Potter Kathleen, Hankey Graeme J, Green Daniel J, Eikelboom John W, Arnolda Leonard F
Department of Cardiology, Level 4, A Block, Royal Perth Hospital, Perth WA6847, Australia.
Arterioscler Thromb Vasc Biol. 2008 Jun;28(6):1158-64. doi: 10.1161/ATVBAHA.108.162743. Epub 2008 Mar 20.
The purpose of this study was to determine whether adjustment for renal function eliminates the relationship between total plasma homocysteine (tHcy) and vascular risk, assessed by carotid intima medial thickness (CIMT) and flow-mediated dilation (FMD) of the brachial artery.
We used cross-sectional data from 173 stroke patients treated with B-vitamins (folic acid 2 mg, vitamin B(6) 25 mg, and vitamin B(12) 0.5 mg) or placebo in a randomized double-blinded trial to test the relationships between posttreatment tHcy, cystatin C (a marker of glomerular filtration rate), estimated glomerular filtration rate (eGFR, Modification of Diet in Renal Disease equation) creatinine, CIMT, and FMD in stepwise and multivariable regression models. The strong linear relationship between tHcy and cystatin C was not altered by long-term B-vitamin treatment. tHcy lost significance as a predictor of the vascular measurements after adjustment for any single marker of renal function. Cystatin C, but not tHcy, was a significant independent predictor of FMD after adjustment for age, sex, smoking, systolic blood pressure, high-density lipoprotein cholesterol, and treatment group.
Adjusting for renal function eliminates the relationship between tHcy and CIMT and FMD, supporting the hypothesis that elevated tHcy is a marker for renal impairment rather than an independent cardiovascular risk factor.
本研究旨在确定通过颈动脉内膜中层厚度（CIMT）和肱动脉血流介导的血管舒张功能（FMD）评估肾功能调整后，血浆总同型半胱氨酸（tHcy）与血管风险之间的关系是否消除。
我们在一项随机双盲试验中使用了173例接受B族维生素（叶酸2mg、维生素B6 25mg和维生素B12 0.5mg）或安慰剂治疗的中风患者的横断面数据，以逐步和多变量回归模型测试治疗后tHcy、胱抑素C（肾小球滤过率标志物）、估计肾小球滤过率（eGFR，肾脏病饮食改良方程）、肌酐、CIMT和FMD之间的关系。长期B族维生素治疗并未改变tHcy与胱抑素C之间的强线性关系。在对任何单一肾功能标志物进行调整后，tHcy作为血管测量指标的预测因子失去了显著性。在对年龄、性别、吸烟、收缩压、高密度脂蛋白胆固醇和治疗组进行调整后，胱抑素C而非tHcy是FMD的显著独立预测因子。
对肾功能进行调整可消除tHcy与CIMT及FMD之间的关系，支持了升高的tHcy是肾功能损害标志物而非独立心血管危险因素的假说。
