同型半胱氨酸与2型糖尿病患者脑卒中的相关性研究

Correlation of homocysteine with stroke in patients with type 2 diabetes Mellitus

目的探讨2型糖尿病患者血清同型半胱氨酸水平与颈部血管的关系,为脑卒中的筛查提供参考依据。方法将2011年10月至2012年3月本科室住院的102例2型糖尿病患者分为2型糖尿病合并脑卒中组(11例)及未合并脑卒中组(91例),观察两组患者的血脂、糖化血红蛋白、血清同型半胱氨酸水平及颈部血管超声检查结果。结果 (1)两组患者的年龄、性别、糖尿病病程和糖化血红蛋白等比较差异无统计学意义;2型糖尿病合并脑卒中组的高血压合并率及血清同型半胱氨酸水平均明显高于未合并脑卒中组(P<0.05);而总胆固醇、甘油三酯及低密度脂蛋白水平无明显升高;(2)2型糖尿病合并脑卒中组颈部血管狭窄发生率(72.7%)及斑块发生率(72.7%)均较未合并脑卒中组(19.8%、65.9%)高,且发生颈部血管狭窄的患者血清同型半胱氨酸水平显著升高(P<0.05)。(3)相关性分析提示血清同型半胱氨酸水平与颈动脉狭窄呈正相关(r=0.383,P=0.004)。结论 (1)高血压的合并率及血清同型半胱氨酸水平均可影响2型糖尿病患者脑卒中的发生。(2)高同型半胱氨酸血症加重了颈部血管斑块的形成,加剧了颈部血管狭窄的发生,是预防2型糖尿病脑卒中的重要筛查指标。

Objective To investigate the relationship between serum homocysteine levels and cervical vessels in patients with type 2 diabetes mellitus（T2DM）,providing a reference for the screening of stroke.Methods One hundred and two inpatients with T2DM admitted in our hospital from October 2011 to March 2012 were divided into two groups：group A（n=11,with stoke） and group B（n=91,without stroke）.The lipid,HbA1c,serum homocysteine levels and vascular ultrasound results of cervical vessels were observed.Results（1） There was no statistically significant difference between the two groups in age,gender,course of diabetes and HbA1c.The incidence of hypertension and levels of homocysteine in the group A were significantly higher than those in group B（P 0.05）,while cholesterol,triglycerides,and low density lipoprotein showed no significant increase in group A.（2） The incidence of carotid stenosis and greasy plaque in group A（72.7% and 72.7%） was elevated significantly than those in group B（19.8% and 65.9%）.The concentration of homocysteine was significantly increased in the patients with carotid stenosis.（3） The levels of homocysteine and the carotid stenosis was positively correlated（r=0.383,P=0.004）.Conclusion The complication of hypertension and serum homocysteine levels can both influence the incidence of stroke in patients with type 2 diabetes mellitus.High homocysteine levels increase formation of neck vascular patches and aggravate carotid stenosis,which serve as the important index for the screening of stroke.