血浆同型半胱氨酸水平与糖尿病肾病的关系及叶酸、甲钴胺干预

Relationship between Plasma Homocysteine and Diabetic Nephropathy,and the Intervention of Folic Acid and Methylcobalamin in the Level of Plasma Homocysteine

目的探讨血浆同型半胱氨酸(Hcy)与糖尿病肾病(DN)的关系,观察甲钴胺、叶酸治疗对2型糖尿病(T2DM)患者血浆Hcy水平的干预作用及意义。方法(1)DN与血浆Hcy水平的关系研究:对照组30例;T2DM患者60例(其中DN组20例,非DN组40例)。测定血脂、肝肾功能、血糖、糖化血红蛋白(HbA1c)、Hcy、尿白蛋白等,Hcy采用荧光免疫偏振法测定。采用Logistic回归模型筛选DN危险因素。(2)甲钴胺、叶酸治疗对T2DM患者血浆Hcy水平的影响:T2DM患者80例,随机分为4组,对照组20例,未予干预;叶酸组20例,予叶酸5 mg口服,每日1次;甲钴胺组20例,予甲钴胺500μg口服,每日3次;叶酸+甲钴胺组20例,予上述剂量的叶酸和甲钴胺联合服用。干预时间均为8周。结果(1)血浆Hcy水平非DN组和DN组均高于对照组(P<0.01),且DN组高于非DN组(P<0.05)。(2)收缩压、Hcy是DN的独立危险因素。(3)T2DM患者血浆Hcy与维生素B12呈显著负相关(P<0.05)。(4)叶酸组、甲钴胺组、叶酸+甲钴胺组血浆Hcy水平较干预前均显著下降(P<0.05),而对照组则无明显变化。比较各干预组治疗后血浆Hcy水平,差别均无统计学意义。结论(1)Hcy可能是DN的独立危险因素,参与DN的发生发展。(2)叶酸治疗、甲钴胺治疗及叶酸与甲钴胺联合治疗均可降低DM患者血中Hcy水平。

Objective To investigate the relationship between homocysteine （Hcy） and diabetic nephropathy （DN）, and the intervention of folic acid and methylcobalamin in the level of plasma homocysteine of patients with type 2 diabetes mellitus （T2DM）. Methods Part 1 involves the study on the rela- tionship between Hey and DN. The patients were divided into normal control group（CON group, n= 30）, T2DM patients without DN （DM group, n=40） and T2DM patients with DN （DN group, n=20）. The blood and urine samples were measured for blood lipid, glucose, HbAlc, urine albumen, and liver and kidney function. Plasma Hcy levels were measured by Polarization Immunoassay. Risk factors of diabetic nephropathy were screened out by Logstic Regress Model. Part 2 invovles the study on the intervention of methylcobalamin and folie acid in plasma Hcy levels of patients with T2DM. Eighty patients with T2DM were randomly divided into four groups： the control group without intervention; the folic acid group given folic acid orally （5 mg/d） ; the methylcobalamin group given methylcobalamin orally （500μg, tid） and the folio acid ＋ methylcohalamin group given methylcobalamin （500 μg, tid） and folic acid （5 mg/d） for 8-week intervention. Results （1） The plasma Hey level of the DM group and DN group was higher than that of the CON group （F=14. 732,P=0. 000）. （2）Logistic regression analysis showed Hcy and SBP were independent risk factors for DN. （3） Hey was negatively correlated with Vitamin B12 （P〈0.05）. （4）After the intervention plasma Hcy levels decreased obviously when compared with those in pre-treatment in the three groups with intervention （P〈0.05）. No difference in plasma Hey level was found among the groups given intervention after the treatment. Conclusion （1）Hcy may be an independent risk factor for DN, and may be involved in the development of diabetic nephropathy. （2）The treat- ment with methytcobalamin and/or folic acid can play an important role in reducing the level of plasma Hcy in diabetic patients.