血同型半胱氨酸与老年2型糖尿病肾病的相关性

Association between Serum Homocysteine Level and Diabetic Kidney Disease in Elderly Patients with Type 2 Diabetes Mellitus

为研究血同型半胱氨酸(homocysteine,Hcy)水平与老年2型糖尿病肾病(diabetic kidney disease,DKD)的相关性。随机选取2017年1月—2020年12月广元市精神卫生中心收治的单纯2型糖尿病(T2DM)患者120例、DKD患者240例为研究对象。根据肾小球滤过率(glomerular filtration rate,eGFR)及尿白蛋白/肌酐(urine albumin/creatinine,UACR)水平来评估DKD患者严重程度,将其分成4组,每组60例。收集患者一般临床资料并检测Hcy水平、肝肾功能等。采用Logistic多元回归模型分析Hcy水平与不同程度DKD的关系。结果表明:与单纯T2DM组相比,DKD组糖化血红蛋白(HbA_(1c))及Hcy水平随DKD严重程度的增加呈上升趋势,而eGFR、叶酸水平则相反,其中ALB-DKD组变化最为显著(P<0.05)。ALB-DKD组、NAALB-DKD组HHcys发生率、高血压患病率显著高于单纯T2DM组和NADKD组(P<0.05),且两组Hcy水平与叶酸、eGFR均呈显著负相关,与UACR、收缩压呈显著正相关关系(P<0.05)。多元回归分析结果显示,Hcy是单纯T2DM患者发展为ALB-NADKD、NAALB-DKD及ALB-DKD组的独立危险因素(P<0.001)。可见HHcy在一定程度上可作为老年T2DM患者发生DKD的强预测因子。

To evaluate the association between serum homocysteine(Hcy)level and diabetic kidney disease(DKD)in elderly patients with T2DM.240 elderly patients with DKD were divided into four study groups based on glomerular filtration rate(eGFR)and urine albumin/creatinine(UACR)levels,120 patients with T2DM without DKD were enrolled in the control groups in the Guangyuan Mental health center from January 2017 to December 2020.After measuring the renal function remarkes,the Logistic regression model was used to to evaluate the association between serum homocysteine level and DKD.The results show that HbA_(1c) and Hcy levels in the DKD groups are significantly higher than in the T2DM group by increasing severity of DKD,eGFR and folic acid levels are significantly decreased in DKD groups,especially the ALB-DKD group(P<0.05).The incidence of HHcys and the prevalence of hypertension in the ALB-DKD group and NAALB-DKD group are significantly higher than in the control group and the NADKD group(P<0.05).Serum Hcy is negatively correlated with folic acid and eGFR,but Hcy is positively correlated with UACR and systolic blood pressure(P<0.05).The results of multivariate logistic regression analysis show that serum Hcy is an independent risk factor for T2DM patients to develop into ALB-NADKD and NAALB-DKD and ALB-DKD(P<0.001).It is concluded that the levels of HHcy in elderly patients with T2DM could be used as a strong predictor of DKD to a certain extent.