血清同型半胱氨酸浓度作为老年患者队列中晚期糖尿病肾病的标志物。
Serum homocysteine concentration as a marker for advanced diabetic nephropathy in a cohort of elderly patients.
机构信息
Department of Endocrinology, Shanghai Xuhui Central Hospital/Xuhui Hospital, Fudan University, 966 Huaihai Middle Road, Xuhui District, Shanghai, 200031, China.
Inpatient department, Jiahui International Hospital (Shanghai), 689 Guiping Road, Xuhui District, Shanghai, 200233, China.
出版信息
BMC Endocr Disord. 2023 May 22;23(1):114. doi: 10.1186/s12902-023-01342-1.
BACKGROUND
Hyperhomocysteinemia has been linked with chronic kidney disease (CKD). The present study investigated whether homocysteine (Hcy) serum levels might serve as a marker for the advancement of diabetic nephropathy (DN).
METHODS
Clinical and laboratory indicators including Hcy, vitamin D (VD), urine protein, estimated glomerular filtration rate (eGFR) and the urinary protein/creatinine ratio in subjects > 65 years with DN (n = 1,845), prediabetes (n = 1,180) and in a non-diabetes (control) group (n = 28,720) were analyzed.
RESULTS
DN patients had elevated Hcy concentrations, decreased VD and higher urinary protein levels, a reduced eGFR and a higher urinary protein/creatinine ratio compared with prediabetic and control subjects. After correcting for urinary protein quantitation, multivariate analysis revealed that both the Hcy concentration (P < 0.010) and urinary protein/creatinine ratio (P < 0.001) were risk factors, while the VD2 + VD3 serum concentration (P < 0.001) was a protective factor for DN. Moreover, Hcy > 12 µmol/L was a cut-off value for predicting advanced DN.
CONCLUSION
Hcy serum concentration is a potential marker for the advancement of CKD in DN but not prediabetes patients.
背景
高同型半胱氨酸血症与慢性肾脏病（CKD）有关。本研究探讨了血清同型半胱氨酸（Hcy）水平是否可作为糖尿病肾病（DN）进展的标志物。
方法
分析了>65 岁的 DN 患者（n=1845）、糖尿病前期患者（n=1180）和非糖尿病对照者（n=28720）的临床和实验室指标，包括 Hcy、维生素 D（VD）、尿蛋白、估算肾小球滤过率（eGFR）和尿蛋白/肌酐比值。
结果
与糖尿病前期和对照组相比，DN 患者的 Hcy 浓度升高，VD 降低，尿蛋白水平升高，eGFR 降低，尿蛋白/肌酐比值升高。在对尿蛋白定量进行校正后，多变量分析显示，Hcy 浓度（P<0.010）和尿蛋白/肌酐比值（P<0.001）均为危险因素，而 VD2+VD3 血清浓度（P<0.001）是 DN 的保护因素。此外，Hcy>12 μmol/L 是预测晚期 DN 的截止值。
结论
Hcy 血清浓度是预测 CKD 进展的潜在标志物，但不能用于预测糖尿病前期患者的 CKD 进展。
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