高同型半胱氨酸血症与2型糖尿病脑梗死的关系及其影响因素的研究

Study the relationship between hyperhomocysteinemia and type 2 diabetes patients with cerebral infarction and its influencing factors

目的研究高同型半胱氨酸血症(HHcy)与2型糖尿病脑梗死之间的关系及其影响因素.方法应用高效液相色谱分析方法测定2型糖尿病脑梗死组(DS组)、2型糖尿病无并发症组(DNC组)患者和正常对照组血Hcy浓度,放免方法测定各组的叶酸、维生素B12水平.结果 DS组、DNC组的Hcy水平和HHcy的发生率均显著高于正常对照组(均P＜0.05);DS组的Hcy水平及HHcy发生率显著高于DNC组(均P＜0.05).单因素相关分析显示2型糖尿病患者血中Hcy水平与体质量指数、尿素氮、肌酐(Cr)、糖化血红蛋白(HbAlc)、Cr清除率呈正相关(r=0.455、0.36、0.48、0.4,P＜0.05～0.01),与叶酸、维生素B12水平呈负相关(r=-0.21、-0.34,均P＜0.05);多元逐步回归分析示维生素B12、HbAlc、Cr清除率和叶酸是影响Hcy水平的因素.结论 HHcy是2型糖尿病脑梗死的一个危险因素.2型糖尿病患者Hcy水平受维生素B12、叶酸、肾功能以及代谢紊乱程度的影响.

Objective To study the relationship between hyperhomocysteinemia and type 2 diabetes patients with cerebral infarction and its influencing factors.Methods Serum homocysteine levels were measured by high performance liquid chromatography (HPLC) in type 2 diabetes patients with cerebral infarction (DS group), type 2 diabetes patients without complications (DNC group) and normal control subjects. Plasma folate and VitB 12 concentrations were detected by radioimmune assay.Results The levels of homocysteine in DS group and DNC group were significantly higher than in normal control group (all P<0.05), furthermore DS group higher than DNC group. Hyperhomocysteine was more prevalent in DS group than in DNC group and normal control group ( P<0.05). In diabetes patients, the level of homocysteine was positively related with BMI, Bun, Cr, HbAlc and creatinine clearance rates( r=0.455,0.36,0.48,0.4, P< 0.05~0.01), while negatively related with folic acids and VitB 12( r=-0.21,-0.34,all P<0.05). By stepwise regression analysis,VitB 12, HbAlc, creatinine clearance rates and plasma folate level were the independent factors for homocystein levels in type 2 diabetes.Conclusion Hyperhomocysteinemia is a risk factor for cerebral infarction in type 2 diabetes. The level of homocystein was influnced by VitB 12, plasma folate, metabolic abnormality of glucose and renal function in type 2 diabetes.