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  • Title: Correlation among cystatin C, homocysteine and arteriosclerosis indexes in patients with chronic kidney disease.
    Author: Chen T, Li Y, Wang J, Wang J.
    Journal: Zhong Nan Da Xue Xue Bao Yi Xue Ban; 2021 Dec 28; 46(12):1338-1345. PubMed ID: 35232902.
    Abstract:
    OBJECTIVES: Chronic kidney disease (CKD) has become an important public health problem in the world. The occurrence of cardiovascular events is the main cause of death in patients with CKD, and arteriosclerosis is an important pathophysiological basis for cardiovascular diseases. Nowadays, brachial-ankle pulse wave velocity (baPWV) and ankle-brachial index (ABI) are clinically important indicators to reflect early atherosclerosis. Cystatin C (Cys C)and homocysteine (Hcy) are related to arteriosclerosis in healthy, hypertensive, and diabetic people, while there are few studies on the correlation among Hcy, CysC and arteriosclerosis in patients with CKD. This study aims to investigate the relationship between Cys C, Hcy and atherosclerosis in patients with CKD. METHODS: A total of 611 individuals, who met the diagnostic criteria for CKD and underwent physical examination in the Health Management Center of Third Xiangya Hospital, Central South University from June 2019 to June 2020, were selected as the research subjects. Height, weight, systolic blood pressure (SBP), and diastolic blood pressure (DBP) were measured and recorded, and body mass index (BMI) was calculated. Blood samples (5 mL) were collected and Cys C, Hcy, fasting blood glucose (FBG), total cholesterol (TC), serum creatinine (SCr), and other blood indexes were tested. Urine was collected to detect microalbumin and creatinine, and the albumin/creatinine ratio (UACR) was calculated. baPWV and ABI were measured by automatic arteriosclerosis detector. The quartiles of Cys C and Hcy were divided into groups, and the proportion of baPWV and ABI abnormalities among groups was compared pairwise. The correlation between Cys C, Hcy, and baPWV was analyzed by Pearson correlation analysis. Univariate and multivariate logistic regression were used to analyze the effects of Cys C and Hcy on ABI and baPWV. RESULTS: Among 611 patients with CKD, 435 (71.19%) had abnormal baPWV and 48 (7.86%) had abnormal ABI. With the increase of Cys C and Hcy levels, the proportion of baPWV and ABI abnormalities were gradually increased. BaPWV was positively correlated with Cys C (r=0.32) and Hcy (r=0.20). After adjusting for confounding factors such as gender, BMI, and FBG, Cys C (OR=6.54, 95% CI 1.93 to 22.14, P<0.01) and Hcy (OR=1.08, 95% CI 1.01 to 1.16, P=0.02) were independent risk factors for abnormal baPWV. Also, after adjusting for confounding factors such as age, sex, BMI, and FBG, Cys C (OR=9.95, 95% CI 2.84 to 34.92, P<0.01) and Hcy (OR=1.06, 95% CI 1.01 to 1.11, P=0.02) were independent risk factors for abnormal ABI. CONCLUSIONS: In patients with CKD, baPWV and ABI are significantly correlated with Cys C and Hcy levels. Detection of Cys C and Hcy levels is helpful for the early diagnosis of arteriosclerosis. 目的: 慢性肾脏病(chronic kidney disease，CKD)已日益成为全球重要的公共卫生问题。心血管事件的发生是CKD患者的主要死因，而动脉硬化是心血管疾病发生和发展的重要病理生理基础。肱踝脉搏波传导速度(brachial-ankle pulse wave velocity，baPWV)和踝臂指数(ankle-brachial index，ABI)是临床上常用的反映早期动脉硬化的重要指标。在健康人群、高血压病及糖尿病人群中，半胱氨酸蛋白酶抑制剂C(cystatin C，Cys C)和同型半胱氨酸(homocysteine，Hcy)均与动脉硬化密切相关，而在CKD患者中，Hcy、Cys C与动脉硬化的相关研究报道甚少。本研究旨在探讨CKD患者体内Cys C、Hcy水平与动脉硬化指标的关系。方法: 选择2019年6月至2020年6月在中南大学湘雅三医院健康管理中心进行健康体检并符合CKD诊断标准的611名个体作为研究对象。测量并记录受试者的身高、体重、收缩压(systolic pressure，SBP)、舒张压(diastolic pressure，DBP)等，并计算体重指数(body mass index，BMI)。抽取受试者血液样本5 mL并检测Cys C、Hcy、空腹血糖(fasting blood glucose，FBG)、总胆固醇(total cholesterol，TC)、血肌酐(serum creatinine，SCr)等指标。留取受试者尿液，检测尿微量白蛋白、尿肌酐，并计算尿微量白蛋白与尿肌酐比值(albumin/creatinine ratio，UACR)。采用全自动动脉硬化检测仪测定baPWV、ABI。以受试者血中Cys C和Hcy水平的四分位数分组，并比较各组间baPWV和ABI异常的比例。采用Pearson相关分析Cys C、Hcy与baPWV的相关性；采用单因素及多因素logistic回归分析Cys C、Hcy对ABI、baPWV的影响。结果: 在611例CKD患者中，435例(71.19%)baPWV异常，48例(7.86%)ABI异常。随着Cys C和Hcy水平的升高，baPWV及ABI异常的比例也逐渐增加。baPWV与Cys C(r=0.32)、Hcy(r=0.20)均呈正相关(均P<0.01)。在校正性别、BMI、FBG等混杂因素后，Cys C(OR=6.54，95% CI：1.93~22.14，P<0.01)及Hcy(OR=1.08，95% CI：1.01~1.16，P=0.02)是baPWV异常的独立危险因素。在校正年龄、性别、BMI、FBG等混杂因素后，Cys C(OR=9.95，95% CI：2.84~34.92，P<0.01)及Hcy(OR=1.06，95% CI：1.01~1.11，P=0.02)是ABI异常的独立危险因素。结论: 在CKD患者中，动脉硬化指标baPWV、ABI与体内Cys C和Hcy水平显著相关。检测Cys C及Hcy的水平有助于对CKD患者动脉硬化的早期诊断。. OBJECTIVE: Chronic kidney disease (CKD) has become an important public health problem in the world. The occurrence of cardiovascular events is the main cause of death in patients with CKD, and arteriosclerosis is an important pathophysiological basis for cardiovascular diseases. Nowadays, brachial-ankle pulse wave velocity (baPWV) and ankle-brachial index (ABI) are clinically important indicators to reflect early atherosclerosis. Cystatin C (Cys C)and homocysteine (Hcy) are related to arteriosclerosis in healthy, hypertensive, and diabetic people, while there are few studies on the correlation among Hcy, CysC and arteriosclerosis in patients with CKD. This study aims to investigate the relationship between Cys C, Hcy and atherosclerosis in patients with CKD. METHODS: A total of 611 individuals, who met the diagnostic criteria for CKD and underwent physical examination in the Health Management Center of Third Xiangya Hospital, Central South University from June 2019 to June 2020, were selected as the research subjects. Height, weight, systolic blood pressure (SBP), and diastolic blood pressure (DBP) were measured and recorded, and body mass index (BMI) was calculated. Blood samples (5 mL) were collected and Cys C, Hcy, fasting blood glucose (FBG), total cholesterol (TC), serum creatinine (SCr), and other blood indexes were tested. Urine was collected to detect microalbumin and creatinine, and the albumin/creatinine ratio (UACR) was calculated. baPWV and ABI were measured by automatic arteriosclerosis detector. The quartiles of Cys C and Hcy were divided into groups, and the proportion of baPWV and ABI abnormalities among groups was compared pairwise. The correlation between Cys C, Hcy, and baPWV was analyzed by Pearson correlation analysis. Univariate and multivariate logistic regression were used to analyze the effects of Cys C and Hcy on ABI and baPWV. RESULTS: Among 611 patients with CKD, 435 (71.19%) had abnormal baPWV and 48 (7.86%) had abnormal ABI. With the increase of Cys C and Hcy levels, the proportion of baPWV and ABI abnormalities were gradually increased. BaPWV was positively correlated with Cys C (r=0.32) and Hcy (r=0.20). After adjusting for confounding factors such as gender, BMI, and FBG, Cys C (OR=6.54, 95% CI 1.93 to 22.14, P<0.01) and Hcy (OR=1.08, 95% CI 1.01 to 1.16, P=0.02) were independent risk factors for abnormal baPWV. Also, after adjusting for confounding factors such as age, sex, BMI, and FBG, Cys C (OR=9.95, 95% CI 2.84 to 34.92, P<0.01) and Hcy (OR=1.06, 95% CI 1.01 to 1.11, P=0.02) were independent risk factors for abnormal ABI. CONCLUSION: In patients with CKD, baPWV and ABI are significantly correlated with Cys C and Hcy levels. Detection of Cys C and Hcy levels is helpful for the early diagnosis of arteriosclerosis.
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