高同型半胱氨酸血症与2型糖尿病合并冠心病的关系研究  

Hyperhomocysteinemia and coronary heart disease in type 2 diabetes mellitus

作　　者：罗丹[1] 鄢盛恺[2] 宋耀虹[2] 李宏义[3] 程歆琦[2] 李君[2] 

机构地区：[1]空军总医院临床检验中心,北京100036 [2]中国医学科学院中国协和医科大学北京协和医院检验科,北京100730 [3]北京医院心内科,北京100730

出　　处：《空军总医院学报》2006年第1期1-4,共4页Journal of General Hospital of Air Force,PLA

摘　　要：目的 探讨我国北方地区汉族人高同型半胱氨酸血症与糖尿病合并冠心病发生的关系，希望能为糖尿病合并冠心病的防治提供新的科学依据。方法研究对象均为北方汉族人群，包括无血缘关系的对照组91名健康人、150名糖尿病患者和104名糖尿病合并冠心病的患者。应用荧光偏振免疫法（FPIA）测定Hcy水平，应用微粒子酶免分析免疫法（MEIA）测定血浆叶酸、维生素B12浓度。同时测定各种血脂、脂蛋白及载脂蛋白。采用SPSS 11．0软件进行统计学分析。结果糖尿病合并冠心病组（合并组）Hcy平均水平（中位数）（15．07μmol／L）显著高于对照组（11．69μmol／L）和糖尿病组（11．32μmol／L），（P〈0．05），对照组与糖尿病组之间差别无统计学意义（P〉0．05）。合并组叶酸、维生素B12明显低于正常对照组及糖尿病组（P〈0．05），对照组与糖尿病组之间差别无统计学意义（P〉0．05）。本研究定义：Hcy大于15．0μmol／L为高同型半胱氨酸血症（Hyperhomocysteinemia，HHcy）。合并组患者104例中有49例高同型半胱氨酸血症占47．1％，而糖尿病组150例中有17例占11．3％。高同型半胱氨酸增加了糖尿病合并冠心病的患病风险，比数比为6．970（X^2=40．89，P〈0．01，95％CI 3．614～13．151）。Logistic回归分析显示高同型半胱氨酸、ApoC3、年龄、Lp（a）、TC是冠心病发生的独立危险因素，OR值分别为3．859、1．438、1．154、1．058、1．030。结论高同型半胱氨酸是我国北方地区汉族人2型糖尿病合并冠心病发生的独立危险因素，可能在糖尿病合并冠心病的发生、发展过程中起到一定作用。Objective To explore the significance of hyperhomocysteinemia in type 2 diabetes mellitus （DM） with coronary heart disease （CHD） in northern China. Methods We selected 104 patients with type 2 DM and CHD,150 patients with type 2 DM,and 91 controls in Han nationality in northern China. Plasma Hcy levels were measured by fluorescence polarization immunoassay （FPIA） and the plasma folate and vitamin B12 levels by microparticle enzyme immunoassay （MEIA）. The levels of plasma lipids,lipoproreins and apolipoproteins were also measured. Results The plasma Hcy levels were significantly higher in DM with CHD group（15.07μmol/L）than in control group （11.69μmol/L） and DM group （11.32μmol/L） （P〈0. 05）. The levels of plasma folate and Vitamin B12 were significantly lower in DM with CHD group than in control group and DM group （P〈0. 05）. In our study, Hyperhomocysteinemia was defined that Hcy level was higher than 15.0μmol/L. In 104 patients with DM and CHD,49 were detected hyperhomocysteinemia（47.1%）, as compared with in 17 of 150 DM group（11.3%）, the odd rations （OR） of hyperhomocysteinemia for DM and CHD was 6. 970 （X^2=40.89,P〈0.01,95%,CI 3.614-13.151）. Logistic-regression analysis indicated that Hyperhomocysteinemia, ApoC3, age, lp （a）, and TC were the independent risk factors for CHD. Conclusion Hyperhomocysteinemia might be independent risk factor for DM with CttD in northern Chinese Han population. It is benefit for prevention from high risk of CHD in type 2 DM patients to detect the levels of Hcy.

关 键 词：高同种半胱氨酸血症 糖尿病 2型 冠状动脉疾病 

分 类 号：R452[医药卫生—治疗学] R543.302.5[医药卫生—临床医学]