2型糖尿病周围神经病变患者血清Hcy水平与糖尿病肾病的相关性研究

Level of serum Hcy levels in patients with type 2 diabetes accompanied with diabetic peripheral neuropathy and relationship between Hcy and diabetic nephropathy

目的 探讨2型糖尿病周围神经病变（DPN）患者血清同型半胱氨酸（Hcy）水平与糖尿病肾病的相关性,阐明Hcy在DPN发病中的作用机制.方法 38例DPN患者（DPN组）,35例非2型糖尿病周围神经病变患者（NDPN组）,同时选择32例正常人作为对照组（NC组）,采用循环酶法测定血清Hcy水平并比较,同时分析血清Hcy与胱抑素C（Cys-c）、尿微量白蛋白/肌酐（ACR）、肾小球滤过率（GFR）、振动觉阈值（VPT）、血糖、血脂、血压等指标的关系.结果 DPN组和NDPN组血清Hcy水平均明显高于NC组（15.13 ±1.56 vs.10.77±3.59 vs.7.19±1.95 μmol/L,P＜0.05或P＜0.01））,而DPN组血清Hcy水平明显高于NDPN组（15.13±1.56 vs.10.77±3.59tmol/L,P＜0.05）.DPN患者血清Hcy水平与GFR成负相关,与VPT、Scr、Cys-c和ACR成正相关（P＜0.05或P＜0.01）.Cys-c和VPT是影响DPN组患者血清Hcy水平的独立相关因素.结论 T2DM患者尤其是伴有DPN患者血清Hcy水平明显增高,与糖尿病肾病早期肾损害密切相关,可能在2型糖尿病周围神经病变的发生发展中具有重要作用.

Objectives To investigate the level of serum homocysteine （Hcy） in patients with type 2 diabetes mellitus（T2DM） accompanied with diabetic peripheral neuropathy（DPN） and the relationship between Hcy and diabetic nephropathy（DN）,and to explore the mechanisms of Hcy in T2DM patients with DPN.Methods 38 patients with T2DM accompanied with DPN （DPN group）,35 T2DM patients without DPN（NDPN group）,and 32 normal controls were chosen（NC group） in this study.Fasting serum homocysteine （Hcy） level was measured by enzymatic cycling assay and compared.The relationship in the change of Hcy,cystatin C （Cys-C）,microalbuminuria -to-creatinine ratio（ACR）,glomerular filtration rate（GFR）,blood pressure,glucose and blood lipid and other parameters was also analyzed.Results ompared with those of control group,serum Hcy level in patients with DPN and NDPN groups significantly increased （15.13±1.56 vs.10.77 ±3.59 vs.7.19 ± 1.95μmol/L,P 〈0.05 orP 〈0.01）.Moreover,DPN patients were detected with higher serum Hcy levels than NDPN patients（15.13 ± 1.56 vs.10.77 ± 3.59μmol/L,P 〈0.05）.Serum Hcy levels correlated negatively with GFR,and correlated positively with vibration perception threshold （VPT）,serum creatinine（Scr）,Cys-C and ACR in DPN patients（P 〈0.05 orP 〈 0.01）.Multiple regression analysis showed that Cys-c and VPT were independent related factors influencing Serum Hcy levels.Conclusions Serum Hcy levels are significantly increased in T2DM patients,especially for DPN patients,which are significantly correlated with early renal function of diabetic nephropathy and may play an important role in the occurrence and development of DPN in T2DM patients.