血浆同型半胱氨酸浓度与2型糖尿病微血管并发症关系探讨

Relationship between plasma homocysteine and microangiopathy in type 2 diabetes mellitus

目的 :探讨空腹血浆总同型半胱氨酸 (tHcy)水平与 2型糖尿病 (DM)微血管病变的关系及其影响因素。方法 :10 8例 2型DM患者和 4 5例正常对照者 (C组 ) ,DM组分为无并发症组 (NDC组 )、视网膜病变组 (DR组 )和肾病组 (DN组 ) ,酶免疫分析法测定血浆tHcy浓度 ;发光免疫法测定血清叶酸 (FA)和VitB1 2 水平。结果 :DR组和DN组的空腹血浆tHcy浓度明显高于NDC组和C组 (P <0 .0 1) ;高Hcy血症的DM患者DN、DR发生率明显高于无高Hcy血症DM患者 (P <0 .0 1) ;VitB1 2 、FA、和血清肌酐 (Scr)、餐后 2h血糖 (2hPBG)均为DM患者tHcy的决定因素 (均P <0 .0 1) ;Logistic回归分析显示空腹tHcy、体质量指数 (BMI)、胆固醇 (TC)、FA、VitB1 2 与DN的发生有关 ;空腹tHcy、2hPBG、TC、Scr均为DR的独立危险因素。结论 :空腹高tHcy血症是糖尿病微血管病变的危险因素 ;血清VitB1 2 、FA、Scr以及代谢紊乱程度影响tHcy的浓度。

Objective:To investigate the relationship between total fasting plasma homocysteine(tHcy) and microangiopathy in type 2 diabetes mellitus(DM)and explore the factors influencing plasma tHcy in cases of DM. Methods:One hundred and eight cases of type 2 DM and 45 cases of normal control(C) were enrolled in the study. The cases of type 2 DM were divided into three groups:one group without complications(NDC) 、one group complicated with retinopathy(DR) and another group with nephropathy(DN). Plasma tHcy was measured by Enzyme Transaction Immunoassay and serum folic acid(FA) and VitB 12 by fluorescent immunoassay. Results:The Concentration of fasting plasma tHcy was significantly higher in DR and DN groups than those in NDC and C groups (P<0.01);type 2 DM with hyperhomocysteinemia(HHcy) had a significantly higher incidence rate of DN and DR than those without HHcy(P<0.01). VitB 12 、serum FA、and creatine(Cr)、postprandial-2 h-glucose (2 h PBG) were all the influential factors for plasma tHcy of DM patients (P<0.01). Multiple logistic regression analysis showed that fasthin tHcy body weight index(BMI)、total cholesterol(TC)、serum FA and VitB 12were associated with DN. Fasting tHcy 、2 h PBG、TC 、and Scr were the independent risk factors for DR in type 2 DM. Conclusion: High fasting plasma Hcy is a risk factor for microangiopathy in type 2 DM. Serum FA、VitB 12、Scr and metabolic disorder may influenced the plasma tHcy level.