高同型半胱氨酸血症与2型糖尿病慢性并发症的关系

Relationship between hyperhomocysteinemia and chronic complications 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)水平与慢性并发症的关系。 方法 应用高效液相色谱仪和荧光检测仪测定 2 16例 2型糖尿病患者和 89名正常对照者的血浆总同型半胱氨酸 (tHcy)水平 ,分析患者组血浆tHcy水平与慢性并发症之间的关系。 结果 (1)患者组血浆tHcy水平高于正常对照组 [(16 .0± 6 .3) μmol/Lvs (11.7± 2 .2 ) μmol/L ,P <0 .0 1];患者组中35 %存在高Hcy血症 (tHcy >16 .2 μmol/L) ,而正常对照组仅 7% (P <0 .0 1)。 (2 )患者组中的高Hcy组 [n =75 ,tHcy为 (2 3.7± 7.4 ) μmol/L]其慢性并发症的发生率为 6 7% ,而正常Hcy组 [n =14 1,tHcy为 (11.6± 2 .5 ) μmol/L]为 4 0 % (P <0 .0 1)。高Hcy组中高血压、冠心病、脑血管病变、下肢血管病变及肾病的发生率均高于正常Hcy组 ,其中以冠心病发生率差异尤为显著 (43%vs 2 3% ,P <0 .0 0 1) ,而视网膜病变及神经病变的发生率则无明显差异。 (3)相关分析显示 ,2型糖尿病患者血浆tHcy水平与年龄、尿白蛋白排泄率呈正相关 (r =0 .36 ,P =0 .0 0 0 9;r =0 .2 7,P =0 .0 184 ) ,与肌酐清除率、血叶酸水平呈负相关 (r =- 0 .5 3,P =0 .0 0 0 3;r =- 0 .2 5 ,P =0 .0 137)。 结论 高Hcy血症与

Objective To assess whether plasma hyperhomocysteine (tHcy) were related to chronic complications in type 2 diabetes mellitus. Methods Plasma tHcy levels were measured by high performance liquid chromatography with fluorescence detection in 216 diabetics and 89 normal subjects. The difference in prevalence of chronic complications (e.g., macroangiopathy, hypertention, proteinuria, decreased creatinine clearance, vascular lesions in the lower limbs, retinopathy and neuropathy) between patients with and without hyperhomocysteinemia was investigated. Results The tHcy level was higher in type 2 DM patients than that in normal control subjects (16.0±6.3 μmol/L vs 11.7±2.2 μmol/L P <0.01). 35% of the patients ( n =75) had raised tHcy (>16.2 μmol/L) and the prevalence of chronic complications was higher in patients with hyperhomocysteinemia than that without hyperhomocysteinemia (67% vs 40% P <0.01). The prevalence of coronary artery disease was particular higher in patients with hyperhomocysteinemia (43% vs 23% P <0.001). The plasma tHcy levels in type 2 diabetes was positively related to age, UAER and negatively related to creatinine clearance rate, plasma folate level. Conclusion hyperhomocysteinemia is related to the prevalence of macroangiopathy and nephropathy in diabetics.