血浆总同型半胱氨酸水平与2型糖尿病肾病的关系

Relationship between plasma total homocystenie levels and type 2 diabetics nephropathy

目的了解2型糖尿病(DM)人群中血浆总同型半胱氨酸(tHcy)水平与其肾病的关系。方法采用高效液相层析法(HPLC)检测191例2型DM患者血浆tHcy水平。放射免疫法测定24h尿清蛋白含量,计算尿清蛋白排泌率(UAER)。比较肾病各期:正常清蛋白尿、微量清蛋白尿、大量清蛋白尿及肾功能不全者间血浆tHcy水平。结果LntHcy值在微量清蛋白尿组明显高于正常清蛋白尿组,肾功能不全组明显高于其他三组,但大量清蛋白尿组与正常清蛋白尿组、微量清蛋白尿组比较均无显著差异。逐步多元回归分析显示同型半胱氨酸(LntHcy)、高血压、糖尿病病程、胆固醇(CHOL)、血清清蛋白与LnUAER独立相关(R2=0.400,P=0.002)。结论①随着糖尿病肾病的加重,血浆tHcy水平有逐渐升高的趋势。②Hcy是糖尿病肾病的独立危险因素,可能成为联系微量清蛋白尿与动脉粥样硬化的中间环节。

Objective To determine the relationship between plasma total homocysteine（tHcy） levels and type 2 diabetic patients with nephropathy. Methods Plasma tHcy levels were measured in 191 patients with type 2 diabetic mellitus by highperformance liquid chromatography（HPLC）. 24 h urine specimens were collected for 3 consecutive days. According to the severity of nephropathy, these patients were divided into 4 subgroups： group 1, normalbuminuria; group 2, microalbuminuria; group 3, macroalbuminuria; group 4, renal dysfunction. Results Ln-transformed plasma tHcy levels were significantly higher in group 2 than in group 1 ,and highest in group 4. Multiple stepwise regression analysis showed that Ln-transformed plasma tHcy levels, CHOL, serum albumin levels, hypertension and the duration of diabetes were independently associated with LnUAER （R^2 = 0. 400,P = 0. 002）. Conclusions Increases in plasma tHcy levels are related to the increases in the severity of the nephropathy. It was suggested that a potential new link existed between microalbuminuria, diabetic nephropathy and macrovascular disease.