甲钴胺对2型糖尿病肾病病人高同型半胱氨酸血症的影响

Effects of mecobalamin on hyperhomocysteinemia in patients with type 2 diabetic nephropathy

目的:探讨血浆同型半胱氨酸(HCY)与2型糖尿病肾病(DN)的关系及甲钴胺对DN病人HCY水平的影响。方法:2型糖尿病病人87例,按尿清蛋白排泄率(UAER)分为3组,尿蛋白正常组(A组)30例,早期DN组(B组)29例,临床DN组(C组)28例,另设非糖尿病病人24例为对照组。入选病例均在常规用药基础上给予甲钴胺500μg,静脉注射,bid,3 wk;后改为500μg,口服,tid, 4 wk,共观察7 wk。在用药前,用药后3、7 wk测定血浆HCY、UAER和脂蛋白(a)水平。结果:甲钴胺治疗前,A组病人HCY水平与对照组比较仅轻度升高,无显著差异(P＞0．05),B组和C组HCY水平明显高于对照组(P＜0．01)。甲钴胺治疗7 wk后,B组和C组病人HCY及UAER水平明显下降(P＜0．01),C组脂蛋白(a)也有明显下降(P＜0．01),而B组脂蛋白(a)无明显变化(P＞0．05)。HCY浓度与UAER和脂蛋白(a)正相关(r=0．42,0．33),与内生肌酐清除率水平负相关(r=-0．46),均P＜0．01。结论:早期和临床DN病人存在高HCY血症,且血浆HCY水平与UAER正相关;甲钴胺可以降低DN病人血浆HCY水平,一定程度上减少尿清蛋白。

AIM： To investigate the association between the plasma homocysteine （HCY） level and diabetic nephropathy （DN） of type 2 diabetic patients, and the effects of mecobalamin on hyperhomocysteinemia in these patients. METHODS： Eighty-seven patients with type 2 diabetic were recruited to participate the study. The patients were assigned to three groups according to urinary albumin excretion rate （UAER） ： group A （n = 30）, UAER ≤ 30 μg·mg^-1·Cr^-1; group B （n = 29）, UAER 〉 30-〈 300 μg·mg^-1·Cr^-1; group C （n = 28）, UAER≥ 300 μg· mg^-1· Cr^-1. Another 24 patients without diabetes mellitus were participated as the control group. On the same basal treatment, all groups of patients were treated with meobalamin for 7 wk ： 500μg, iv, bid for 3 wk and followed by 500 μg, po, tid for 4 wk. The levels of HCY, UAER, lipoprotein （a） etc at before and 3, 7 wk after treatment were determined. RESULTS： Before the treatment, the level of HCY in group A was similar or slightly higher to that in control group （P 〉 0.05）, while HCY in group B and C were much higher than that of control group （P 〈 0.01 ） . After treatment with meobalamin for 7 wk, the levels of HCY and UAER in group B and C decreased significantly （P 〈 0.01 ）, and the level of lipoprotein （a） in group C decreased obviously too （P 〈 0.01） while that in group B showed no obvious changes （P 〉 0.05） . The level of HCY was positively related to those of UAER and lipoprotein （a） （r = 0.42, 0.33） and negatively related to that of endogeneous creatinine clearance （r = -0.46） , all P 〈 0.01. CONCLUSION： The patients with DN have hyperhomocysteinemia in initial and clinical stages, and the level of plasma HCY is positively related to UAER. Mecobalamin can decrease the levels of HCY in DN patients and thus with a certain extent of urinary albumin.