新诊断的2型糖尿病患者同型半胱氨酸血症与尿微量白蛋白/肌酐的关系研究

Study on the relationship between homocysteinemia and urinary microalbumin/creatinine in patients with newly diagnosed T2DM

目的探讨高同型半胱氨酸血症(HHCY)对新诊断的2型糖尿病(T2DM)患者尿微量白蛋白/肌酐(UACR)的影响。方法选取2014年9月至2018年9月就诊于北京航天总医院门诊的90名新诊断的2型糖尿病患者,根据是否合并HHCY分组,其中45例合并高同型半胱氨酸血症(T2DM+HHCY组),45例同型半胱氨酸正常(T2DM+NHCY组),测定两组患者的身高、体重、血糖、胰岛素、同型半胱氨酸、肌酐、总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇及三酰甘油,UACR,并计算体质指数和胰岛素抵抗指数。通过相关分析计算UACR与同型半胱氨酸(HCY)等代谢指数的相关性,并通过多元线性回归计算UACR的独立影响因素。结果T2DM+HHCY组患者胰岛素抵抗指数,UACR显著高于T2DM+NHCY组[(21.90±7.23)mg/g vs.(18.41±7.44)mg/g,P<0.05]。UACR与糖化血红蛋白(r=0.211,P<0.05),空腹血糖(r=0.217,P<0.05),胰岛素抵抗指数(r=0.236,P<0.05),同型半胱氨酸水平(r=0.248,P<0.05),三酰甘油(r=0.231,P<0.05)呈正相关。多元回归分析发现,同型半胱氨酸、糖化血红蛋白是UACR的危险因素。结论新诊断的T2DM合并HHCY患者尿微量白蛋白/肌酐升高,同型半胱氨酸是2型糖尿病患者尿微量白蛋白/肌酐的独立危险因素。

Objective To investigate the effect of hyperhomocysteinemia(HHCY)on UACR in patients with newly diagnosed type 2 diabetes mellitus(T2DM).Methods A total of 90 patients with newly diagnos ed T2DM attending the Outpatient Clinic of Beijing Aerospace General Hospital from September 2014 to September 2018 were selected as the study subjects.These patients were grouped into the T2DM+HHCY group(n=45,with HHCY)and the T2DM+NHCY group(n=45,with normal HCY)according to the presence or absence of HHCY.The height,weight,blood glucose,insulin,HCY,creatinine,total cholesterol,high density liptein cholesterol,low density liptein cholesterol,triglycerides,and UACR of patients in both groups were measured,and body mass index and insulin resistance index(IRI)in both groups were calculated.Correlations between UACR and metabolic indexes such as HCY were calculated by correlation analysis,and independent influencing factors on UACR were analyzed by multiple linear regression analysis.Results IRI and UACR in patients in the T2DM+HHCY group were significantly higher than those in the T2DM+NHCY group([21.90±7.23]mg/g vs.[18.41±7.44]mg/g,P<0.05).UACR was positively correlated with glycated hemoglobin(r=0.211,P<0.05),fasting glucose(r=0.217,P<0.05),IRI(r=0.236,P<0.05),HCY level(r=0.248,P<0.05),and triglycerides(r=0.231,P<0.05).Multiple regression analysis showed that HCY and glycated hemoglobin were risk factors for UACR.Conclusion UACR is elevated in patients with newly diagnosed T2DM combined with HHCY,and HCY is an independent risk factor for UACR in patients with T2DM.