高同型半胱氨酸血症对2型糖尿病视网膜病变的影响

Effect of Hyperhomocysteinemia on Diabeteic Retinopathy in Patients with Type 2 Diabetes Mellitus

目的:探讨高同型半胱氨酸( HHcy)对2型糖尿病视网膜病变(DR)发生发展的影响。方法:检测152例2型糖尿病(T2DM)患者,包括DR组和非视网膜病变(NDR)组各76例以及50例同期健康体检者(对照组)血浆总Hcy(t Hcy)浓度、空腹血糖(FBG)、空腹胰岛素(FI NS)、糖化血红蛋白( HbA1c)、血脂等,并对上述指标及临床资料进行回顾性分析。结果:DR组血浆t Hcy水平高于NDR组及对照组(P<0 .01) ;DR组中增值型视网膜病变(PDR)亚组t Hcy水平高于背景型视网膜病变(BDR)亚组(P<0 .05) ;Logistic回归分析示,DR的发生与病程、HbA1c、t Hcy和胆固醇有关,血浆t Hcy水平是DR的独立危险因素。结论:HHcy血症是T2DM患者DR发生发展的重要的危险因子之一。

Objective:To discuss the influence of hyperhomocysteinemia(HHcy) on the pathogenesis and development of diabetic retinopathy(DR) in patients with type 2 diabetes mellitus(T2DM).Method:T2DM group:152 in-patients of endocrinology department were divided into a group with type 2 diabetic retinopathy(DR,76 cases) and a group without retinopathy complications(NDR,76 cases).The DR group was subdivided into background diabetic retinopathy group(BDR,42 cases) and proliferative diabetic retinopathy(PDR,34 cases).Fifty persons were served as control group(CON).Fasting blood glucose(FBG),fasting insulin(FINS),the blood lipids include the total cholesterol(CHO),the triglyceride(TG) et al,were measured for 152 type 2 diabetes and 50 normal control subjects.HOMA-IR was calculated.Those clinical data were analyzed retrospectively.Results:Plasma total Hcy levels were significantly higher in DR group [(15.89±3.61)μmol/l] than those in NDR group [(11.3±4.94) μmol/l] and CON group [(11.91±2.3 0)μmol/l ] P=0.0048.In DR group,plasma tHcy was significantly higher in proliferative diabetic retinopathy(PDR) group than that in background diabetic retinopathy(BDR) group [(16.64±2.30)μmol/l vs(14.76±3.54)μmol/l] P=0.046.Logistic regression analysis results showed that disease course,HbA1c,and Hcy were correlated with DR and the higher blood Hcy level might be the independent risk factor of DR.Conclusion:It is suggested that hyperhomocysteinemia is a risk factor for the development and progression of diabetic retinopathy in patients with type 2 diabetes mellitus.