急性缺血性脑卒中患者同型半胱氨酸水平与急性肾损伤的关系研究

BackgroundAcute ischemic stroke AIS is the second leading cause of death worldwide after coronary heart disease. Acute kidney injury AKI is one serious complication after AISand homocysteine Hcy may be an important factor associated with AKI and accelerated deterioration of renal function. Howeverthere are few studies on the relationship between Hcy and AKIespecially in patients with AIS. Objective To investigate the relationship between plasma Hcy level and AKI in patients with AISand to provide new ideas for the prevention and treatment of AKI. Methods Baseline clinical data of 1 202 patients with AIS who were admitted to Department of Neurologythe Second Hospital of Tianjin Medical University were collected from the electronic medical record systemfrom January 2018 to April 2021. Patients were divided into normal HcyHcy 15 mol/L n=618mild hyperhomocysteinemia HHcy15 mol/L30 mol/L n=125groups according to the Expert Consensus on the DiagnosisTreatmentand Prevention of Hyperhomocysteinemia. Patients were divided into AKI group and non-AKI group by the values of ambulatorily monitored renal function and urine volume within seven days after admission recommended in the KDIGO 2021 Clinical Practice Guideline for the Management of Glomerular Diseases. Multivariate Logistic regression was used to explore the effects of Hcy on post-AIS AKI as a continuous variable and a categorical variablerespectively. Subgroup analysis was used to investigate the relationship between Hcy and AKI in subgroups. The nonlinear relation between Hcy and AKI was explored by restricted cubic spline regression. Results One hundred and fifty patients 12.48% developed AKI in all subjects. Multivariate Logistic regression showed that after adjustment for potential confounders the risk of AKI increased by 1.035 times OR=1.03595%CI1.0191.052 P<0.05 for every 1 mol/L increase in Hcy. With reference to normal Hcymild and moderate-to-severe HHcy has been associated with a 1.770-fold OR=1.77095%CI1.1502.724 P<0.05and 2.927-fold OR=2.92795%CI1.6715.126 P<0.05 increased risk of AKIseparately. Subgroup analysis found that the risk of AKI after AIS increased with the increase of Hcy level used as a continuous variablein femalesthose aged 75 yearsthose with hypertensiondiabetes or moderate to severe stroke at admissionand those whose stroke type was large-artery atherosclerosis LAAsmall artery occlusion SAO or cardio embolism CE P<0.05. When Hcy was analyzed as a categorical variablemild HHcy was associated with a higher risk of AKI compared with normal Hcy in the male populationthose aged<75 yearsthose with hypertensiondiabetesa history of stroke or mild stroke at admissionand those without coronary heart disease P<0.05. And moderate-to-severe HHcy was associated with a higher risk of AKI compared with normal Hcy in the female populationthose with hypertensiondiabetesor moderate or moderate-to-severe stroke at admissionand those whose stroke type was LAASAO or CE regardless of agecoronary heart disease and history of stroke P<0.05. Restricted cubic regression manifested that there was a nonlinear correlation between Hcy and the risk of AKIand the curve was convex P=0.026. The risk of AKI after AIS increased rapidly with the increase of Hcy when admission Hcy was less than 17 mmol/Lbut increased slowly with the increase of Hcy when admission Hcy was greater than or equal to 17 mmol/L.Conclusion Elevated Hcy is a risk factor for AKI whether as a continuous variable or a categorical variable in AIS patients. So monitoring the level of Hcy is conducive to early identification and prevention of AKIwhich is helpful to improve the prognosis in AIS patients.