血浆同型半胱氨酸浓度可预测有或无蛋白尿的非胰岛素依赖型糖尿病患者的死亡率。

Plasma homocysteine concentration predicts mortality in non-insulin-dependent diabetic patients with and without albuminuria.

作者信息

Stehouwer C D, Gall M A, Hougaard P, Jakobs C, Parving H H

机构信息

Department of Internal Medicine, Academisch Ziekenhuis Vrije Universiteit and Institute for Cardiovascular Research, Vrije Universiteit, Amsterdam, the Netherlands.

出版信息

Kidney Int. 1999 Jan;55(1):308-14. doi: 10.1046/j.1523-1755.1999.00256.x.

DOI:10.1046/j.1523-1755.1999.00256.x

PMID:9893141

Abstract

BACKGROUND

A high plasma total homocysteine (tHcy) concentration is a risk factor for cardiovascular disease in the nondiabetic population and in nondiabetic patients with end-stage renal disease.

METHODS

We prospectively evaluated the impact of tHcy concentrations on mortality in 211 white non-insulin-dependent diabetic (NIDDM) patients of less than 70 years of age at entry (61 with microalbuminuria and 44 with macroalbuminuria). They were followed for a median of 6.4 (range 0.2 to 7.1) years.

RESULTS

At the end of the follow-up period, 49 of 211 (23%) patients had died, 30 (61%) from cardiovascular disease. Univariate Cox survival analysis revealed that baseline tHcy level (1 micromol/liter) was associated with an increased all-cause mortality risk of 1.11 [95% confidence interval (CI) 1.08 to 1.15, P < 0.0001], and a cardiovascular mortality risk of 1.09 (CI 1.03 to 1.16, P < 0.01). The six-year cumulative all-cause mortality hazard was 44%, 14%, and 15% in the high (tHcy >/= 8.2 micromol/liter), the middle (tHcy 6. 2-8.1 micromol/liter), and the low (tHcy </= 6.1 micromol/liter) tertile of tHcy levels, respectively (P < 0.001 high vs. middle; P < 0.001 high vs. low; and P = 0.88 middle vs. low). Cox proportional hazards regression analysis revealed significant predictors of all-cause mortality to be tHcy level (per 1 micromol/liter), relative risk 1.09 (1.03 to 1.14); pre-existing coronary heart disease (yes vs. no), relative risk 1.98 (1.09 to 3.61); log10 albumin excretion rate (AER; factor 10), relative risk 1.89 (1.31 to 2.74); and age (per 1 year), relative risk 1.08 (1.03 to 1.13). Predictors of cardiovascular mortality were pre-existing coronary heart disease, log10 AER, and age. tHcy level did not predict cardiovascular mortality independently of these risk factors.

CONCLUSION

Plasma tHcy concentration is a significant predictor of mortality in NIDDM patients with or without albuminuria.

摘要

背景

高血浆总同型半胱氨酸（tHcy）浓度是无糖尿病人群及终末期肾病非糖尿病患者心血管疾病的一个危险因素。

方法

我们前瞻性评估了tHcy浓度对211例年龄小于70岁的白人非胰岛素依赖型糖尿病（NIDDM）患者死亡率的影响（61例有微量白蛋白尿，44例有大量白蛋白尿）。对他们进行了中位时间为6.4年（范围0.2至7.1年）的随访。

结果

在随访期末，211例患者中有49例（23%）死亡，30例（61%）死于心血管疾病。单因素Cox生存分析显示，基线tHcy水平每升高1微摩尔/升，全因死亡风险增加1.11[95%置信区间（CI）1.08至1.15，P<0.0001]，心血管死亡风险增加1.09（CI 1.03至1.16，P<0.01）。tHcy水平处于高（tHcy≥8.2微摩尔/升）、中（tHcy 6.2 - 8.1微摩尔/升）、低（tHcy≤6.1微摩尔/升）三分位数时，六年累积全因死亡风险分别为44%、14%和15%（高与中比较，P<0.001；高与低比较，P<0.001；中与低比较，P = 0.88）。Cox比例风险回归分析显示，全因死亡的显著预测因素为tHcy水平（每1微摩尔/升），相对风险1.09（1.03至1.14）；既往冠心病（是与否），相对风险1.98（1.09至3.61）；log10白蛋白排泄率（AER；乘以10），相对风险1.89（1.31至2.74）；以及年龄（每1岁），相对风险1.08（1.03至1.13）。心血管死亡的预测因素为既往冠心病、log10 AER和年龄。tHcy水平独立于这些危险因素不能预测心血管死亡。