2型糖尿病微血管病变患者血浆同型半胱氨酸的变化及其机制的探讨

Changes of the plasma homocysteine and its mechanism in type 2 diabetes with microangiopathy

目的 了解血浆同型半胱氨酸 (Hcy)与 2型糖尿病微血管病变 (DMAP)间的关系 ,并分析影响糖尿病(DM)患者 Hcy代谢的因素。方法 15 7例 DM患者分为三组 :无微血管并发症组 (NDC)、糖尿病视网膜病变组 (DR)和糖尿病肾病 (DN)组 ;正常对照组 (CON)组 2 8例。测定血浆 Hcy、叶酸、维生素 B1 2 浓度 ,并以 PCR- RFL P技术检测亚甲基四氢叶酸还原酶 (MTHFR) C6 6 7T突变和蛋氨酸合成酶还原酶 (MSR) A6 6 G突变率。结果 DM各组血 Hcy浓度及空腹高 Hcy血症发生率高于 CON组 ,DN组又高于 NDC组 (P<0 .0 5 )。DM患者血 Hcy浓度与 MTHFR BB基因型、BMI、Hb A1c、FBG、PBG、二甲双胍的使用呈正相关 ,与血浆叶酸和 Vit B1 2 呈明显负相关 ,与 MSR基因型无关。多元逐步回归分析结果显示 ,Vit B1 2 、Hb A1c、MTHFR基因型和叶酸是 DM患者血 Hcy浓度的影响因素。结论 空腹高 Hcy血症是DMAP的危险因子 ;2型 DM中 MTHFR基因型、Vit B1 2 、叶酸以及代谢紊乱的程度影响

Objective To study the possibility of homocysteine(Hcy) as a risk factor for microangiopathy in type 2 diabetes(DMAP)and its mechanism. Methods Plasma Hcy levels were measured by Fluorescence Polarization Immunoassay(FPIA) in 157 diabetics with or without microangiopathy and 28 normal subjects. Plasma folic acids; vitamin B12 levels, BMI, HbA1c, FBG, PBG, BUN, Cr, Ch and TG were measured. The mutations of the C667T transition of MTHFR and the A66G of MSR were determined by PCR RFLP.Results The patients with DMAP had higher Hcy levels and higher prevalence of hyperhomocysteinemia(HHcy)than normal group, while diabetics with nephropathy higher than those without this complication. The Hcy levels in type 2 diabetes were positively related to BB genetype of MTHFR, BMI, HbA1c, FBG, PBG and metformin treatment, and was negtively related to plasma folate and vitamin B 12 levels.By stepwise regression analysis, vitamin B 12 , HbA1c, BB genetype of MTHFR and plasma folate level were the independent factors for plasma Hcy level in type 2 diabetes.Conclusion Hhcy was a independent risk for DMAP, and vitamin B 12 , HbA1c, BB genetype of MTHFR and folate level influenced the plasma Hcy level in type 2 diabetes.