老年高血压患者血同型半胱氨酸水平与肾功能损伤的相关性

Relationship between homocysteine level and renal function impairment in elderly patients with hypertension

关键词:  老年人  H型高血压  同型半胱氨酸  肾功能损伤  肾小球滤过率

Key words:  elderly people  H-type hypertension  homocysteine  glomerular filtration rate  impaired renal function

摘要:

目的 探讨老年高血压患者血同型半胱氨酸（homocysteine, Hcy）水平与肾功能损伤的相关性。方法本研究数据来自于“如皋衰老队列研究”第2次横断面调查。共纳入Hcy、肾小球滤过率资料均完整的老年高血压患者1295例，年龄70～87岁，平均年龄(77.2±4.3)岁，其中男性582例，女性713例。以血肌酐估算的肾小球滤过率（estimated glomerular filtration rate, eGFR）<90mL/(min·1.73m2)定义肾功能损伤。采用Pearson相关性分析高血压人群中Hcy水平与eGFR的相关性，Logistic回归分析Hcy水平升高与肾功能受损的风险比（OR）。结果 在老年高血压人群中，Hcy平均水平(14.77±6.39)μmol/L，eGFR(89.44±11.96)mL/(min·1.73m2)。Pearson相关性分析显示，血Hcy水平与eGFR相关（r=-0.398,P<0.001）。线性回归分析结果显示，Hcy水平增高与eGFR降低相关（β=-0.745，P<0.001）；Logistic回归分析表明，Hcy每增加1μmol/L,发生肾功能损伤的风险增加0.16倍（P<0.001）。与正常组相比,Hcy轻度升高组（10μmol/L≤Hcy<15μmol/L）,中度升高组（15μmol/L≤Hcy<30μmol/L），重度升高组（Hcy≥30μmol/L组）发生肾功能损伤的OR（95%CI）分别为2.65(1.53～4.58)、8.00(4.45～14.38)和11.87(3.23～43.63)，校正多因素后，差异仍具有统计学意义（P<0.001）。结论 在老年高血压人群中，Hcy升高与eGFR降低相关。Hcy升高增加了老年高血压人群发生肾功能损伤的风险。

Abstract:

Objective To investigate the relationship between serum homocysteine (Hcy) level and renal function impairment in elderly patients with hypertension. Methods Data of 1 295 elderly individuals with hypertension were collected from the Rugao Longevity and Ageing Study. The mean age of participants was (77.2 ± 4.3) year (70-87 years), including 582 men and 713 women. The estimated glomerular filtration rate (eGFR)<90 mL/ (min·1.73m2) was defined as renal impairment. The correlation between serum Hcy level and eGFR in hypertensive patients was analyzed by Pearson’s correlation. Logistic regression analysis was used to analyze the odd ratio of Hcy and the risk of impaired renal function. Results The average level of Hcy was (14.77±6.39) μmol/L and eGFR was (89.44±11.96)mL/(min·1.73m2) in the elderly hypertensive patients. Pearson correlation analysis showed that the level of Hcy was negatively correlated with eGFR (r=-0.398, P<0.001). A significantly trend was found between Hcy and eGFR (β=-0.745, P<0.001). Logistic regression analysis showed that elevated Hcy increased the risk of renal impairment by 0.16 times per 1 μmol/L. The analyses were adjusted for potential confounding factors, including age, gender, BMI, occupation, marital status, education level, smoking status, drinking status, diabetes. In addition, the individuals in mild Hcy group (10 μmol/L≤Hcy<15 μmol/L), moderate group (15 μmol/L≤Hcy<30 μmo/L), severe group (Hcy≥30 μmol/L) had more chances to have renal impairment with ORs of 2.65 (95%CI: 1.53-4.58), 8.00 (95%CI: 4.45-14.38), 11.87 (95%CI: 3.23-43.63), respectively, compared with the normal group (Hcy<10μmol/L). Conclusion Elevated serum homocysteine is significantly associated with the decrease of eGFR and risk of renal impairment in the elderly hypertensive population.