血浆总同型半胱氨酸水平与2型糖尿病和糖尿病肾病  

The level of total plasma homocysteine in type 2 diabetes patients with and without diabetic nephropathy

作　　者：梁国威[1] 张捷[1] 

机构地区：[1]北京大学第三医院检验科,北京100083

出　　处：《中国实验诊断学》2006年第9期1048-1051,共4页Chinese Journal of Laboratory Diagnosis

摘　　要：目的 探讨2型糖尿病（T2DM）和糖尿病肾病（DN）患者血浆总同型半胱氨酸（tHcy）水平、影响因素及与DN之间的关系。方法 对诊断T2DM有大量蛋白尿的34例患者（组1），T2DM有微量白蛋白尿的60例患者（组2），T2DM微量白蛋白尿正常的148例患者（组3），尿微量白蛋白正常的非糖尿病对照的140例者（组4）的血浆tHey及临床基本资料、血、尿相关指标进行调查和检测，并计算内生肌酐清除率（Ccr）和胰岛素抵抗指数（HOMA）。结果 各组之间的血浆tHcy水平有显著性差异（P〈0．001），组1 tHey（16．9±5．0μmaol／L），组2（13．4±3．7μmol／L），组3（11．8±4．2μmol／L）皆明显高于组4（11．0±6．0μmol／L）。组3、组2、组1的高同型半胱氨酸血症（HHe）发生率依次增高（15．5％，36．4％，58．8％），各组之间呈显著性差异（P〈0．001），皆明显高于组4（7．9％）。组4至组1患者血清叶酸、VitB12呈明显下降趋势（P〈0．001）。以糖尿病患者组（组1、组2、组3，n=242）lg tHcy为因变量，多元线性回归分析显示年龄、Scr、叶酸、VitB12是血浆lg tHcy的独立影响因素（R=0．613，R^2=0．376）。在2型糖尿病患者（组1、组2、组3，n=242）中，以DN为因变量，经二项分类Logistic回归分析显示，血浆tHcy每升高5μmaol／L，DN发病的危险率增加2．041倍（OR=2．041，95％CI 1．377-3．024）。结论 尿微量白蛋白正常的T2DM患者血浆tHcy水平及HHe发生率明显升高，随DN的发展，血浆tHcy水平及HHe发生率呈梯度升高，各组之间有显著性差异。通过Logistic回归分析显示血浆tHcy水平升高是T2DM肾病的危险因素。提示临床需要关注和干预T2DM患者的高同型半胱氨酸血症。Objective The aim of this study is to explore the distribution and determinants of plasma total homocysteine （tHcy） concentrations in type 2 diabetes patients with and without diabetic nephropathy, and to assess the relationship between high they and diabetic nephropathy.Methods We studied 242 type 2 diabetes patients including 34 with macroalbuminuria （groupl） ,60 with microalbuminuria （group2）,148 with normal microalbuminuria （group3）,and 140 with normal gluense tolerance served as nommal controis （group4）. Basic material are investigated , and Fasting blood and Urine samples are collected for measurement. Creatinine clearance（Ccr） is estimated by Cockcroft-Gauh formula and insulin resistance is calculated by the homeostasis model assessment （HOMA） .Results The level of tHey in groupl ,group2 and group3 are signifieantly higher than that in group4（ 16.9±5.0 μmol/L, 13.4 ±3.7 μmol/L, 11.8 ± 4.2 μmol/L vs 11.0 ± 6.0 μmol/L, P 〈 0.001 ）. The same consequence is also found for the prevalence of hyperhomoeysteinemia（HHe） in four groups （group1：58.8%, group2：36.4%, group3：15.5%, vs group4：7.9%, P 〈 0.001）.There is a significant decreasing trend of serum folate and VitB12 from group4 to groupl （ P 〈 0.001 ）. In patients with type 2 diabetes （ groupl, 2,3, n = 242）, using multivariate linear regression, the age, folate, VitB12 and Scr are independent predictors of lg they（ R = 0.613, R^2 = 0.376 ）. The risk factors for diabetic nephropathy are evaluated by binary logistic regression. The increment of tHey （per 5.0 μmol/L tHcy） resulted in a markedly elevated risk for diabetic nephropathy （OR： 2.041,95 % CI ： 1. 377 - 3.024） in type 2 diabetes patients. Conclusion Compared with normal controls, the level of tHcy and the prevalence of HHe significantly increase in type 2 diabetes with normal microalbuminuria, and have a considerably increasing trend with the development of diabetic nephropathy. The increased plasma tHcy is one of the r

关 键 词：糖尿病肾病 同型半胱氨酸 

分 类 号：R587.1[医药卫生—内分泌] R692[医药卫生—内科学]