2型糖尿病患者血浆同型半胱氨酸与血糖波动的相关性研究

The relationships between homocysteine and glycemic variability in type 2 diabetes mellitus

目的探讨2型糖尿病患者血浆同型半胱氨酸(Hcy)与血糖波动之间的相关性。方法选取120例2型糖尿病患者,按本院实验室标准,Hcy水平≥10mmol/L的62例患者纳入高同型半胱氨酸组(HHcy),Hcy水平<10mmol/L的58例患者纳入正常同型半胱氨酸组(NHcy),测定两组患者的血生化指标、胰岛功能,并进行动态血糖监测,比较两组的生化指标、胰岛素指数及血糖波动值。结果 HHcy组患者日间血糖平均绝对差、胰岛素抵抗指数、血肌酐、尿微量白蛋白和24h尿蛋白定量均高于NHcy组,差异均有统计学意义(均P<0.05);但两组患者平均血糖值、糖化血红蛋白、日间平均血糖波动幅度(MAGE)、胰岛素分泌指数、胰岛素敏感指数、尿素氮和肾小球滤过率(GFR)比较差异均无统计学意义(均P>0.05)。Pearson相关分析显示Hcy水平与MAGE呈正相关(r=0.548,P<0.01),与GFR值呈负相关(r=-0.577,P<0.01)。结论 Hcy水平在一定程度上能反映2型糖尿病患者的肾功能进展以及对胰岛素的敏感性和抵抗程度,并与血糖波动存在一定的相关性,可作为临床上反映血糖波动的一个简便的筛选指标。

Objective To explore the relationships between homocysteine and glycemic variability in patients with type 2 diabetes mellitus. Methods A total of 120 patients with type 2 diabetes metlitus was enroll in the research. All of them were divided separately by the level of homocystiene （HHcy and NHcy）, then blood glucose and insulin function will be tested and calculated. Evaluate the relationships by obtaining the laboratory index, HOMA factors and glycemic variability parameters after continuously monitoring glucose. Results Factors such as MODD, HOMA-IR, Ser, mAIb and UAER in HHcy are higher than ones in NHcy （all P〈0.05）, and other factors like MBG, HbAlc, MAGE, HOMA-B, H^MA-S, BUN, GFR seem no significant differences in two groups （all P 〉0.05）. Pearson analysis shows levels of Hcy have positive correlation with MAGE （r=0.548, P〈 0.01）, while they＇re negatively related to GFR（r=-0.577, P〈0.01）. Conclusion This study demonstrates homocysteine may reflect renal function, insulin sensitivity and resistance in type 2 diabetes patients. Also, the results suggest that the Hcy may be of limited value for assessing glucose variability in the patients with type 2 daibetes mellitus, it also can be chosen as a convenient indicator for glucose variability.