2型糖尿病肾病患者血清同型半胱氨酸水平及临床意义

The level and significance of sera homocysteine in patients with type 2 diabetic nephropathy

目的：探讨同型半胱氨酸（Hcy）水平在2型糖尿病肾病发展中的变化及意义。方法随机选取该院2013年1-12月住院治疗的124例2型糖尿病患者，根据尿微量清蛋白与尿肌酐比值（UACR）分为四组：（1）糖尿病非肾病组（DM组，UACR〈30 mg/g）30例；（2）早期糖尿病肾病组（DN1组，UACR 30-300 mg/g）26例；（3）临床糖尿病肾病组[DN2组，UACR〉300 mg/g，血清肌酐（SCr）〈133μmol/L]36例；（4）糖尿病肾病慢性肾功能衰竭组（DN3组，UACR〉300 mg/g，SCr≥133μmol/L）32例。测定血清Hcy、SCr、BUN及糖化血红蛋白（HbA1c）水平，并对检测结果进行统计分析。结果四组检测指标结果比较，Hcy、SCr、BUN水平均随着疾病的严重程度呈升高趋势。Hcy水平在DM组和DN1组、DN2组、DN3组间比较，差异均有统计学意义（P＜0．05）。血清Hcy与UACR水平呈正相关（r=0.546，P〈0.05），SCr水平与Hcy呈正相关（r=0.361，P＜0.05），HbA1c水平与Hcy呈负相关（r=-0.203，P＜0.05）。结论 Hcy高水平可能是2型糖尿病肾病进展的危险因素之一，与2型糖尿病肾病的发生、发展具有密切关系，可作为2型糖尿病肾病早期诊断的临床检测指标。

Objective To investigate the change and significance of homocysteine （Hcy） on the development of type 2 diabetic nephropathy（T2DN）. Methods A total of 124 patients with type 2 diabetic mellitus,who were treated in the hospital from January to December of 2013,were selected randomly and divided into 4 groups according to urinary albumin to creatinine ratio （UACR）：（1）the simple diabetes mellitus（DM） group（DM group,UACR〈30 mg/g,n=30）;（2）the early-stage diabetic nephropathy （DN） group（DN1 group,UACR 30-300 mg/g,n=26）;（3）the clinical DN group[DN2 group,UACR〉300 mg/d,serum creatinine （SCr）〈133μmol/L,n=36];（4）DN uremia group （DN3 group,UACR〉300 mg/d,SCr≥133μmol/L,n=32）.The sera Hcy,SCr and blood urea nitrogen（BUN） in all the groups were determined and analyzed statistically. Results The levels of Hcy SCr and BUN in the 4 groups increased with the severity of disease. Compared with the DM group respectively ,the differences of Hcy in DN1 group,DN2 group and DN3 group all had statistical significance（P〈0.05）. Sera HCy was positively correlated with UACR level （r=0.546,P〈0.05）, SCr level was positively correlated with Hcy（r=0.361,P〈0.05）,and the haemoglobin A1c（HbA1c） level was negatively correlated with Hcy（r=-0.203,P〈0.05）. Conclusion High level of Hcy might be one of the risk factors for development of T2DN,and it is closely related with the occurrence and development of T2DN,so it can be considered as clinical indicators for early diagnosis of T2DN.