慢性肾功能衰竭患者高同型半胱氨酸血症与血清维生素B12、叶酸、脂蛋白(α)水平的关系

目的 探讨慢性肾功能衰竭(CRF)患者血清同型半胱氨酸(HCY)水平与其代谢因子叶酸、维生素B_(12)水平、血肌酐(SCr)及有关生化指标之间的关系。方法 本研究分为两组:正常对照组47例,慢性肾功能衰竭组46例。应用荧光偏振免疫分析(FPIA)方法测定血清HCY浓度,同时测定血清叶酸、维生素B_(12)、SCr、ALB、血脂、脂蛋白及瘦素(Leptin)浓度。结果 CRF患者血清HCY浓度(24.6±8.1)μmol/L比正常对照组(10.7±3.8)μmol/L,显著升高(P<0.001);CRF患者叶酸水平(14.5±8.8)ng/ml比正常人(5.5±2.5)ng/ml显著升高(P<0.001),血清维生素B_(12)(456±309)pg/ml比正常人(346±117)pg/ml明显升高(P<0.05);血清HCY浓度与叶酸、维生素B_(12)浓度呈明显负相关(分别为r=-0.586,P<0.01;r=-0.442,P<0.05);血清HCY浓度与SCr、Lp(a)浓度呈明显正相关,与瘦素及其它血脂水平无明显相关;血液透析患者透析后血清HCY水平(17.6±6.2)μmol/L比透析前(25.4±8.2)μmol/L明显下降(P<0.001)。结论CRF患者血清HCY水平比正常人明显升高;CRF患者肾功能、血清叶酸、维生素B_(12)水平是影响HCY水平的重要因素;血清脂蛋白(a)增高与高HCY血症密切相关;口服叶酸治疗不能满意纠正高HCY血症;血液透析可清除体内部分HCY。如何完全纠正CRF患者高HCY血症尚

The relationship between hyperhomocycteinemia and Vitamin B12, folate,lipoprotein(a) level in chronic renal failure patients

Objective To investigate the association between the plasma homocysteine level and serum folate, Vitamin B12, creatinine in chronic renal failure patients. Methods This study has two groups. Group I: healthy control group(n = 47) ; Group II: chronic renal failure group(n = 46) .The concentration of plasma total homocysteine(tHcy) was measured by using FPIA. The serum concentration of folate, Vitamin B12 , creatinine, albumin, lipid, lipoprotein and leptin were measured also. Results Levels of plasma tHcy in CRF patients were significantly higher than healthy control group. Levels of serum folate and Vitamin B12 in CRF patients were significantly higher than control group. Plasma tHcy levels were negatively correlated with serum folate and Vitmin B12 concentration. Plasma tHcy levels were positively correlated with SCr, Lp(a) and were not significantly related with leptin and lipid level. Plasma tHcy levels were signifi-cantly decreased after hetnodialysis. Conclusion Plasma tHcy levels were significantly higher than healthy control.Serum creatinine, folate and Vitamin B12 levels have significantly influence on plasma tHcy. Serum lipoprotein( a) level are positively correlated with plasma tHcy. Oral folate can' t decrease hyperhomocysteinemia effectively. One part of tHcy can be cleared by hemodialysis. Further study is needed to treat hyperhomocysteinemia effectively.