目的 探讨血清胱抑素C（SCys-C）、同型半胱氨酸（Hcy）及尿微量白蛋白（UmAlb）在高血压患者肾损害早期评估中的应用价值。方法 选择2022年9月—2023年9月期间福建中医药大学附属第三人民医院接收的150例高血压患者作为观察组,另选择健康体检者150例为对照组,测定肾小球滤过率（GFR）、SCys-C、Hcy、UmAlb,比较不同血压程度及对照组的各指标水平,比较观察组各指标检测阳性率及诊断符合率,依据GFR值评估肾损害程度,比较不同肾损害程度患者的SCys-C、Hcy、UmAlb水平。结果 高血压2级、高血压3级患者SCys-C、Hcy、UmAlb水平高于高血压1级患者（t=5.255、10.976、21.578,P<0.05;t=7.378、18.012、23.708,P<0.05）及对照组患者（t=8.308、19.675、31.891,P<0.05;t=10.661、31.511、21.578,P<0.05）,高血压3级患者高于高血压2级患者（t=2.776、12.725、7.779,P<0.05）。观察组肾损害患者SCys-C、Hcy、UmAlb的阳性率79.41%、73.53%、83.82%高于无肾损害患者的阳性率6.10%、4.88%、6.10%（χ²=83.733、76.040、92.613,P<0.05）。观察组中重度肾损害、轻度肾损害患者的SCys-C、Hcy、UmAlb水平高于无损害患者（t=7.567、24.214、30.836,P<0.05;t=5.783、16.054、25.164,P<0.05）,中重度肾损害高于轻度肾损害患者（t=2.685、7.179、9.561,P<0.05）。结论 高血压分级越高患者的SCys-C、Hcy、UmAlb水平越高,各指标联合检测的阳性率高,而且SCys-C、Hcy、UmAlb水平越高,肾损害程度越严重。

Objective To explore the application value of serum cystatin C（SCys-C）,homocysteine（Hcy） and urinary microalbumin（UmAlb）in early assessment of renal damage in hypertensive patients．Methods A total of 150 hypertensive patients admitted to the Third People’s Hospital Affiliated to Fujian University of Traditional Chinese Medicine from September 2022 to September 2023 were selected as the observation group,and 150 healthy individuals were selected as the control group．Glomerular filtration rate（GFR）,serum cystatin C（SCys-C）,homocysteine（Hcy）,and UmAlb were measured,and the levels of various indicators in different blood pressure levels and the control group were compared．The positive rate and diagnostic accuracy of each indicator in the observation group were compared,and the degree of renal damage was evaluated based on GFR values．The levels of SCys-C,Hcy and UmAlb in patients with different degrees of renal damage were compared．Results The levels of SCys-C,Hcy and UmAlb in patients with grade 2 and grade 3 hypertension were significantly higher than those in patients with grade 1 hypertension（t=5.255,10.976,21.578,P<0.05;t=7.378,18.012,23.708,P<0.05）,as well as in the control group（t=8.308,19.675,31.891,P<0.05;t=10.661,31.511,21.578,P<0.05）,patients with grade 3 hypertension were significantly higher than those with grade 2 hypertension（t=2.776,12.725,7.779,P<0.05）．The positive rates of SCys-C,Hcy and UmAlb in patients with renal injury in the observation group were 79.41%,73.53% and 83.82%,which were significantly higher than the positive rates of 6.10%,4.88% and 6.10% in patients without renal injury（χ²=83.733,76.040,92.613,P<0.05）．The levels of SCys-C,Hcy and UmAlb in patients with severe and mild kidney damage in the observation group were significantly higher than those in patients without damage（t=7.567,24.214,30.836,P<0.05;t=5.783,16.054,25.164,P<0.05）,patients with moderate to severe kidney damage were significantly higher than those with mild kidney damage（t=2.685,7.179,9.561,P<0.05）．Conclusions The higher the grading of hypertension,the higher the levels of SCys-C,Hcy and UmAlb in patients,and the higher the positive rate of combined detection of various indicators．Moreover,the higher the levels of SCys-C,Hcy and UmAlb,the more severe the renal damage．

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。

Objective Elevated serum homocysteine（Hcy）levels are linked to chronic kidney disease（CKD）progression,yet the nonlinear relationship in middle-aged populations remains underexplored．Methods This study analyzed data from 5 361 participants aged 45-65 years in the NHANES 1996-2006 cohort．Renal dysfunction was defined as an estimated glomerular filtration rate（eGFR）<60 mL/min/1.73 m² and urinary albumin-to-creatinine ratio（uACR）≥30 mg/g．Results Logistic regression and smoothed curve fitting revealed that each 1 µmol/L increase in Hcy elevated the risk of reduced eGFR by 8%（OR=1.08,95% CI：1.06-1.10）and uACR by 2%（OR=1.02,95% CI：1.00-1.04）．A nonlinear threshold effect was identified at 13.4 µmol/L,with a stronger association below this threshold（OR=1.59,95% CI：1.49-1.70）and no significant effect above it．Subgroup analyses showed no interactions with gender or hypertension,but a stronger Hcy-eGFR association was observed in diabetics（interaction P=0.0158）．Conclusions These findings suggest that controlling Hcy levels may mitigate renal decline,particularly in diabetic populations,warranting further causal investigations．

目的 了解疫情期间医护人员代谢综合征(MS)、高同型半胱氨酸血症(HHcy)的患病率、二者关系及靶器官损害。方法 选取2020年1月—2021年11月在天津市某三级综合医院的1 544名医护人员作为研究对象。测量人体指标,测定血液生化、免疫等指标。分析MS及其组分的患病率、HHcy的患病率及靶器官损害。采用χ²检验,比较MS组、HHcy组与对照组靶器官损害的差异。采用Logistic回归模型分析MS与HHcy的关系。结果 三级综合医院医护人员疫情期间MS患病率为23.7%,MS组分:中心性肥胖、高血压/高血压病、高甘油三酯、低高密度脂蛋白和高空腹葡萄糖/糖尿病的患病率分别为49.4%、19.3%、24.3%、0.5%和37%。HHcy的患病率为29.7%。MS组、HHcy组与对照组靶器官损害程度差异有统计学意义(P<0.001)。HHcy与MS无直接相关性。结论 疫情期间医护人员MS和HHcy患病率较高,与对照组相比有明显的靶器官损害,HHcy不是MS的独立危险因素。

Objective To explore the prevalence of metabolic syndrome (MS) and hyperhomocysteinemia (HHcy), their relationship and target organ damage among medical staff during the pandemic. Methods A total of 1 544 medical staff in a third-class general hospital in Tianjin from January 2020 to November 2021 were selected as the object of study. The indexes of human body were measured, and the indexes of blood biochemistry and immunity were detected. The prevalence of MS and its components, the prevalence of HHcy and target organ damage were analyzed. χ² test was used to analyze the difference of target organ damage among MS group, HHcy group and control group. The relationship between HHcy and MS was analyzed by Logistic regression model. Results The prevalence of MS among medical staff in the third-class general hospital during the pandemic was 23.7%. The prevalence of central obesity, hypertension / hypertension disease, high triglyceride, low high density lipoprotein cholesterol and high fasting plasma glucose/diabetes were 49.4%, 19.3%, 24.3%, 0.5% and 37%, respectively. The prevalence of HHcy was 29.7%. There was significant difference in target organ damage among MS group, HHcy group and control group (P<0.001). There was no direct correlation between HHcy and MS. Conclusions During the pandemic period, the prevalence of MS and HHcy in medical staff were high, and there was obvious target organ damage in those staff compared with the control staff. HHcy is not an independent risk factor of MS.

目的 分析血清小而密低密度脂蛋白胆固醇和同型半胱氨酸与脑梗死的关系。方法 择取2018年9月—2019年8月本院收治的脑梗死患者135例设为观察组,同期本院参与体检的健康志愿者135例为对照组,两组受试者均开展血液检测,收集并分析临床资料。结果 观察组性别、平均年龄、吸烟、fib水平与对照组差异无统计学意义(P＞0.05);观察组高血压患病率、糖尿病患病率、TG、LDL-C、sdLDL-C、Lp-PLA2、FBG、Hcy、D-D水平均高于对照组(P＜0.05);观察组TC、HDL-C、PT、APTT、TT水平均低于对照组(P＜0.05);按照NIHSS＜4分、4～15分、≥16分分成轻度组(甲组,n=53)、中度组(乙组,n=49)、重度组(丙组,n=33);甲组、乙组及丙组,两两亚组比较LDL-C、HDL-C、Hcy、sdLDL-C、Lp-PLA2、D-D、PT、APTT、TT及FBG,差异有统计学意义(P＜0.05);甲组、丙组饮酒率差异有统计学意义(P＜0.05);甲组与丙组、乙组与丙组冠心病患病率、Fib水平差异有统计学意义(P＜0.05)。结论 血清小而密低密度脂蛋白胆固醇和同型半胱氨酸与脑梗死有一定关联。

Objective To analyze the relationship of serum small and dense low density lipoprotein cholesterol and homocysteine in cerebral infarction. Methods 135 patients with cerebral infarction admitted to our hospital from September 2018 to August 2019 were selected as the observation group, and 135 healthy volunteers who participated in physical examination in our hospital during the same period were selected as the control group. Results There were no significant differences in sex, average age, smoking, fib level between the observation group and the control group (P>0.05). The prevalence of hypertension, diabetes mellitus, TG, LDL-C, SDLDL-C, LP-PLA2, FBG, Hcy and D-D in the observation group were all higher than those in the control group (P<0.05). The TC, HDL-C, PT, APTT and TT levels in the observation group were all lower than those in the control group (P<0.05). According to NIHSS<4 points, 4~15 points and ≥16 points, the patients were divided into mild group (group A, n=53), moderate group (group B, n=49) and severe group (group C, n=33). Ldl-c, HDL-C, Hcy, SDLDL-C, LP-PLA2, D-D, PT, APTT, TT and FBG were compared in group A, group B and group C, and the differences were statistically significant (P<0.05). The difference of drinking rate between group A and group C was statistically significant (P<0.05). The difference of coronary heart disease prevalence and Fib level between group A and group C, group B and group C was statistically significant (P<0.05). Conclusion Small and dense low density lipoprotein cholesterol and homocysteine are associated with cerebral infarction.

目的 探讨脑梗塞与雌激素及高同型半胱氨酸血症之间的相关性。方法 纳入我院2013年1月—2014年11月确诊为脑梗塞的患者100例,正常对照的健康体检者100例,比较两组患者的血浆高同型半胱氨酸和雌激素水平。结果 脑梗死患者的血浆同型半胱氨酸水平高于正常组,两组比较差异有统计学意义(P＜0.05);高同型半胱氨酸血症脑梗塞组为72例,正常组为18例,两组比较差异有统计学意义(P＜0.05);同型半胱氨酸的阳性率男性为92%,女性为44%,男性患者高于女性,(P＜0.05);脑梗塞组雌激素水平降低,脑梗塞和雌激素水平呈负相关(P＜0.05),有糖尿病和酗酒的患者E2水平低于无糖尿病和酗酒的E2水平,差异有统计学意义(P＜0.05)。结论 急性脑梗塞患者同型半胱氨酸水平高于正常组,雌激素水平低于正常组,高同型半胱氨酸血症是脑梗死的重要危险因素,雌激素为脑梗塞患者的保护性因素。

       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。

        Objective   Elevated serum homocysteine（Hcy）levels are linked to chronic kidney disease（CKD）progression，yet the nonlinear relationship in middle-aged populations remains underexplored．Methods  This  study analyzed data from 5 361 participants aged 45–65 years in the NHANES 1996–2006 cohort．Renal dysfunction was defined as an estimated glomerular filtration rate（eGFR）＜60 mL/min/1.73 m²  and urinary albumin-to-creatinine ratio（uACR）≥30 mg/g．Results  Logistic regression and smoothed curve fitting revealed that each 1 µmol/L increase in Hcy elevated the risk of reduced eGFR by 8%（OR=1.08，95% CI：1.06–1.10）and uACR by 2%（OR=1.02，95% CI：1.00–1.04）．A nonlinear threshold effect was identified at 13.4 µmol/L，with a stronger association below this threshold（OR=1.59，95% CI：1.49–1.70）and no significant effect above it．Subgroup analyses showed no interactions with gender or hypertension，but a stronger Hcy-eGFR association was observed in diabetics（interaction P=0.0158）．Conclusions  These findings suggest that controlling Hcy levels may mitigate renal decline，particularly in diabetic populations，warranting further causal investigations．