Ruan Litao, Chen Wei, Srinivasan Sathanur R, Xu Jihua, Toprak Ahmet, Berenson Gerald S
Tulane Center for Cardiovascular Health and Department of Epidemiology, Tulane University Health Sciences Center, 1440 Canal Street, New Orleans, LA 70112, USA.
Eur J Epidemiol. 2009;24(6):315-9. doi: 10.1007/s10654-009-9340-0. Epub 2009 Apr 25.
That plasma homocysteine is elevated markedly in renal dysfunction is well recognized. But whether the increased homocysteine is an independent correlate of glomerular filtration rate, a marker of renal function, in asymptomatic younger individuals is not clear. The aim of this study was to determine the association between plasma homocysteine and renal function in a biracial (black-white) community-based cohort of asymptomatic young adults. Plasma homocysteine along with cardiovascular disease risk factor variables were measured in 805 white and 330 black subjects, ages 24-44 years, enrolled in the Bogalusa Heart Study. Modification of Diet in Renal Disease Study equation was used to calculate the estimated glomerular filtration rate (eGFR) from serum creatinine level. Males versus females showed higher homocysteine levels (8.83 +/- 3.16 vs. 7.35 +/- 2.84 micromol/L, p < 0.0001) and lower eGFR (99.1 +/- 17.6 vs. 102.5 +/- 21.0 mL/min/1.73 m(2), p = 0.024). Whites versus blacks had lower eGFR (97.3 +/- 18.0 vs. 110.0 +/- 20.6 mL/min/1.73 m(2), p < 0.0001). In a multivariate regression analysis that included age, race, sex, body mass index, blood pressure, lipoprotein variables, insulin resistance index and homocysteine, white race, age and homocysteine, in that order, were independently and negatively associated with eGFR. The odds ratio (95% confidence interval) of individuals in the homocysteine quintiles II, III, IV and V vs. I for having the risk of impaired eGFR defined as <10th percentile was 2.28 (0.95-5.50, p = 0.065), 2.97 (1.24-7.12, p = 0.015), 3.32 (1.45-7.60, p = 0.005) and 6.99 (3.06-15.94, p < 0.0001), respectively. Homocysteine is an independent correlate of renal function in asymptomatic black and white young adults.
肾功能不全时血浆同型半胱氨酸显著升高已得到广泛认可。但在无症状的年轻个体中，升高的同型半胱氨酸是否是肾小球滤过率（一种肾功能指标）的独立相关因素尚不清楚。本研究的目的是在一个基于社区的双种族（黑人和白人）无症状年轻成年人队列中，确定血浆同型半胱氨酸与肾功能之间的关联。在参加博加卢萨心脏研究的805名白人及330名黑人受试者（年龄在24 - 44岁之间）中，测量了血浆同型半胱氨酸以及心血管疾病风险因素变量。采用肾脏病饮食改良研究方程，根据血清肌酐水平计算估算肾小球滤过率（eGFR）。男性的同型半胱氨酸水平高于女性（8.83±3.16 vs. 7.35±2.84 μmol/L，p<0.0001），eGFR低于女性（99.1±17.6 vs. 102.5±21.0 mL/min/1.7³ m²，p = 0.024）。白人的eGFR低于黑人（97.3±18.0 vs. 110.0±20.6 mL/min/1.7³ m²，p<0.0001）。在一项多变量回归分析中，纳入了年龄、种族、性别、体重指数、血压、脂蛋白变量、胰岛素抵抗指数和同型半胱氨酸，结果显示白人种族、年龄和同型半胱氨酸依次与eGFR独立且呈负相关。同型半胱氨酸五分位数II、III、IV和V组个体与I组相比，发生eGFR受损（定义为<第10百分位数）风险的比值比（95%置信区间）分别为2.28（0.95 - 5.50，p = 0.065）、2.97（1.24 - 7.12，p = 0.015）、3.32（1.45 - 7.60，p = 0.005）和6.99（3.06 - 15.94，p<0.0001）。同型半胱氨酸是无症状黑人和白人年轻成年人肾功能的独立相关因素。
