终末期肾病患者发生高同型半胱氨酸血症的影响因素

目的探讨终末期肾病(end-stage renal disease, ESRD)患者血清同型半胱氨酸(homocysteine, Hcy)水平变化及发生高同型半胱氨酸血症(hyperhomocysteinemia, HHcy)的影响因素。方法 140例ESRD患者,依据血清Hcy水平分为正常组(血清Hcy≤15μmol/L)21例和HHcy组(血清Hcy>15μmol/L)119例。比较2组一般资料、血红蛋白及血清白蛋白、尿酸、β2-微球蛋白、C反应蛋白等水平;多因素logistic回归分析ESRD患者发生HHcy的影响因素。结果 HHcy组合并冠心病比率(43.2%)高于正常组(14.3%)(P<0.05),合并高血压、糖尿病比率(97.5%、36.9%)与正常组(85.7%、28.6%)比较差异无统计学意义(P>0.05)。2组原发病、透析模式比较差异无统计学意义(P>0.05)。HHcy组血红蛋白(92.24±20.81)g/L]、血清白蛋白(35.06±5.01)g/L]水平低于正常组(103.81±16.65)、(37.48±3.43)g/L],C反应蛋白19.8(15.0,27.9)mg/dL]、β2-微球蛋白(23.04±11.00)mg/dL]、尿酸434(378,521)μmol/L]水平高于正常组8.6(5.4,12.9)mg/dL、(17.20±5.77)mg/dL、393(351,455)μmol/L](P<0.05),血肌酐(816.14±396.24)μmol/L]、甲状旁腺激素(423.30±146.17)ng/L]、铁蛋白358(182,716)μg/L]与正常组(863.98±303.52)μmol/L、(467.20±85.90)ng/L、357(289,675)μg/L]比较差异无统计学意义(P>0.05)。多因素logistic回归分析结果显示,合并冠心病(OR=10.974,95%CI:1.923~62.631,P=0.007)、C反应蛋白(OR=1.083、95%CI:1.027~1.283,P=0.003)、β2-微球蛋白(OR=1.077、95%CI:1.002~1.157,P=0.043)是ESRD患者发生HHcy的影响因素。结论 ESRD患者HHcy发生率高,有冠心病及血清C反应蛋白、β2-微球蛋白增高是其发生HHcy的危险因素。

Risk factors for hyperhomocysteinemia in patients with end-stage renal disease

Objective To investigate the changes of homocysteine(Hcy) and the risk factors for hyperhomocysteinemia(HHcy) in patients with end-stage renal disease(ESRD). Methods Totally 140 patients with ESRD were divided into 21 patients with Hcy≤15 μmol/L(normal Hcy group) and 119 patients with Hcy>15 μmol/L(HHcy group) according to the level of serum Hcy. The general data, hemoglobin, serum albumin, uric acid, β2-microglobulin and C-reactive protein(CRP) were compared between two groups. Multivariate logistic regression analysis was used to assess the risk factors for HHcy. Results The percentage of coronary heart disease was higher in HHcy group(43.2%) than that in normal Hcy group(14.3%)(P<0.05), and the percentages of hypertension and diabetes showed no significant differences between HHcy group(97.5%, 36.9%) and normal Hcy group(85.7%, 28.6%)(P>0.05). There were no significant differences in the primary diseases and dialysis modes between two groups(P>0.05). The levels of hemoglobin((92.24±20.81) g/L) and serum albumin((35.06±5.01) g/L) were lower, and the levels of C-reactive protein(19.8(15.0, 27.9) mg/dL), β2-microglobulin((23.04±11.00) mg/dL) and uric acid(434(378, 521) μmol/L) were higher in HHcy group than those in normal Hcy group((103.81±16.65) g/L,(37.48±3.43) g/L, 8.6(5.4, 12.9) mg/dL,(17.20±5.77) mg/dL, 393(351, 455) μmol/L)(P<0.05), while the levels of serum creatinine, parathyroid hormone and ferritin showed no significant differences between HHcy group((816.14±396.24) μmol/L,(423.30±146.17) ng/L, 358(182, 716) μg/L) and normal Hcy group((863.98±303.52) μmol/L,(467.20 ± 85.90) ng/L, 357(289, 675) μg/L)(P>0.05). Multivariate logistic regression analysis results showed that coronary heart disease(OR=10.974, 95%CI: 1.923-62.631, P=0.007), C-reactive protein(OR=1.083, 95%CI: 1.027-1.283, P=0.003) and β2-microglobulin(OR=1.077, 95%CI: 1.002-1.157, P=0.043) were the influencing factors for HHcy in ESRD patients. Conclusion ESRD patients have high prevalence of HHcy, while coronary heart disease, and the elevated levels of C-reactive protein and β2-microglobulin are the influencing factors for HHcy in ESRD patients.