肾移植术后患者同型半胱氨酸、肾功能和血脂水平的变化及其相关性分析

目的:分析肾移植术后患者血清的同型半胱氨酸(Hcy)、肾功能和血脂水平的变化和相关性,探讨其在肾移植术后评价肾功能的应用价值。方法:将2013年10月~2016年9月就诊于我院确诊慢性肾衰并进行肾移植手术的300例术后随访患者作为观察组,选择同期健康志愿者100例作为对照组。检测并比较两组Hcy、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)水平。根据观察组患者Hcy水平的不同将其分成Hcy正常组与Hcy异常组,并对比两组患者的血脂指标水平;测定半胱氨酸蛋白抑制剂C(CysC)的水平并计算肾小球滤过率(eGFR);对观察组血清Hcy与eGFR值、血脂指标水平进行相关性分析,并采用Logistic回归分析分析观察组肾移植术后eGFR下降的影响因素。结果:观察组患者的血清Hcy、TC、TG、HDL-C、LDL-C水平均明显高于对照组(P0.05)。Hcy异常组血清LDL-C水平明显高于Hcy正常组,而HDL-C水平明显低于Hcy正常组(P0.05)。观察组患者血清Hcy与eGFR、HDL-C水平呈负相关关系(r=-0.573、-0.414,P0.05);与TG水平呈正相关(r=0.432,P0.05),与TC、LDL-C无相关(P0.05)。多元Logistic回归分析显示,Hcy、TG、LDL-C水平均与患者eGFR下降有关(P0.05)。结论:在肾移植术后,慢性肾衰患者的TG、LDL-C、Hcy水平均升高,且伴有eGFR水平的降低;肾移植术后肾功能的改变与血清TG、LDL-C、Hcy水平相关;检测肾移植患者血脂指标、Hcy的水平可以评估移植肾功能受损情况。

Study on Changes of Homocysteine, Renal Function and Blood Lipid Levels in Renal Transplanted Recipients

ABSTRACT Objective: To analyze the changes of serum homocysteine (Hcy), renal function and blood lipid levels in renal transplanted recipients and their correlation, so as to investigate the application value of them in the evaluation of renal function after renal transplantation. Methods: A total of 300 cases of renal transplanted recipients followed up postoperatively, who were diagnosed as chronic renal failure and underwent renal transplantation in the Affiliated Hospital of Qingdao University during October 2013 to September 2016, were chosen as observation group; 100 healthy volunteers in the same period were chosen as control group.The levels of Hcy, total cholesterol (TC), three triacylglycerol (TG), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) of the two groups were detected and compared. According to the different levels of Hcy in the observation group, the patients were further divided into Hcy normal group and Hcy abnormal group,and the blood lipid indexes of the two groups were compared. The level of cysteine protein inhibitor C (CysC) was measured and glomerular filtration rate (eGFR) was calculated. The correlation between serum Hcy and eGFR, blood lipid indexes levels in the observation group was analyzed.Logistic regression analysis was used to analyze the influencing factors of eGFR decline after renal transplantation in the observation group. Results: The levels of Hcy, TC, TG, HDL-C and LDL-C in the observation group were significantly higher than those in the control group (P<0.05). The level of LDL-C in Hcy abnormal group was higher than that in Hcy normal group, while the level of HDL-C was lower than that in Hcy normal group (P<0.05). The serum Hcy level of the observation group was negatively correlated with the levels of eGFR and HDL-C (r= -0.573,-0.414; P<0.05), and positively correlated with the level of TG (r=0.432, P<0.05), but was not related to TC and LDL-C (P>0.05).Multivariate Logistic regression analysis showed that the levels of Hcy, TG and LDL-C were related to the decrease of eGFR in patients (P<0.05). Conclusion: After renal transplantation, the TG, LDL-C and Hcy levels in patients with chronic renal failure will rise and eGFR level will drop. The change of renal function after renal transplantation is related to the levels of serum TG, LDL-C and Hcy. Detection of lipid profile and Hcy levels in renal transplant recipients can assess impaired graft function.