高同型半胱氨酸血症与2型糖尿病冠心病

Relationship between hyperhomocysteinemia and coronary heart disease in patients with type 2 diabetes

目的 探讨 2型糖尿病中高同型半胱氨酸 (Hcy)血症与冠状动脉粥样硬化的关系。方法117例患者于冠状动脉造影前测定血浆Hcy及血脂、血糖、肾功能等指标 ,将所有患者分为糖尿病合并冠心病组 (3 1例 )、糖尿病不伴冠心病组 (10例 )、冠心病不伴糖尿病组 (5 8例 )和正常对照组 (18名 ) 4组 ,再根据冠脉病变支数分为 0 ,1,2和 3支病变。结果 糖尿病合并冠心病组及冠心病不伴糖尿病组血浆Hcy水平较对照组相比均明显增高 (均P <0 .0 1) ;糖尿病合并冠心病组血浆Hcy水平较冠心病不伴糖尿病及糖尿病不伴冠心病组Hcy水平均显著增高 (均P <0 .0 1) ;多元回归分析表明在糖尿病中血浆Hcy与冠脉病变程度呈正相关 (r=0 .5 4,P <0 .0 1)。结论 2型糖尿病中高同型半胱氨酸血症是冠心病的危险因素。

Objective To study the relation between hyperhomocysteinemia and coronary arteriosclerosis in patients with type 2 diabetes. Methods One hundred and seventeen patients (82 men and 35 women) underwent coronary angiography. Plasma total homocysteine (Hcy), lipids, blood glucose and serum creatinine levels were measured. These patients were divided into 4 groups according to American Diabetes Association (1997) criteria and the result of coronary angiography: (1) Control without diabetes and coronary artery disease (CAD) (Ⅰ,n=18); (2) CAD without diabetes (Ⅱ,n=58); (3) Diabetes without CAD (Ⅲ, n=10); (4) CAD and diabetes (Ⅳ, n=31), and subjects were graded as nonstenotic, single-vessel stenotic, two-vessel stenotic, or three-vessel stenotic based on the number of stenotic coronary arteries. Results The plasma Hcy levels in patients with both diabetes and CAD and patients with CAD alone were higher than that in patients without diabetes and CAD (both P<0.05); The plasma Hcy level was significantly higher in patients with diabetes and CAD than that in patients with either diabetes or CAD (both P<0.01). Stepwise regression analysis showed that the plasma Hcy level was strongly correlated with the number of stenotic coronary arteries in the patients with diabetes (r=0.54, P<0.01). Conclusion Hyperhomocysteinemia is a risk factor of coronary arterioclerosis in patients with type 2 diabetes.