叶酸、维生素B_(12)与2型糖尿病尿白蛋白排泄率的相关性研究

Relationship between serum folic acid/vitamin B12 and urinary albumin excretion rate in T2DM

目的探讨叶酸、维生素B12水平与2型糖尿病尿微量白蛋白排泄率(UAER)的关系,从而探求新的经济、有效早期防治糖尿病肾病(DN)的方法。方法93例T2DM患者分为3组:正常白蛋白尿组(NAU,UAER<20μg／min,n=35),微量白蛋白尿组(MAU,UAER 20-200μg／min．n=31)和临床白蛋白尿组(CAU,UAER>200μg／min,n=27)。35例健康人做正常对照组(NC)。放免法检测各组对象的血清叶酸、维生素B12水平。结果MAU组和CAU组UAER显著高于NC组(P<0．01)。2型糖尿病各组患者血清叶酸水平显著低于NC组(P<0．01),维生素B12水平亦低于NC组(P<0．05),叶酸和维生素B12水平在NAU组和MAU组间有显著性差异(P<0．01)。随UAER的增高,血清叶酸和维生素B12水平下降。UAER与叶酸(r=-0．321,P<0．01)及维生素B12水平(r=-0．210,P<0．01)呈负相关。结论 T2DM患者UAER与血清叶酸、维生素B12水平呈负相关。NAU期血清叶酸和维生素B12开始下降,且随UAER的增高,血清叶酸、维生素B12水平进行性下降,叶酸和维生素B12水平可间接反映糖尿病肾病(DN)的病情轻重。糖尿病肾病早期补充叶酸、维生素B12可能是延缓DN进展的经济、有效的方法。

Objective The purpose of this study was to investigate the relationship between serum folic acid vitamin B12 and urinary albumin excretion rate（UAER） in type 2 diabetes mellitus（T2DM）. Methods 93 patients with T2DM and 35 healthy persons as control were included. Patients were classified into 3 groups according to their UAER： normal albuminuria（NAU, UAER〈20 μg/min, n = 35）, microalbuminuria（MAU, UAER 20-200 μg/min, n = 31） and clinical albuminuria（CAU, UAER〉200 μg/min, n = 27）, and serum folic acid as well as vitamin B12 was measured radioimmunologically. Results UAER was significantly higher in MAU and CAU groups than that in control（P 〈 0.01）, serum folic acid as well as vitamin B12 in all T2DM groups was lower than that in control（P 〈 0.01, P 〈 0.05, respectively）, and there was a negative correlation between UAER and serum folic acid（r = -0.321, P 〈 0.01） as well as vitamin B12（r = -0.210, P 〈 0.01）. Conclusion Serum folic acid as well as vitamin B12 has negative correlation with UAER in T2DM. Serum folic acid and vitamin B12 begin to decrease in NAU group and continuously decrease as UAER increases. The levels of serum folic acid and vitamin B12 are important in evaluating the injury of diabetic nephropathy. Earlier supplement of folic acid and vitamin B12 may be beneficial to the prevention of diabetic nephropathy.