血浆同型半胱氨酸与老年2型糖尿病血管并发症关系

Relationship between plasma homocysteine and vascular complications in elderly type 2 diabetics

目的探讨老年2型糖尿病血浆同型半胱氨酸(Hcy)水平与大血管、微血管并发症之间的关系,同时了解血浆Hcy与叶酸、维生素(Vit)B_(12)、超敏C反应蛋白(s-CRP)、纤维蛋白原(Fg)之间的关系。方法测定227例老年2型糖尿病患者血浆Hcy、空腹血糖(FPG)、餐后血糖(2hPG)、糖化血红蛋白(HbA_1c)、空腹胰岛素(FINS)、C肽、胆同醇(Tc)、三酰甘油(TG)、高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-C)、尿微量白蛋白/肌酐比值(Alb/ Cr)、叶酸、VitB_(12)、hs-CRP和纤维蛋白原(Fg),采用B超测量大动脉内膜中层厚度(IMT)并进行眼底视网膜检查。结果①血浆Hcy≥12μmol/L组的脉压差、体重指数(BMI)、HbA_1c、TC、TG、尿Alb/Cr、hs-CRP、Fg及颈总动脉、股总动脉、腘动脉IMT、视网膜病变比例、尿Alb/Cr均显著高于血浆＜12μmol/L组(P＜0．05～0．01)；叶酸、VitB_(12)显著降低(P值均＜0．01)。Hcy与2hPG(β=0．380)、TG(β=0．384)、脉压差(β=0．177)、s-CRP(β= 0．455)、Fg(β=0．609)、颈总动脉IMT(β=0．214)、股总动脉IMT(β=0．362)、腘动脉IMT(β=0．382)、视网膜病变(β=0．361)呈显著正相关(P＜0．05)；与叶酸(β=-0．242)、VitB_(12)(β=-0．253)呈显著负相关(P＜0．05)。②大动脉内膜中层增厚(IMT≥1．2 mm)、蛋白尿组(Alb/Cr≥2．25mg/mmol)的血浆Hcy值均明显增高(P值均＜0．01)。结论血浆Hcy值≥12μmol/L时,老年2型糖尿病患者的大血管及微血管病变发生的危险性明显增加。血浆Hcy值随大动脉IMT的增加和尿Alb/Cr的增高而增高。Hcy与hs-CRP、Fg等炎症因子可能共同参与了老年2型糖尿病大血管和微血管并发症的发展。

objective To appraise the relationship between plasma homocysteine（Hcy） level and macro-, microvascular complications in type 2 diabetic elderly and the relevance of plasma homocysteine（Hcy） and folic acid, Vitamin B12 （VitB12）, highly sensitive C-reactive protein（hs-CRP） and fibrinogen（Fg）. Methods Two hundred and twenty-seven elderly subjects with type 2 diabetes were undertaken detection of plasma Hey, fasting plasma glucose, post prandial glucose（PPG）, hemoglobin A1c （HbA1c）, fasting insulin（FINS）, C-peptide, total cholesterol （ TC）, triglyceride （ TG）, high-density lipoprotein-cholesterol （HDL-C）, low-density lipoprotein-cholesterol （LDL-C）, folic acid, VitB12, hs-CRP, Fg, microalbuminuria/creatinine ratio（Alb/Cr）; and the arterial intimamedial thickness（IMT） was measured by B ultrasound and fundoscopy. Results ①Pulse pressure, BMI, HbA1c, TC, TG, urine Alb/Cr, folic acid, VitB12, hs-CRP and Fg in the group with plasma Hcy =12μmol/L were significantly higher than those in the group with plasma Hey level 〈12 μmol/L（P 〈 0.05 - 0.01）, while the levels of folate and VitaminB12 of the former were lower than those of the latter（P 〈 0.01）. Not only the IMT of carotid, femoral and popliteal arteries varied between the two groups（P 〈 0.01）, but also the retinopathy and microalbuminuria/creatinine ratio（Alb/Cr） were significantly different（P 〈0. 01）. Multiple regression analysis showed that the plasma Hey level was positively correlated with PPG, TG, pulse pressure, hs-CRP, Fg, IMT of carotid, femoral and popliteal arteries and retinopathy found（P 〈 0.05） but negatively correlated with folic acidand VitB12 （P 〈 0.05）.②A higher Hcy level was observed in those with a thicker arterial intima-medial layer（P 〈 0.01）. ③Hcy value in the group of elevated urine Alb/Cr increased significantly（P 〈 0.01）. Conclusions ①The risk of developing macro-and microvascular complications rises predominantly in those with plasma Hcy level higher than 12 μmol/L in the elderly diabetics. ②Elevated plasma Hcy level shows consistency with increase of IMT and urine Alb/Cr. ③Negative correlation existed in folic acid and VitB12 versus plasma Hcy level. ④Plasma Hcy and the inflammatory factors, like hs-CRP and Fg, may all contribute to the progression of macro-and microvascular complications in the elderly diabetics.