基于NHANES数据库中年人群血清同型半胱氨酸水平与肾功能下降的阈值效应分析

来源期刊：广州医药 | 1061-1068 发布时间：2025-09-17 收稿时间：2025/11/13 18:52:16 阅读量：28

作者：: 何婷,

彭晓辉,

黄玉宇,

王衍慧,

连兴基,

张兵,

关键词：: 血清同型半胱氨酸肾功能下降阈值效应 NHANES; homocysteine renal function decline threshold effect NHANES

DOI：: 10.20223/j.cnki.1000-8535.2025.08.007

收稿时间：: 2025-03-11
修订日期：
接收日期：
引用总数：: 0

目的血清同型半胱氨酸（Hcy）水平与慢性肾脏病（CKD）的进展相关,但中年人群的非线性关联研究较少,本研究旨在寻找慢性肾脏病危险因素。方法本研究基于NHANES 1996—2006年数据,纳入5 361例45~65岁参与者,以估算肾小球滤过率（eGFR）<60 mL/（min·1.73 m²）和尿白蛋白/肌酐比值（uACR）≥30 mg/g评估肾功能下降。结果通过逻辑回归及平滑曲线拟合分析发现,Hcy每升高1 µmol/L,eGFR降低的风险增加8%（OR=1.08,95%CI：1.06~1.10）,uACR升高的风险增加2%（OR=1.02,95%CI：1.00~1.04）。非线性分析显示,Hcy对eGFR的阈值效应拐点为13.4 µmol/L（拐点左侧OR=1.59,95%CI：1.49~1.70;右侧无显著关联）。亚组分析表明,性别、高血压、糖尿病等协变量无交互作用,然而,在敏感性分析中,糖尿病患者中Hcy与eGFR降低的关联更强（交互P=0.015 8）。结论本研究提示,控制Hcy水平或可延缓美国中年人群（尤其是糖尿病患者）的肾功能衰退。

1、 WANG L,CHEN J,LI J,et al.Threshold effect of plasma total homocysteine levels on cognitive function among hypertensive patients in China:A cross-sectional study[J].Front Neurol,2022(13):890499.

2、 CAI C,XIAO R,van HALM-LUTTERODT N,et al.Association of MTHFR,SLC19A1 genetic polymorphism,serum folate,vitamin B₁₂ and hcy status with cognitive functions in Chinese adults[J].Nutrients,2016,8(10):665.

3、 ZHANG C,XIA M,BOINI K M,et al.Epithelial-to-mesenchymal transition in podocytes mediated by activation of NADPH oxidase in hyperhomocysteinemia[J].Pflugers Arch,2011,462(3):455-467.

4、 XIAO W,YE P,WANG F,et al.Plasma homocysteine is a predictive factor for accelerated renal function decline and chronic kidney disease in a community-dwelling population[J].Kidney Blood Press Res,2021,46(5):541-549.

5、 OSTRAKHOVITCH E A,TABIBZADEH S.Homocysteine in chronic kidney disease[J].Adv Clin Chem,2015(72):77-106.

6、 KUMAR J,INGELSSON E,LIND L,et al.No evidence of a causal relationship between plasma homocysteine and type 2 diabetes:A mendelian randomization study[J].Front Cardiovasc Med,2015(2):11.

7、 HUANG T,REN J,HUANG J,et al.Association of homocysteine with type 2 diabetes:A meta-analysis implementing mendelian randomization approach[J].BMC Genomics,2013(14):867.

8、 COHEN E,MARGALIT I,SHOCHAT T,et al.The relationship between the concentration of plasma homocysteine and chronic kidney disease:A cross sectional study of a large cohort[J].J Nephrol,2019,32(5):783-789.

9、 FRANCIS M E,EGGERS P W,HOSTETTER T H,et al.Association between serum homocysteine and markers of impaired kidney function in adults in the United States[J].Kidney Int,2004,66(1):303-312.

10、 KONG X,MA X,ZHANG C,et al.Hyperhomoc-ysteinemia increases the risk of chronic kidney disease in a Chinese middle-aged and elderly population-based cohort[J].Int Urol Nephrol,2017,49(4):661-667.

11、 RASZEWSKI G,LOROCH M,OWOC A,et al.Homocysteine and cognitive disorders of postmenopausal women measured by a battery of computer tests:Central nervous system vital signs[J].Arch Womens Ment Health,2015,18(4):623-630.

12、 MORRIS M S.The role of B vitamins in preventing and treating cognitive impairment and decline[J].Adv Nutr,2012,3(6):801-812.

13、 LEVEY A S,STEVENS L A,SCHMID C H,et al.A new equation to estimate glomerular filtration rate[J].Ann Intern Med,2009,150(9):604-612.

14、魏锦坤,林锡民,黄南和.冠心病患者血清HCY、HO-1水平及其与冠状动脉Gensini积分的相关性研究[J].广州医药,2022,53(5):72-75.

15、 SHEN Z,ZHANG Z,ZHAO W.Relationship between plasma homocysteine and chronic kidney disease in US patients with type 2 diabetes mellitus:A cross-sectional study[J].BMC Nephrol,2022,23(1):419.

16、 SHANKAR A,WANG J J,CHUA B,et al.Positive association between plasma homocysteine level and chronic kidney disease[J].Kidney Blood Press Res,2008,31(1):55-62.

17、 LI Y,DAVID SPENCE J,WANG X,et al.Effect of vitamin B₁₂ levels on the association between folic acid treatment and CKD progression:A post hoc analysis of a folic acid interventional trial[J].Am J Kidney Dis,2020,75(3):325-332.

18、 XU X,QIN X,LI Y,et al.Efficacy of folic acid therapy on the progression of chronic kidney disease:The renal substudy of the China stroke primary prevention trial[J].JAMA Intern Med,2016,176(10):1443-1450.

19、 CLARKE R,COLLINS R.Can dietary supplements with folic acid or vitamin B6 reduce cardiovascular risk Design of clinical trials to test the homocysteine hypothesis of vascular disease[J].J Cardiovasc Risk,1998,5(4):249-255.

20、 PERNA A F,INGROSSO D.Homocysteine and chronic kidney disease:An ongoing narrative[J].J Nephrol,2019,32(5):673-675.

21、 LIU S,NIU J,WU S,et al.Urinary albumin-to-creatinine ratio levels are associated with subclinical atherosclerosis and predict CVD events and all-cause deaths:A prospective analysis[J].BMJ Open,2021,11(3):e040890.

22、 LU H,LUO Y,WANG C,et al.The urine albumin-to-creatinine ratio is a reliable indicator for evaluating complications of chronic kidney disease and progression in IgA nephropathy in China[J].Clinics(Sao Paulo),2016,71(5):243-250.

23、 MADERO M,LEVIN A,AHMED S B,et al.Evaluation and management of chronic kidney disease:Synopsis of the kidney disease:Improving global outcomes 2024 clinical practice guideline[J].Ann Intern Med,2025,178(5):705-713.

24、 MILLS K T,XU Y,ZHANG W,et al.A systematic analysis of worldwide population-based data on the global burden of chronic kidney disease in 2010[J].Kidney Int,2015,88(5):950-957.