高同型半胱氨酸血症对糖尿病患者视网膜和肾脏病变的影响

Impact of the evaluated plasma homocysteine on T2DM patients with diabetic nephropathy and diabetic retinopathy

目的：探讨血浆同型半胱氨酸水平对2型糖尿病（T2DM）视网膜病变（DR）和肾病（DN）的影响，分析血浆同型半胱氨酸浓度与胰岛素抵抗（ HOMA-IR、ISI）和血管内皮生长因子（ VEGF）的关系。方法纳入241例T2DM患者，根据2010版中国2型糖尿病防治指南视网膜病变和肾病诊断标准分组，分析其年龄、BMI、高血压病史、糖尿病病程、空腹胰岛素（FINS）、空腹血糖（FPG）、HOMA-IR、胰岛素敏感指数（ISI）以及糖化血红蛋白（HbA1c）、微量白蛋白（MAU）与VEGF及同型半胱氨酸（Hcy）水平。结果相关分析显示年龄、BMI、高血压病史、糖尿病病程、HOMA-IR、HbA1c以及MAU与VEGF及Hcy水平增高均呈正相关，ISI与VEGF及Hcy水平增高呈负相关；Hcy与VEGF两者之间也呈正相关（ r ＝0.498， P ＜0.01）；分组分析结果显示年龄较大、糖尿病病程较长、HbA1c和VEGF水平较高、ISI较低、Hcy≥10μmol/L可能为DR的危险因素（ P ＜0.05），而较高的Hcy和VEGF水平可能为DN早期的危险因素（ P ＜0.05）。结论血浆VEGF和Hcy两者之间呈正相关，均与ISI呈负相关；高血浆Hcy、VEGF水平可能是T2DM患者患DR、DN早期的危险因素，较低ISI的患者DR的危险程度较高，但ISI降低可能并不是DN进展的主要影响因素。

Objective To investigate the impact of plasma homocysteine （ Hcy） on type 2 diabetics （ T2DM） patients with diabetic nephropathy （ DN） and diabetic retinopathy （ DR） , and to explore the correlation among the levels of plasma Hcy , vascular endothelial growth factor （VEGF）, homeostasis model assessment of insulin resistance （HOMA-IR）, and insulin resistance （ISI）. Methods A total of 241 cases of diabetes was recruited as subjects according to the 2010 China guideline for type 2 diabetes.The history of smoking, hypertension, duration of diabetes, height, and weight were measured.Fasting blood were collected to analyze the levels of fasting insulin （FINS）, fasting plasma glucose （FPG）, glycated hemoglobin a1c （HbA1c）, plasma Hcy （Rate method）, and VEGF [enzyme-linked immunosorbent assay, ELISA）].Results The age, body mass index （BMI）, the history of hyperten-sion, duration of diabetes, HbA1c, homeostasis model assessment of insulin resistance （HOMA-IR）, microalbuminuria （MAU）, and VEGF were positively correlated with the levels of plasma Hcy or VEGF .The levels of ISI were reduced with the increased levels of Hcy or VEGF.The history of smoking was positively correlated with the VEGF .Spearman correlation analysis demonstrated that the levels of plasma Hcy were positively correlated with the levels of VEGF （ r =0.498 , P ＆lt;0.01 ） .In the groups of diabetic retinopathy and early diabetic nephropathy , it could find that increased duration of diabetes , increased IR, higher levels of HbA1c and VEGF, and the levels of plasma Hcy≥10μmol/L might be the risk factors of DR （ P ＆lt;0.05 ） .Only the history of hypertension and high levels of VEGF and Hcy in early DN showed a strong correlation （ P ＆lt;0.05 ） .Conclusions Spearman correlation analysis demonstrated that the levels of plasma Hcy were positively correlated with the levels of VEGF .Higher levels of Hcy and VEGF might be the risk factors of the early DN and DR.At the same time, lower level of ISI might be the risk factor of DR , but the reduction of ISI might not be the main risk factor of the early DN .