Moustapha A, Gupta A, Robinson K, Arheart K, Jacobsen D W, Schreiber M J, Dennis V W
Department of Internal Medicine, Cleveland Clinic Foundation, Ohio, USA.
Kidney Int. 1999 Apr;55(4):1470-5. doi: 10.1046/j.1523-1755.1999.00378.x.
Hyperhomocysteinemia is an independent risk factor for atherosclerotic complications in patients with end-stage renal disease, although the mechanisms remain unclear. The major determinants of plasma homocysteine concentration are usually folate, vitamin B12, pyridoxal 5'-phosphate (vitamin B6), and glomerular filtration rate.
We measured factors, including plasma folate, vitamin B12, vitamin B6, creatinine, as well as the dose and duration of dialysis, that might affect plasma homocysteine concentrations in 130 patients on hemodialysis (HD) and compared these observations with those in 46 patients on peritoneal dialysis (PD). Independent determinants of total homocysteine were identified using a multiple logistical regression analysis.
Total homocysteine values averaged 29.8 mumol/liter in HD patients, significantly higher than the mean value of 19.9 mumol/liter observed in patients on PD (P < 0.001). The prevalence of hyperhomocysteinemia was 90.8% among HD patients, significantly higher than the prevalence of 67.4% among PD patients. Folate values in HD patients averaged 45.5 nmol/liter and were significantly lower than in PD patients (104.2 nmol/liter, P < 0.001). For patients on HD, the only determinant of total homocysteine concentration was plasma folate (r = -0.31, P < 0.001). In contrast, for PD patients, total homocysteine did not correlate with plasma folate, vitamin B12, or vitamin B6.
Hyperhomocysteinemia is more prevalent and intense in HD patients compared with those on PD. The homocysteine response may become refractory to excess folate supplementation in PD patients.
高同型半胱氨酸血症是终末期肾病患者发生动脉粥样硬化并发症的一个独立危险因素，尽管其机制尚不清楚。血浆同型半胱氨酸浓度的主要决定因素通常是叶酸、维生素B12、磷酸吡哆醛（维生素B6）和肾小球滤过率。
我们测定了130例血液透析（HD）患者中可能影响血浆同型半胱氨酸浓度的因素，包括血浆叶酸、维生素B12、维生素B6、肌酐以及透析剂量和时间，并将这些观察结果与46例腹膜透析（PD）患者的结果进行比较。使用多元逻辑回归分析确定总同型半胱氨酸的独立决定因素。
HD患者的总同型半胱氨酸值平均为29.8μmol/升，显著高于PD患者观察到的平均值19.9μmol/升（P<0.001）。HD患者中高同型半胱氨酸血症的患病率为90.8%，显著高于PD患者中的患病率67.4%。HD患者的叶酸值平均为45.5nmol/升，显著低于PD患者（104.2nmol/升，P<0.001）。对于HD患者，总同型半胱氨酸浓度的唯一决定因素是血浆叶酸（r=-0.31，P<0.001）。相比之下，对于PD患者，总同型半胱氨酸与血浆叶酸、维生素B12或维生素B6无关。
与PD患者相比，HD患者中高同型半胱氨酸血症更普遍且更严重。PD患者中同型半胱氨酸反应可能对过量补充叶酸变得难治。
