發(fā)布時間：2018-03-29 22:36

  本文選題：同型半胱氨酸　切入點(diǎn)：高同型半胱氨酸血癥　出處：《天津醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的隨著關(guān)于同型半胱氨酸(Hcy)研究的增多,越來越多的研究者發(fā)現(xiàn)血清Hcy濃度增高與腎功能損傷之間存在一定的相關(guān)性。腎功能損害發(fā)展到終末期時,血清Hcy水平顯著升高,可高于正常值的3-5倍。目前關(guān)于Hcy水平與腎損傷之間關(guān)系的研究,多集中于臨床確診的有明確引起腎損傷的原發(fā)病的患者中,如高血壓腎損害、糖尿病腎病等。而在沒有可引起腎損害的疾病的人群中,血清Hcy濃度升高是否與腎功能變化也有關(guān)系?目前這方面的研究相對還較少,仍無明確定論,針對該問題我們前期已研究了健康老年男性血清Hcy水平與腎損傷的關(guān)系,發(fā)現(xiàn)血清Hcy水平增高和高齡是導(dǎo)致腎損傷的不可忽視的危險(xiǎn)因素。那么在同時排除疾病與年齡因素的影響之后,血清Hcy水平與腎功能變化是否仍有關(guān)系?我們進(jìn)一步以中年男性體檢者為觀察對象,旨在探討排除疾病與高齡的影響之后,血清Hcy水平與腎功能變化的關(guān)系。方法在2014年1月到2015年12月于天津醫(yī)科大學(xué)總醫(yī)院干部體檢中心進(jìn)行健康體檢的人群中,隨機(jī)選取44-90歲近兩年無吸煙史及規(guī)律飲酒史的男性體檢者共974例,剔除其中數(shù)據(jù)不全者、明確診斷患有高血壓、糖尿病、冠心病、高脂血癥、各種慢性腎臟病等疾病并服用降壓、降糖、降脂等藥物的患者、近期服用過具有明顯腎毒性藥物的患者,最終選取752例男性健康體檢者納入本研究。抽取靜脈血,采用酶法測定Hcy,乳膠免疫比濁法測定胱抑素C(Cys C),以Hoek′s公式或Cockcroft-Gault(CG)公式計(jì)算GFR。將研究對象按年齡分組,44-64歲的體檢者為中年男性組(n=403),65歲及以上的體檢者為老年男性組(n=349),分析對比兩組之間血清Hcy、GFR分布的不同。根據(jù)美國腎臟病基金會制定的慢性腎臟病分期,將GFR90 ml/(min·1.73m~2)作為早期腎損傷的判斷標(biāo)準(zhǔn),GFR60 ml/(min·1.73m~2)作為中度腎損傷的判斷標(biāo)準(zhǔn)。以血清Hcy濃度≥15μmol/L為高同型半胱氨酸血癥(HHcy)診斷標(biāo)準(zhǔn),將403例中年男性分為HHcy組(n=130)和對照組(n=273),分析比較兩組之間血清Hcy水平、年齡、身高、體重、BMI、血壓、血糖、血脂、尿素、尿酸、肌酐、Cys C、GFR、早期腎功能損傷患病率等指標(biāo)的差異;分析中年男性組GFR與血清Hcy濃度、收縮壓、舒張壓之間的相關(guān)性;按血清Hcy水平四分位間距將403例中年男性分成4組,用Logistic回歸模型分析血清Hcy水平與早期腎功能損傷患病危險(xiǎn)度的關(guān)系。結(jié)果老年男性組血清Hcy平均水平為15.66μmol/L,HHcy患病率為45.27%(158/349),GFR平均水平為67.83ml/(min·1.73m~2),中度腎功能損傷患病率為36.67%(128/349)。中年男性組血清Hcy平均水平為14.30μmol/L,HHcy患病率為32.26%(130/403),Cys C平均水平為0.79mg/L,GFR平均水平為99.99ml/(min·1.73m~2),早期腎功能損傷患病率為24.07%(97/403)。中年男性人群HHcy組血清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]、早期腎功能損傷患病率[(36.15%)vs(18.31%)]顯著高于對照組,GFR[(94.96±15.00)vs(102.38±14.19)ml/(min·1.73m~2)]顯著低于對照組(P均0.001),收縮壓與舒張壓高于對照組,差異不顯著(P分別為0.070、0.055)。中年男性組GFR與Hcy(r=-0.247,P0.001)、收縮壓(r=-0.098,P=0.049)負(fù)相關(guān),與舒張壓無相關(guān)性(r=-0.078,P=0.118)。將中年男性組按Hcy水平四分位分組之后進(jìn)行Logistic回歸分析顯示,隨血清Hcy水平升高,早期腎功能損傷患病風(fēng)險(xiǎn)增加,以1組為參考,2、3、4組OR值分別為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);單因素方差分析顯示,四組中可能影響GFR的各指標(biāo)中只有Hcy(F=269.556,P0.001)和血糖(F=3.948,P=0.009)有顯著差異,向后回歸分析結(jié)果發(fā)現(xiàn)血糖對早期腎功能損傷無顯著影響(P=0.146),血清Hcy水平對早期腎功能損傷患病風(fēng)險(xiǎn)有影響(P0.001)。結(jié)論本研究通過調(diào)查天津市干部體檢中部分44-90歲中老年男性血清Hcy水平和腎功能,發(fā)現(xiàn)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作為腎功能的評價指標(biāo),發(fā)現(xiàn)中年男性早期腎損傷患病率接近四分之一,老年男性早期腎損傷患病率百分之五十,中度腎損傷患病率達(dá)三分之一。在中年男性HHcy組中,GFR平均水平更低,早期腎功能損傷患病率更高;隨著血清Hcy水平升高,GFR逐漸下降,早期腎功能損傷患病危險(xiǎn)度上升。因此我們推測,血清Hcy水平升高是腎功能損傷的一個重要的危險(xiǎn)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鹵11)vs(80鹵9)渭mol/L],Cys C[(0.83鹵0.13)vs(0.77鹵0.10)mg/L],鏃╂湡鑲懼姛鑳芥崯浼ゆ?zhèn)ｇ梾鐜嘯(36.15%)vs(18.31%)]鏄捐憲楂樹簬瀵圭収緇，

本文編號：1683203