School of Medicine, Shandong Provincial Qianfoshan Hospital, Shandong University , Jinan, China.
Department of Cardiology, The First Affiliated Hospital of Shandong First Medical University , Jinan, China.
Clin Exp Hypertens. 2020 Aug 17;42(6):565-570. doi: 10.1080/10641963.2020.1739698. Epub 2020 Mar 14.
In several studies, homocysteine (hcy) is a documented risk for predicting renal function decline. The differential effects between various levels of hcy have yet to be quantified.
In this retrospective cohort study, data was obtained from patients admitted to our hospital from Jan. 2015 to Apr. 2019. Hyperhomocysteinemia is defined as serum hcy concentration >15 μmol/L. Study population eligible subjects included those who had a diagnostic hypertension. The endpoint event was defined as a fall in eGFR between the follow-up and baseline. Logistic regression models were used to examine the related ratio risk results. Cox models were performed to explore the effect of study groups on survival. The significant level was set at a value of <0.05.
A total of 7,240 patients presented over 3,564 person-years and were retrospectively enrolled in this study. Overall, 1,145 patients had a hypertension grade 1 [15.8%], 2,455 hypertension grade 2 [33.9%], and 3,640 hypertension grade 3 [50.27%]. Among patients who developed hyperhomocysteinemia (3,604 patients), their renal function had a higher long-term rate of decline (= .005, hazard ratio (HR) = 1.097, 95% confidence interval (CI) [1.028, 1.171]), compared to patients who didn't developed hyperhomocysteinemia (3,636 patients). After adjusting for covariables, patients' (hcy > 15 μmol/L group) eGFR decreasing had a more hazard ratio ( = .002, = 1.112; 95%CI [1.039, 1.190]). Compared with the serum hcy ≤ 10 μmol/L patients, their renal function decline ratio was higher in the 10 μmol/L < hcy ≤ 15 μmol/L group ( = .008, = 1.195, 95% CI [1.048,1.364]), 15 μmol/L < hcy ≤ 20 μmol/L group ( = .000, = 1.400, 95%CI [1.227,1.597]), and hcy > 20 μmol/L group ( = .000, HR = 1.475, 95%CI [1.305,1.667]).
Elevated hcy concentration increases the risk of renal function decline in hypertensive patients. Hcy concentration might also be considered as an important factor in risk stratification of the renal function for hypertensive patients.
在几项研究中，同型半胱氨酸（hcy）是预测肾功能下降的已知风险因素。但不同 hcy 水平的差异影响尚未被量化。
在这项回顾性队列研究中，数据来自于 2015 年 1 月至 2019 年 4 月期间在我院住院的患者。高同型半胱氨酸血症定义为血清 hcy 浓度>15μmol/L。合格的研究人群包括那些患有诊断性高血压的患者。终点事件定义为随访和基线之间 eGFR 的下降。使用逻辑回归模型来检查相关的比值风险结果。使用 Cox 模型来探讨研究组对生存的影响。显著性水平设定为 P 值 <0.05。
共有 7240 名患者在 3564 人年中出现，并被回顾性纳入本研究。总体而言，1145 名患者患有 1 级高血压[15.8%]，2455 名患者患有 2 级高血压[33.9%]，3640 名患者患有 3 级高血压[50.27%]。在发生高同型半胱氨酸血症的患者中（3604 例），他们的肾功能有更高的长期下降率（=0.005，风险比（HR）=1.097，95%置信区间（CI）[1.028，1.171]），与未发生高同型半胱氨酸血症的患者（3636 例）相比。在调整了协变量后，患者的（hcy>15μmol/L 组）eGFR 下降的风险比更高（=0.002，=1.112；95%CI [1.039，1.190]）。与血清 hcy≤10μmol/L 的患者相比，血清 hcy 为 10μmol/L<hcy≤15μmol/L 组（=0.008，=1.195，95%CI [1.048，1.364]）、15μmol/L<hcy≤20μmol/L 组（=0.000，=1.400，95%CI [1.227，1.597]）和 hcy>20μmol/L 组（=0.000，HR=1.475，95%CI [1.305，1.667]）的肾功能下降比例更高。
升高的 hcy 浓度增加了高血压患者肾功能下降的风险。hcy 浓度也可能被视为高血压患者肾功能风险分层的一个重要因素。
