Bostom A G, Gohh R Y, Bausserman L, Hakas D, Jacques P F, Selhub J, Dworkin L, Rosenberg I H
Division of General Internal Medicine, Memorial Hospital of Rhode Island, Providence, USA.
J Am Soc Nephrol. 1999 Jan;10(1):164-6. doi: 10.1681/ASN.V101164.
Serum creatinine, a surrogate for both renal function and homocysteine generation, is an important determinant of fasting plasma total homocysteine levels in stable renal transplant recipients. In this study, it is hypothesized that among stable renal transplant recipients with normal creatinine levels (i.e., < or = 1.5 mg/dl), serum cystatin C, a more sensitive indicator of GFR, would better predict fasting total homocysteine levels compared with serum creatinine. Fasting plasma total homocysteine, folate, vitamin B12, and pyridoxal 5'-phosphate levels, along with serum cystatin C, creatinine, and albumin levels, were determined in 28 consecutive renal transplant recipients (mean age 47 +/- 14 yr; 60.7% men) with stable allograft function, whose serum creatinine was < or = 1.5 mg/dl. General linear modeling with analysis of covariance revealed that serum cystatin C was independently predictive (partial R = 0.494; P = 0.023) of fasting total homocysteine levels after adjustment for age, gender, vitamin status, albumin, and creatinine levels. In contrast, creatinine levels were not predictive of fasting total homocysteine levels in this model (P = 0.110) or an identical model that excluded cystatin C (P = 0.131). Serum cystatin C levels may reflect subtle decreases in renal function that independently predict fasting total homocysteine levels among stable renal transplant recipients with a normal serum creatinine.
血清肌酐是肾功能和同型半胱氨酸生成的替代指标，是稳定肾移植受者空腹血浆总同型半胱氨酸水平的重要决定因素。在本研究中，我们假设在肌酐水平正常（即≤1.5mg/dl）的稳定肾移植受者中，血清胱抑素C（一种更敏感的肾小球滤过率指标）与血清肌酐相比，能更好地预测空腹总同型半胱氨酸水平。对28例连续的肾移植受者（平均年龄47±14岁；60.7%为男性）进行了研究，这些受者移植肾功能稳定，血清肌酐≤1.5mg/dl，测定了他们的空腹血浆总同型半胱氨酸、叶酸、维生素B12和5'-磷酸吡哆醛水平，以及血清胱抑素C、肌酐和白蛋白水平。通过协方差分析的一般线性模型显示，在调整年龄、性别、维生素状态、白蛋白和肌酐水平后，血清胱抑素C可独立预测空腹总同型半胱氨酸水平（偏相关系数R = 0.494；P = 0.023）。相比之下，在该模型中肌酐水平不能预测空腹总同型半胱氨酸水平（P = 0.110），在排除胱抑素C的相同模型中也是如此（P = 0.131）。血清胱抑素C水平可能反映了肾功能的细微下降，这可独立预测血清肌酐正常的稳定肾移植受者的空腹总同型半胱氨酸水平。
