慢性肾脏病5期非透析患者同型半胱氨酸与腹主动脉钙化的相关性

doi:10.3969/j.issn.1004-583X.2024.01.004

摘要/Abstract

摘要：

目的评估慢性肾脏病(chronic kidney disease, CKD)患者同型半胱氨酸(homocysteine,Hcy)水平和腹主动脉钙化(abdominal aortic calcification, AAC)情况,探讨Hcy水平与CKD患者AAC的相关性。方法选取2019年12月1日至2022年12月1日就诊于沧州市中心医院肾内科的CKD患者291例,通过侧卧位腹平片评估AAC情况后,分为钙化组( $n$ =140)和非钙化组( $n$ =151)。记录两组一般资料及Hcy水平,分析Hcy水平与CKD患者AAC的相关性。结果钙化组Hcy水平高于非钙化组,差异有统计学意义( $P$ <0.05)。多因素Logistic回归分析提示,Hcy升高( $P$ <0.01, $O R$ =1.033, 95% $C I$ =1.016~1.051)是CKD患者发生AAC的独立危险因素之一。结论高Hcy是CKD患者AAC的独立危险因素之一。

关键词: 慢性肾脏病, 同型半胱氨酸, 腹主动脉钙化

Abstract:

Objective To evaluate the levels of homocysteine (Hcy) and abdominal aortic calcification (AAC) in patients with chronic kidney disease (CKD), and to explore the correlation between Hcy levels and AAC in CKD patients. Methods A total of 291 CKD patients who visited the Department of Nephrology at Cangzhou Central Hospital from December 1, 2019 to December 1, 2022 were selected. They were assigned into a calcified group ( $n$ =140) and a non calcified group ( $n$ =151) according to the evaluating results of lateral abdominal X-ray for AAC. The general information and Hcy levels were recorded between groups, and the correlation between Hcy levels and the occurrence of AAC in CKD patients was analyzed. Results The Hcy level in the calcified group was significantly higher than that of the non calcified group ( $P$ <0.05). Multivariate Logistic regression analysis suggests that elevated Hcy ( $O R$ =1.033, 95% $C I$ : 1.016-1.051, $P$ <0.01) was one of the independent risk factors for the occurrence of AAC in CKD patients. Conclusion High Hcy is one of the independent risk factors for the occurrence of AAC in CKD patients.

Key words: chronic kidney disease, homocysteine, abdominal aortic calcification

中图分类号:

R692

杨星梦, 马晓迎, 生玉平, 刘烨, 张浩然, 徐海平, 王娜, 孙福云. 慢性肾脏病5期非透析患者同型半胱氨酸与腹主动脉钙化的相关性[J]. 临床荟萃, 2024, 39(1): 30-33.

Yang Xingmeng, Ma Xiaoying, Sheng Yuping, Liu Ye, Zhang Haoran, Xu Haiping, Wang Na, Sun Fuyun. Correlation between homocysteine and abdominal aortic calcification in non-dialysis patients with stage 5 chronic kidney disease[J]. Clinical Focus, 2024, 39(1): 30-33.

导出引用管理器 EndNote|Ris|BibTeX

链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2024.01.004

https://huicui.hebmu.edu.cn/CN/Y2024/V39/I1/30

图/表 3

表1 两组一般资料和实验室资料比较

Tab.1 Comparison of general and laboratory between groups

项目	所有患者( $n$ =291)	钙化组( $n$ =140)	非钙化组( $n$ =151)	χ²/ $t$ 值	$P$ 值
年龄(岁)	56.72±14.56	64.89±10.55	49.15±13.67	-11.039	<0.01
男性[例(%)]	183(62.9)	87(62.1)	96(63.6)	0.064	0.809
使用钙剂[例(%)]	174(60.0)	74(52.8)	100(66.2)	5.087	0.031
体质量指数(kg/m²)	24.48±4.19	24.31±3.81	24.64±4.53	2.478	0.511
收缩压(mmHg)	151.24±22.45	151.21±23.42	151.27±21.59	0.022	0.983
舒张压(mmHg)	88.73±15.09	83.79±13.37	93.31±15.18	5.637	<0.01
糖尿病病史[例(%)]	103(35.4)	69(49.3)	34(22.5)	23.249	<0.01
高血压病史[例(%)]	266(91.4)	130(92.9)	136(90.1)	1.141	0.394
白蛋白(g/L)	36.59±5.64	36.41±5.85	36.75±5.46	0.526	0.599
C反应蛋白(mg/L)	5.6(1.3, 14.8)	7.5(1.8, 17.0)	5.1(1.3, 13.3)	0.050	0.824
血磷(mmol/L)	1.9(1.5, 2.2)	1.8(1.5, 2.1)	1.9(1.6, 2.3)	0.996	0.319
血钙(mmol/L)	1.95±0.29	1.99±0.26	1.91±0.31	4.555	0.014
血镁(mmol/L)	1.0(0.9, 1.1)	1.0(0.9, 1.1)	1.0(0.9, 1.1)	1.448	0.230
肌酐(umol/L)	656(506, 852)	612.0(491.0, 783.8)	693.0(541.0, 936.0)	8.590	0.004
尿素(mmol/L)	29.84±10.88	29.68±10.96	29.99±10.86	0.242	0.809
LDL-C(mmol/L)	2.67±0.97	2.77±1.04	2.58±0.89	-1.657	0.099
HDL-C(mmol/L)	1.1(0.9, 1.3)	1.1(0.9, 1.2)	1.1(0.8, 1.3)	0.878	0.350
胆固醇(mmol/L)	4.60±1.36	4.70±1.44	4.52±1.27	-1.068	0.287
甘油三酯(mmol/L)	1.3(1.1, 1.9)	1.3(1.1, 1.8)	1.3(1.1, 2.0)	2.332	0.128
碱性磷酸酶(U/L)	88.0(67.0, 131.3)	85.0(63.0, 126.0)	90.0(68.5, 136.0)	0.856	0.356
Hcy(mmol/L)	28.8(19.2, 42.4)	29.1(18.8, 42.0)	28.5(19.9, 47.0)	4.031	0.046
甲状旁腺激素(ng/L)	276.7(146.8, 455.6)	258.8(131.8, 380.9)	298.0(204.6, 462.6)	9.869	0.002

表1 两组一般资料和实验室资料比较

Tab.1 Comparison of general and laboratory between groups

项目	所有患者( $n$ =291)	钙化组( $n$ =140)	非钙化组( $n$ =151)	χ²/ $t$ 值	$P$ 值
年龄(岁)	56.72±14.56	64.89±10.55	49.15±13.67	-11.039	<0.01
男性[例(%)]	183(62.9)	87(62.1)	96(63.6)	0.064	0.809
使用钙剂[例(%)]	174(60.0)	74(52.8)	100(66.2)	5.087	0.031
体质量指数(kg/m²)	24.48±4.19	24.31±3.81	24.64±4.53	2.478	0.511
收缩压(mmHg)	151.24±22.45	151.21±23.42	151.27±21.59	0.022	0.983
舒张压(mmHg)	88.73±15.09	83.79±13.37	93.31±15.18	5.637	<0.01
糖尿病病史[例(%)]	103(35.4)	69(49.3)	34(22.5)	23.249	<0.01
高血压病史[例(%)]	266(91.4)	130(92.9)	136(90.1)	1.141	0.394
白蛋白(g/L)	36.59±5.64	36.41±5.85	36.75±5.46	0.526	0.599
C反应蛋白(mg/L)	5.6(1.3, 14.8)	7.5(1.8, 17.0)	5.1(1.3, 13.3)	0.050	0.824
血磷(mmol/L)	1.9(1.5, 2.2)	1.8(1.5, 2.1)	1.9(1.6, 2.3)	0.996	0.319
血钙(mmol/L)	1.95±0.29	1.99±0.26	1.91±0.31	4.555	0.014
血镁(mmol/L)	1.0(0.9, 1.1)	1.0(0.9, 1.1)	1.0(0.9, 1.1)	1.448	0.230
肌酐(umol/L)	656(506, 852)	612.0(491.0, 783.8)	693.0(541.0, 936.0)	8.590	0.004
尿素(mmol/L)	29.84±10.88	29.68±10.96	29.99±10.86	0.242	0.809
LDL-C(mmol/L)	2.67±0.97	2.77±1.04	2.58±0.89	-1.657	0.099
HDL-C(mmol/L)	1.1(0.9, 1.3)	1.1(0.9, 1.2)	1.1(0.8, 1.3)	0.878	0.350
胆固醇(mmol/L)	4.60±1.36	4.70±1.44	4.52±1.27	-1.068	0.287
甘油三酯(mmol/L)	1.3(1.1, 1.9)	1.3(1.1, 1.8)	1.3(1.1, 2.0)	2.332	0.128
碱性磷酸酶(U/L)	88.0(67.0, 131.3)	85.0(63.0, 126.0)	90.0(68.5, 136.0)	0.856	0.356
Hcy(mmol/L)	28.8(19.2, 42.4)	29.1(18.8, 42.0)	28.5(19.9, 47.0)	4.031	0.046
甲状旁腺激素(ng/L)	276.7(146.8, 455.6)	258.8(131.8, 380.9)	298.0(204.6, 462.6)	9.869	0.002

表2 AAC与各临床指标的相关性分析

Tab.2 Correlation analysis between AAC and other variables

项目	$r s$ 值	$P$ 值
年龄(岁)	0.541	<0.01
钙剂	-0.132	0.024
肌酐	-0.170	0.004
Hcy	0.119	0.046
舒张压	-0.316	<0.01
糖尿病	0.283	<0.01

表2 AAC与各临床指标的相关性分析

Tab.2 Correlation analysis between AAC and other variables

项目	$r s$ 值	$P$ 值
年龄(岁)	0.541	<0.01
钙剂	-0.132	0.024
肌酐	-0.170	0.004
Hcy	0.119	0.046
舒张压	-0.316	<0.01
糖尿病	0.283	<0.01

表3 CKD患者AAC的多因素Logistic回归分析

Tab.3 Logistic regression analysis of risk factors of AAC in CKD patients

因素	回归系数	标准误	Wald χ²值	$P$ 值	$O R$ 值	95% $C I$
因素	回归系数	标准误	Wald χ²值	$P$ 值	$O R$ 值	下限	上限
年龄	0.105	0.016	42.365	<0.01	1.111	1.076	1.147
钙剂	-0.150	0.345	0.189	0.664	0.861	0.438	1.692
肌酐	0.000	0.001	0.013	0.908	1.000	0.999	1.001
LDL-C	0.533	0.171	9.708	0.002	1.704	1.219	2.383
Hcy	0.033	0.008	14.888	<0.01	1.033	1.016	1.051
舒张压	-0.022	0.013	2.851	0.091	0.979	0.954	1.003
糖尿病	1.274	0.355	12.898	<0.01	3.574	1.784	7.163

表3 CKD患者AAC的多因素Logistic回归分析

Tab.3 Logistic regression analysis of risk factors of AAC in CKD patients

因素	回归系数	标准误	Wald χ²值	$P$ 值	$O R$ 值	95% $C I$
因素	回归系数	标准误	Wald χ²值	$P$ 值	$O R$ 值	下限	上限
年龄	0.105	0.016	42.365	<0.01	1.111	1.076	1.147
钙剂	-0.150	0.345	0.189	0.664	0.861	0.438	1.692
肌酐	0.000	0.001	0.013	0.908	1.000	0.999	1.001
LDL-C	0.533	0.171	9.708	0.002	1.704	1.219	2.383
Hcy	0.033	0.008	14.888	<0.01	1.033	1.016	1.051
舒张压	-0.022	0.013	2.851	0.091	0.979	0.954	1.003
糖尿病	1.274	0.355	12.898	<0.01	3.574	1.784	7.163

参考文献 20

[1]	Malluche HH, Blomquist G, Monier-Faugere MC, et al. High parathyroid hormone level and osteoporosis predict progression of coronary artery calcification in patients on dialysis[J]. J Am Soc Nephrol, 2015, 26(10): 2534-2544. doi: 10.1681/ASN.2014070686 pmid: 25838468
[2]	Liu ZH, China Dialysis Calcification Study(CDCS) Group. Vascular calcification burden of Chinese patients with chronic kidney disease: Methodology of a cohort study[J]. BMC Nephrol, 2015, 16:129. doi: 10.1186/s12882-015-0132-3 URL
[3]	朱林, 章衍达, 陈明月, 等. 同型半胱氨酸与冠状动脉钙化的相关性[J]. 中华老年多器官疾病杂志, 2020, 19(2):93-97.
[4]	Kidney disease: Improving Global Outcomes(KDIGO) CKD-MBD Work Group. KDIGO clinical pratice guideline for the diagnosis,evaluation,prevention,and treatment of chronic kidney disease-mineral and bone disorder(CKD-MBD)[J]. Kidney Int Suppl, 2009, 113(113): S44-S49.
[5]	Kauppila LI, Polak JF, Cupples LA, et al. New indices to classify location, severity and progression of calcific lesions in the abdominal aorta: A 25- year follow-up study[J]. Atherosclerosis, 1997, 132(2):245-250. doi: 10.1016/s0021-9150(97)00106-8 pmid: 9242971
[6]	国家肾脏疾病临床医学研究中心. 中国慢性肾脏病矿物质和骨异常诊治指南概要[J]. 肾脏病与透析肾移植杂志, 2019, 28(1): 52-57.
[7]	Wu W, Guan Y, Xu K, et al. Plasma homocysteine levels predict the risk of acute cerebral infarction in patients with carotid artery lesions[J]. Mol Neurobiol, 2016, 53(4): 2510-2517. doi: 10.1007/s12035-015-9226-y pmid: 26063590
[8]	Zaric BL, Obradovic M, Bajic V, et al. Homocysteine and hyperhomocysteinaemia[J]. Curr Med Chem, 2019, 26(6): 2948-2961. doi: 10.2174/0929867325666180313105949 URL
[9]	程虹. 中晚期慢性肾脏病患者血管钙化管理[J]. 中国实用内科杂志, 2023, 43(3):218-224.
[10]	郑丽华, 杜润森, 赵亚恒, 等. 血管钙化的影响因素及预测指标[J]. 临床荟萃, 2022, 37(2):114-118.
[11]	Chao MC, Hu SL, Hsu HS, et al. Serum homocysteine level is positively associated with chronic kidney disease in a Taiwan Chinese population. J Nephrol, 2014, 27(3): 299-305. doi: 10.1007/s40620-013-0037-9 URL
[12]	王翠, 林昊, 武萍萍, 等. 2型糖尿病患者高同型半胱氨酸血症与早期肾脏疾病的相关性[J]. 临床荟萃, 2023, 38(1):42-45.
[13]	Zhou YF, Guan YF. [Hyperhomocysteinemia and kidney diseases][J]. Sheng Li Xue Bao, 2018, 70(6):607-611.
[14]	Fang K, Chen Z, Liu M, et al. Apoptosis and calcification of vascular endothelial cell under hyperhomocysteinemia[J]. Med Oncol, 2015, 32(1): 403.
[15]	Farrokhi E, Samani KG, Chaleshtori MH. Oxidized low-density lipoprotein increases bone sialoprotein expression in vascular smooth muscle cells via runt-related transcription factor 2[J]. Am J Med Sci, 2015, 349(3): 240-243. doi: 10.1097/MAJ.0000000000000381 pmid: 25504218
[16]	詹雪梅, 张珣, 王婧婧, 等. 同型半胱氨酸、超敏C反应蛋白和载脂蛋白A联合检测冠心病的可靠性评价[J]. 基层医学论坛, 2023, 27(8):26-28.
[17]	Yan W, Cao Y, Zhen P, et al. Decreased autophagy of vascular smooth muscle cells was involved in hyperhomocysteinemia-induced vascular ageing[J]. Clin Exp Pharmacol Physiol, 2021, 48((4):524-533. doi: 10.1111/cep.v48.4 URL
[18]	Fu Y, Wang X, Kong W. Hyperhomocysteinaemia and vascular injury: Advances in mechanisms and drug targets[J]. Br J Pharmacol, 2018, 175(8):1173-1189. doi: 10.1111/bph.v175.8 URL
[19]	Mccully KS. Homocysteine and the pathogenesis of atherosclerosis[J]. Expert Rev Clin Pharmacol, 2015, 8(2):211-219. doi: 10.1586/17512433.2015.1010516 URL
[20]	Ammirati AL, Dalboni MA, Cendoroglo M, et al. The progression and impact of vascular calcification in peritoneal dialysis patients[J]. Perit Dial Int, 2007, 27(3):340-346. doi: 10.1177/089686080702700325 URL