjusted OR of hyperhomocyteinemia was 2.34 (95 ％ CI:1.18 ～ 4.61) for CKD.Conclusions The prevalence of hyperhomocyteinemia is higher in adults with newly diagnosed diabetic patients.The issue of strengthening educational programmes of CKD is prominent and needs further attention in adults with diabetes,especially in diabetes adults with hyperhomocyteinemia.