高同型半胱氨酸血症是接受血液透析的慢性肾衰竭患者发生无症状性脑梗死的一个重要危险因素。

Hyperhomocysteinemia is a significant risk factor for silent cerebral infarction in patients with chronic renal failure undergoing hemodialysis.

作者信息

Anan Futoshi, Takahashi Naohiko, Shimomura Tsuyoshi, Imagawa Muneharu, Yufu Kunio, Nawata Tomoko, Nakagawa Mikiko, Yonemochi Hidetoshi, Eshima Nobuoki, Saikawa Tetsunori, Yoshimatsu Hironobu

机构信息

Department of Cardiology, Oita Red Cross Hospital, and Department of Cardiovascular Science, School of Medicine, Oita University, Oita 879-5593, Japan.

出版信息

Metabolism. 2006 May;55(5):656-61. doi: 10.1016/j.metabol.2005.12.007.

DOI:10.1016/j.metabol.2005.12.007

PMID:16631443

Abstract

In patients with chronic renal failure undergoing hemodialysis (HD), the presence of silent cerebral infarction (SCI) is associated with high mortality. Plasma total homocysteine (tHcy), which increases with renal dysfunction, has been flagged as a novel predictor for cerebrovascular events. We tested the hypothesis that the presence of SCI correlates with tHcy in HD patients. Based on brain magnetic resonance imaging findings, 44 patients undergoing HD were divided into a with-SCI group (61+/-9 years [mean+/-SD]; n=24) and a without-SCI group (60+/-8 years, n=20), in whom 24-hour ambulatory blood pressure monitoring was performed. The number of patients with diabetes or hypertension was not different between the 2 groups. We made the following observations: (1) the percentage of smokers was higher in the with-SCI group than in the without-SCI group (P<.05); (2) plasma levels of high-density lipoprotein cholesterol were lower and tHcy was higher in the with-SCI group than in the without-SCI group (P<.05 and P<.0001, respectively); (3) and systolic ambulatory blood pressure and mean heart rate during nighttime were higher in the with-SCI group than in the without-SCI group (P<.05). Multivariate logistic analysis identified hyperhomocysteinemia as an independent and significant risk factor for SCI (odds ratio, 1.22; 95% CI, 1.10-1.36; P<.01). Our findings indicate that plasma tHcy may be a novel useful predictor for SCI in patients with chronic renal failure undergoing HD.

摘要

在接受血液透析（HD）的慢性肾衰竭患者中，无症状脑梗死（SCI）的存在与高死亡率相关。随着肾功能不全而升高的血浆总同型半胱氨酸（tHcy）已被视为脑血管事件的一种新的预测指标。我们检验了SCI的存在与HD患者tHcy相关的这一假设。根据脑磁共振成像结果，44例接受HD的患者被分为SCI组（61±9岁[均值±标准差]；n = 24）和无SCI组（60±8岁，n = 20），对两组患者进行了24小时动态血压监测。两组间糖尿病或高血压患者数量无差异。我们有以下观察结果：（1）SCI组吸烟者的百分比高于无SCI组（P<0.05）；（2）SCI组的血浆高密度脂蛋白胆固醇水平低于无SCI组，而tHcy高于无SCI组（分别为P<0.05和P<0.0001）；（3）SCI组夜间的动态收缩压和平均心率高于无SCI组（P<0.05）。多因素逻辑分析确定高同型半胱氨酸血症是SCI的一个独立且显著的危险因素（比值比，1.22；95%可信区间，1.10 - 1.36；P<0.01）。我们的研究结果表明，血浆tHcy可能是接受HD的慢性肾衰竭患者中SCI的一种新的有用预测指标。