男性健康体检者血清同型半胱氨酸水平与肾功能损伤的关系

发布时间：2018-03-29 22:36

  本文选题：同型半胱氨酸　切入点：高同型半胱氨酸血症　出处：《天津医科大学》2017年硕士论文

【摘要】：目的随着关于同型半胱氨酸(Hcy)研究的增多,越来越多的研究者发现血清Hcy浓度增高与肾功能损伤之间存在一定的相关性。肾功能损害发展到终末期时,血清Hcy水平显著升高,可高于正常值的3-5倍。目前关于Hcy水平与肾损伤之间关系的研究,多集中于临床确诊的有明确引起肾损伤的原发病的患者中,如高血压肾损害、糖尿病肾病等。而在没有可引起肾损害的疾病的人群中,血清Hcy浓度升高是否与肾功能变化也有关系?目前这方面的研究相对还较少,仍无明确定论,针对该问题我们前期已研究了健康老年男性血清Hcy水平与肾损伤的关系,发现血清Hcy水平增高和高龄是导致肾损伤的不可忽视的危险因素。那么在同时排除疾病与年龄因素的影响之后,血清Hcy水平与肾功能变化是否仍有关系?我们进一步以中年男性体检者为观察对象,旨在探讨排除疾病与高龄的影响之后,血清Hcy水平与肾功能变化的关系。方法在2014年1月到2015年12月于天津医科大学总医院干部体检中心进行健康体检的人群中,随机选取44-90岁近两年无吸烟史及规律饮酒史的男性体检者共974例,剔除其中数据不全者、明确诊断患有高血压、糖尿病、冠心病、高脂血症、各种慢性肾脏病等疾病并服用降压、降糖、降脂等药物的患者、近期服用过具有明显肾毒性药物的患者,最终选取752例男性健康体检者纳入本研究。抽取静脉血,采用酶法测定Hcy,乳胶免疫比浊法测定胱抑素C(Cys C),以Hoek′s公式或Cockcroft-Gault(CG)公式计算GFR。将研究对象按年龄分组,44-64岁的体检者为中年男性组(n=403),65岁及以上的体检者为老年男性组(n=349),分析对比两组之间血清Hcy、GFR分布的不同。根据美国肾脏病基金会制定的慢性肾脏病分期,将GFR90 ml/(min·1.73m~2)作为早期肾损伤的判断标准,GFR60 ml/(min·1.73m~2)作为中度肾损伤的判断标准。以血清Hcy浓度≥15μmol/L为高同型半胱氨酸血症(HHcy)诊断标准,将403例中年男性分为HHcy组(n=130)和对照组(n=273),分析比较两组之间血清Hcy水平、年龄、身高、体重、BMI、血压、血糖、血脂、尿素、尿酸、肌酐、Cys C、GFR、早期肾功能损伤患病率等指标的差异;分析中年男性组GFR与血清Hcy浓度、收缩压、舒张压之间的相关性;按血清Hcy水平四分位间距将403例中年男性分成4组,用Logistic回归模型分析血清Hcy水平与早期肾功能损伤患病危险度的关系。结果老年男性组血清Hcy平均水平为15.66μmol/L,HHcy患病率为45.27%(158/349),GFR平均水平为67.83ml/(min·1.73m~2),中度肾功能损伤患病率为36.67%(128/349)。中年男性组血清Hcy平均水平为14.30μmol/L,HHcy患病率为32.26%(130/403),Cys C平均水平为0.79mg/L,GFR平均水平为99.99ml/(min·1.73m~2),早期肾功能损伤患病率为24.07%(97/403)。中年男性人群HHcy组血清Hcy[(20.60±6.55)vs(11.30±2.16)μmol/L]、肌酐[(85±11)vs(80±9)μmol/L]、Cys C[(0.83±0.13)vs(0.77±0.10)mg/L]、早期肾功能损伤患病率[(36.15%)vs(18.31%)]显著高于对照组,GFR[(94.96±15.00)vs(102.38±14.19)ml/(min·1.73m~2)]显著低于对照组(P均0.001),收缩压与舒张压高于对照组,差异不显著(P分别为0.070、0.055)。中年男性组GFR与Hcy(r=-0.247,P0.001)、收缩压(r=-0.098,P=0.049)负相关,与舒张压无相关性(r=-0.078,P=0.118)。将中年男性组按Hcy水平四分位分组之后进行Logistic回归分析显示,随血清Hcy水平升高,早期肾功能损伤患病风险增加,以1组为参考,2、3、4组OR值分别为2.512(95%CI:1.076-5.863)、5.456(95%CI:2.460-12.103)、5.380(95%CI:2.419-11.966)(P均0.05);单因素方差分析显示,四组中可能影响GFR的各指标中只有Hcy(F=269.556,P0.001)和血糖(F=3.948,P=0.009)有显著差异,向后回归分析结果发现血糖对早期肾功能损伤无显著影响(P=0.146),血清Hcy水平对早期肾功能损伤患病风险有影响(P0.001)。结论本研究通过调查天津市干部体检中部分44-90岁中老年男性血清Hcy水平和肾功能,发现HHcy患病率中年男性接近三分之一,老年男性接近二分之一。以GFR作为肾功能的评价指标,发现中年男性早期肾损伤患病率接近四分之一,老年男性早期肾损伤患病率百分之五十,中度肾损伤患病率达三分之一。在中年男性HHcy组中,GFR平均水平更低,早期肾功能损伤患病率更高;随着血清Hcy水平升高,GFR逐渐下降,早期肾功能损伤患病危险度上升。因此我们推测,血清Hcy水平升高是肾功能损伤的一个重要的危险因素。
[Abstract]:With the purpose of homocysteine (Hcy) on the increase, more and more researchers have found that there is a correlation between serum Hcy concentration and renal function damage. Renal damage progression to end-stage, serum Hcy levels were significantly increased, can be 3-5 times higher than the normal value. The current research on the relationship between Hcy levels and renal injury, focused on the clinical diagnosis of renal injury caused by a clear primary disease, such as hypertension, renal damage, diabetic nephropathy. In the absence of renal damage can cause diseases, serum Hcy concentration and renal function changes have relations? The current research in this area is still relatively less, still no clear conclusion, aiming at this problem, we have studied the relationship between the pre Hcy levels of serum in healthy elderly men with kidney injury, found elevated levels of serum Hcy and the elderly is the leading cause of kidney damage can not be The risk factors ignored. Then after effects and eliminate disease and age factors, whether the change of serum Hcy level and renal function is still a relationship? We further to the middle-aged male persons as the object of observation, after examined to exclude the impact of disease and the age of the relationship between serum Hcy levels and renal function. Methods in January 2014 December 2015 for the health examination in General Hospital Affiliated to Tianjin Medical University medical examination center of the crowd, randomly selected 44-90 nearly two years of smoking and drinking history of male subjects were 974 cases, according to the number of out of which all patients diagnosed with hypertension, diabetes, coronary heart disease, hyperlipidemia, chronic kidney disease and blood pressure hypoglycemic, lipid-lowering drugs, patients recently treated with obvious renal toxicity drugs, selected 752 healthy male subjects were included in this Study. Venous blood Hcy was determined by enzyme method, determination of cystatin C latex immunoturbidimetry (Cys C), using Hoek 's formula or Cockcroft-Gault (CG) GFR. will be the research object according to the age formula, a 44-64 year old middle-aged male subjects (n=403 group), 65 years old and in the volunteers aged male group (n=349), comparative analysis between the two groups of serum Hcy, GFR. The different distribution of chronic kidney disease according to National Kidney Foundation to develop stage, GFR90 ml/ (min 1.73m~2) as the criteria of early renal injury, GFR60 ml/ (min 1.73m~2) as a criterion for moderate kidney in order to injury. The serum Hcy concentration of more than 15 mol/L for hyperhomocysteinemia (HHcy) diagnostic criteria, 403 cases of middle-aged men were divided into HHcy group (n=130) and control group (n=273), analysis of the comparison between the two groups of serum Hcy level, age, height, weight, blood pressure, blood glucose, blood lipid BMI. Urea, urine. Acid, creatinine, Cys C, GFR, the difference of early renal injury prevalence rate index; analysis of middle aged male group GFR and serum Hcy concentration, systolic pressure, diastolic pressure and the correlation between the serum level of Hcy four; according to the spacing of 403 cases of middle-aged men were divided into 4 groups, using Logistic regression model analysis of serum Hcy the level and early renal function relationship risk injury. Results the serum Hcy in elderly male group average is 15.66 mol/L, the prevalence of HHcy was 45.27% (158/349) GFR, the average level of 67.83ml/ (min, 1.73m~2), moderate renal injury incidence rate was 36.67% (128/349). The average level of serum Hcy in middle-aged men 14.30 mol/L, the prevalence of HHcy was 32.26% (130/403), Cys C 0.79mg/L GFR for the average level, the average level of 99.99ml/ (min - 1.73m~2), early renal injury incidence rate was 24.07% (97/403). The middle-aged male group HHcy serum Hcy[(20.60 + 6.55 + 11.30 (VS) 2.16)渭mol/L],鑲岄厫[(85卤11)vs(80卤9)渭mol/L],Cys C[(0.83卤0.13)vs(0.77卤0.10)mg/L],鏃╂湡鑲惧姛鑳芥崯浼ゆ偅鐥呯巼[(36.15%)vs(18.31%)]鏄捐憲楂樹簬瀵圭収缁，

本文编号：1683203