糖尿病肾病患者同型半胱氨酸水平与颈动脉粥样硬化关系的研究

Relationship between homocysteine level and carotid atherosclerosis in patients with diabetic nephropathy

目的探讨糖尿病肾病患者同型半胱氨酸水平与颈动脉粥样硬化的关系。方法选取2型糖尿病肾病住院患者159例。检测颈动脉内膜中层厚度及有无粥样斑块形成,根据结果分为两组,颈动脉正常组50例;颈动脉粥样硬化组,且颈部动脉有或者无斑块形成109例。收集并比较两组患者的一般临床资料、生化指标和颈动脉彩超指标。用Logistic回归分析比较自变量对CIMT增厚及斑块形成的影响。再根据Hcy水平将患者分为3组,比较各组间颈动脉粥样硬化发生率。使用ROC曲线分析Hcy对糖尿病肾病患者颈动脉粥样硬化的预测价值。结果(1)在糖尿病肾病患者中,颈动脉粥样硬化组患者的Hcy、尿素、年龄高于正常组,差异具有统计学意义(P<0.05);(2)Hcy是CIMT增厚及斑块形成的独立危险因素(P<0.05);(3)不同Hcy水平的3组患者的CIMT增厚及斑块形成率差异具有统计学意义(P<0.05);(4)通过ROC曲线分析Hcy用于预测颈动脉粥样硬化的价值:ROC曲线下面积0.731,P<0.001。结论(1)在糖尿病肾病患者中,并发颈动脉粥样硬化患者Hcy水平明显升高,且随着Hcy水平升高,颈动脉粥样硬化发生率增加;(2)Hcy升高是糖尿病肾病患者颈动脉粥样硬化的独立危险因素,并且对颈动脉粥样硬化的发生具有一定的预测价值。

Objective To investigate the relationship between homocysteine levels and carotid atherosclerosis in patients with diabetic kidney disease.Methods One hundred and fifty-nine inpatients with type 2 diabetic kidney disease were enrolled.Carotid intima-media thickness(CIMT)and the presence or absence of carotid plaque formation were detected.According to results,they were divided into two groups.50 cases are the normal carotid artery group;109 cases are the carotid atherosclerosis group,with or without plaque formation in the neck artery.The general clinical data,biochemical indexes and carotid color Doppler ultrasound indexes of the two groups of patients were collected and compared.Logistic regression analysis was used to compare the effects of independent variables on CIMT thickening and plaque formation.According to the level of Hcy,patients was divided into three groups,the incidence of carotid atherosclerosis were compared among groups.ROC curve was used to analyze the predictive value of Hcy for carotid atherosclerosis in patients with diabetic kidney disease.Results(1)Among the patients with diabetic kidney disease,the Hcy,urea,and age of the carotid atherosclerosis group were higher than that of the normal group,the difference was statistically significant(P<0.05);(2)Hcy was an independent risk factor for CIMT thickening and plaque formation(P<0.05);(3)Differences in CIMT thickening and plaque formation rate among the three groups of patients with different Hcy levels were statistically significant(P<0.05);(4)Analyze the value of Hcy for the diagnosis of carotid atherosclerosis through the ROC curve:the area under the ROC curve is 0.731,P<0.001.Conclusions(1)In patients with diabetic nephropathy,patients with concurrent carotid atherosclerosis have significantly increased Hcy levels,and as Hcy levels increase,the incidence of carotid atherosclerosis increases;(2)Elevated Hcy is an independent risk factor for carotid atherosclerosis in patients with diabetic nephropathy,and has certain predictive value for the occurrence of carotid atherosclerosis.