2型糖尿病患者血浆总同型半胱氨酸水平变化及其与糖尿病血管并发症之间的关系

Changes of Plasma Total Homocysteine in Type Ⅱ Diabetic Patients Its Association with Diabetic Vascular Complications

目的研究正常糖耐量(NGT)人群和2型糖尿病(T2DM)患者血浆总同型半胱氨酸(total homocysteine,tHcy)水平,探讨影响血浆tHcy水平的因素以及T2DM患者血浆tHcy与糖尿病血管并发症之间的关系。方法纳入研究对象135例(其中NGT 55例、T2DM患者80例),检测其空腹血浆tHcy水平,同时测量受试者身高、体质量、腰围(WC)、臀围、血压,并计算体重指数(BMI)和腰臀比(WHR);测定血脂、空腹及服糖后0.5h、1 h、2 h血糖和胰岛素,并计算葡萄糖(AUCGlu)与胰岛素(AUCIns)曲线下面积、HOMA胰岛素抵抗指数(HOMA-IR)。结果T2DM组平均血浆tHcy水平〔(21.09±10.99)μmol/L〕显著高于NGT组〔(3.70±5.54)μmol/L〕(P=0.000);AUCGlu和WC是影响血浆tHcy水平的重要危险因素(调整后R2=0.378,P=0.000);血浆tHcy水平(OR=1.109)和年龄(OR=1.146)是T2DM患者周围动脉血管病变发生的重要危险因素。结论T2DM患者血浆tHcy水平明显高于NGT人群;血糖和WC是影响血浆tHcy水平的重要危险因素;血浆tHcy水平升高是导致T2DM患者周围动脉血管病变的独立危险因素。

Objective To identify the differences and contributing factors of plasma total homocysteine （tHey） in people with type Ⅱ diabetes mellitus（T2DM） and people who had normal glucose tolerance （NGT） ; and to explore the association between plasma they and diabetic vascular complications. Methods One hundred and thirty-five people （ fifty-five in NGT group, eighty in T2DM group） were enrolled in this cross sectional study. The height, weight, waist circumference, hip circumference, and blood pressure of the participants were measured. The body mass index （BMI） and waist-hip ratio （WHR） were calculated. The fasting plasma tHey, serum vitamin B12, and plasma folio acid were determined. Oral glucose tolerance test and insulin releasing test were performed to assess insulin secretion area under the curve （AUC） and insulin Sensitivity （HOMA-IR）, Lipid profiles were also assessed at the same time. Results T2DM patients had significantly higher plasma tHey [（21. 09±10.99） μmol/L] than the people in the NGT group [（3.70±5.54）μmol/L, P=0. 000]. The stepwise multiple regression analysis showed that LnAUCGlu and WC were independent contributors to the increase of plasma tHey （adjusting R^2= 0. 378, P= 0. 000）. The logistic regression analysis showed that tHey （OR= 1. 109） and age （OR = 1. 146） were associated with diabetic macroangiopathy. Conclusion Plasma they increase in patients with type Ⅱ diabetes. Glucose and WC are important contributors to the increase of plasma tHey in T2DM patients. The increase of plasma they contributes to diabetic macroangiopathy.