Hoogeveen E K, Kostense P J, Jager A, Heine R J, Jakobs C, Bouter L M, Donker A J, Stehouwer C D
Institute for Research in Extramural Medicine, Vrije Universiteit, Amsterdam, The Netherlands.
Kidney Int. 1998 Jul;54(1):203-9. doi: 10.1038/sj.ki.4495353.
Microalbuminuria (MA) is a strong predictor of cardiovascular disease, but its causes are incompletely understood. Hyperhomocysteinemia is a recently recognized risk factor for cardiovascular disease independent of established risk factors. It is not known whether hyperhomocysteinemia is associated with MA, and thus could be a possible cause of microalbuminuria.
We studied an age-, sex- and glucose-tolerance-stratified random sample of a 50- to 75-year old general Caucasian population (N = 680). The urinary albumin-to-creatinine ratio (ACR) was measured in an early morning spot urine sample. MA was defined as an ACR > 3.0 mg/mmol.
The prevalence of MA was 4.3% (13 of 304) in subjects with normal glucose tolerance, 9.2% (17 of 185) in impaired glucose tolerance and 18.3% (30 of 164) in non-insulin-dependent diabetes mellitus (NIDDM); it was 3.7% (15 of 402) in subjects without hypertension and 17.9% (45 of 251) in those with hypertension. After adjusting for age, sex, glucose tolerance category, hypertension, dyslipidemia and smoking, the odds ratio [OR; 95% confidence interval (95%CI)] for MA per 5 mumol/liter total homocysteine increment was 1.33 (1.08 to 1.63). Additional adjustment for HbA1c, waist-hip ratio, protein intake and serum creatinine did not attenuate the association between MA and total homocysteine. A 0.1 g/kg.day increment of protein intake was also associated with an increased risk for MA after adjustment for age, sex, classical risk factors and serum total homocysteine [OR (95% CI); 1.20 (1.08 to 1.32)].
Both hyperhomocysteinemia and protein intake are related to microalbuminuria independent of NIDDM and hypertension. Hyperhomocysteinemia may partly explain the link between MA and increased risk of cardiovascular disease.
微量白蛋白尿（MA）是心血管疾病的有力预测指标，但其病因尚未完全明确。高同型半胱氨酸血症是最近被认识到的独立于既定危险因素的心血管疾病危险因素。目前尚不清楚高同型半胱氨酸血症是否与MA相关，因此可能是微量白蛋白尿的一个潜在病因。
我们研究了一个年龄、性别和糖耐量分层的50至75岁白种人普通人群随机样本（N = 680）。在清晨随机尿样中测量尿白蛋白与肌酐比值（ACR）。MA定义为ACR > 3.0mg/mmol。
糖耐量正常者中MA患病率为4.3%（304例中的13例），糖耐量受损者中为9.2%（185例中的17例），非胰岛素依赖型糖尿病（NIDDM）患者中为18.3%（164例中的30例）；无高血压者中为3.7%（402例中的15例），有高血压者中为17.9%（251例中的45例）。在调整年龄、性别、糖耐量类别、高血压、血脂异常和吸烟因素后，总同型半胱氨酸每增加5μmol/L时MA的优势比[OR；95%置信区间（95%CI）]为1.33（1.08至1.63）。进一步调整糖化血红蛋白、腰臀比、蛋白质摄入量和血清肌酐后，MA与总同型半胱氨酸之间的关联并未减弱。在调整年龄、性别、经典危险因素和血清总同型半胱氨酸后，蛋白质摄入量每增加0.1g/kg·天也与MA风险增加相关[OR（95%CI）；1.20（1.08至1.32）]。
高同型半胱氨酸血症和蛋白质摄入量均与微量白蛋白尿相关，且独立于NIDDM和高血压。高同型半胱氨酸血症可能部分解释了MA与心血管疾病风险增加之间的联系。
