2型糖尿病合并高同型半胱氨酸血症与缺血性血管疾病关系的研究

Relationship between Type 2 Diabetes Mellitus Combined with Hyperhomocysteinemia and Ischemic Cerebrovascular Disease

目的探讨2型糖尿病患者合并高同型半胱氨酸血症(HHCY)与缺血性血管疾病的关系,观察叶酸和维生素B6治疗HHCY的效果。方法 2型糖尿病合并HHCY患者207例,按随机数字表法分成两组:用叶酸和维生素B6治疗102例(治疗组),未经叶酸和维生素B6治疗的105例为对照组。定期测定血清中空腹血糖(FBG)和餐后2h血糖(PBG)含量及血清HCY水平,统计5年后缺血性血管疾病的发病率。结果追踪观察5年,两组患者的血糖控制在正常水平内,治疗组血清HCY降至正常,与治疗前及对照组比较差异有统计学意义(P<0.01)。治疗组短暂性脑缺血发作、脑梗死、下肢血管栓塞、心肌梗死、心绞痛发病率明显低于对照组(P<0.05)。结论 HHCY是2型糖尿病患者发生缺血性血管疾病的重要危险因素之一;早期用叶酸和维生素B6治疗2型糖尿病合并HHCY患者可以预防和降低缺血性血管疾病的发生;测定2型糖尿病患者血清HCY水平有助于早期预防缺血性血管疾病的发生。

Objective To investigate the relationship between type 2 diabetes mellitus （T2DM） combined with hyperhomocysteinemia（HHCY） and ischemic cerebrovascular disease,and observe the effect of folic acid tablet and vitamin B6 table on HHCY. Methods Two hundred and seven T2DM patients complicated with HHCY were randomly divided into two groups, 102 cases were treated with folic acid tablet and vitamin B6 tablet （treatment group） and 105 cases were not treated with folic acid tablet and vitamin B6 tablet （ control group）. Serum fasting blood-glucose （FBG） ,2-hour postprandial blood glucose（PBG） and homocysteine（HCY） levels were detected at regular intervals, and the 5-year incidence of ischemic cerebrovascular disease was caculated. Results The patients in the two group were followed up for 5 years, and their blood glucose was controlled in the normal range. HCY level in the treatment group decreased to a normal range, which was significantly different from that before treatment and the controls（P 〈0. 01 ）. The incidence of ischemic cerebrovascular disease such as transient ischemic attack （TIA）, cerebral infarction, lower limb vascular embolization, myocardial infarction and angina pectoris in the treatment group was significantly lower than that in the control group （P 〈 0.05 ）. Conclusion HHCY is one of the important risk factors for the occurrence of ischemic cerebrovascular disease among T2DM patients; Folic acid and vitamin B6 used in the early treatment of T2DM combined with HHCY can prevent and control ischemic cerebrovascular disease;Determination of serum HCY level in T2DM patients may contribute to early prevention of ischemic cerebrovascular disease.