血浆同型半胱氨酸水平及亚甲基四氢叶酸还原酶基因多态性与2型糖尿病患者微量白蛋白尿的关系  

Relationship between plasma level of homocysteine and urine microalbumin in incipient type 2 diabetic nephropathy

作　　者：岳红[1] 柳洁[1] 康文娟[1] 胡玲[1] 秦洁[1] 雷琨[1] 薛雪华[1] 

机构地区：[1]山西省人民医院内分泌科,太原030012

出　　处：《中华全科医师杂志》2006年第12期725-729,共5页Chinese Journal of General Practitioners

摘　　要：目的探讨血浆同型半胱氨酸(Hcy)水平及亚甲基四氢叶酸还原酶(MTHFR)基因多态性与2型糖尿病(T2DM)早期肾病的关系及影响因素。方法对252例T2DM患者[140例为无并发症者(NDC组),112例为早期糖尿病肾病者(DN组)]和30例对照者,测定血浆Hcy、叶酸、维生素B12(VitB12)、糖化血红蛋白(HbA1c)、空腹血糖、餐后2h血糖(PBG)、胆固醇(CHO)、甘油三酯(TG)、肌酐、转化生长因子β1(TGF-β1)水平,尿N-乙酰-D氨基葡萄糖苷酶(NAG)、微量白蛋白/肌酐(MAlb/Cr)值、MAlb水平,并以聚合酶链反应-限制性内切酶片段长度多态性技术(PCR-RFLP)检测MTHFR基因C677T突变率。结果DN组血浆Hcy水平高于对照组[(16·6±12·6)与(9·7±2·0)μmol/L,P<0·05],DN组又高于NDC组[(16·6±12·6)与(11·9±7·3)μmol/L,P<0·05];高Hcy血症患者的早期糖尿病肾病发生率明显高于血Hcy水平正常患者(61·4%与36·1%,P<0·05)。T2DM患者血浆Hcy水平与MTHFR基因型、体重指数、HbA1c、空腹血糖、PBG、NAG、MAlb/Cr、病程、吸烟、二甲双胍的使用呈正相关,与叶酸、VitB12呈明显负相关;logistic回归分析显示病程、舒张压、空腹血糖、NAG、Hcy均为早期糖尿病肾病的危险因素。结论空腹高Hcy血症是早期糖尿病肾病的危险因素;MTHFR基因型、叶酸、VitB12、MAlb/Cr、NAG以及代谢紊乱程度影响血浆Hcy水平。Objective To investigate the relationship between plasma level of homocysteine（Hcy） and urine microalbumin （MAIb） in incipient type 2 diabetic （T2DM） nephropathy,and its relevant factors. Methods Two hundred and fifty-two cases of T2DM and 30 cases of normal control were enrolled in the study. Cases of T2DM were divided into two groups, one with incipient diabetic nephropathy and another without renal complication （NDC）. Plasma levels of Hcy, folate （FA）, vitamin B12 （VitB12）, glycosylated hemoglobin Alc（ HbAlc）, and fasting blood glucose （ FBG）, postprandial blood glucose （PBG） , blood levels of creatinine （ Cr）, cholesterol, triglycerlde, transforming growth factor β1, urine levels of N- acetylglucosaminidase （ NAG）, MAIb and ratio of MAIb/Cr were measured for all the subjects. Mutation of the C677T transition of methylenetetrahydrofolate reductase （MTHFR） gene was determined by polymerase chain reaction-restriction fragment length polymorphism. Results Plasma level of Hcy was （ 16. 6± 12.6） μmol/L in patients with incipient type 2 diabetic nephropathy, significantly higher than that in normal control group （9.7 ± 2.0） μmol/l,, P 〈 0.05, and that was （ 16.6 ± 12.6） μmol/L in patients with incipient type 2 diabetic nephropathy, also significantly higher than that in those without renal complication （ 11.9 ± 7. 3 ）μmol/L, P 〈 0.05. Occurrence of incipient diabetic nephropathy was significantly higher in those with hyperhomocysteinmia than those with normal plasma level of Hcy （61.4% vs 36.1% , P 〈 0.05）. Plasma level of Hcy in T2DM patients was positively related to the TT genetype of MTHFR, body mass index, FBG, PBG, HbAIc, NAG, MAlb/Cr, course of disease, smoking and mefformin treatment, and were negatively related to plasma levels of FA and VitB12. Multivariate logistic regression analysis showed that course of disease, diastolic blood pressure, FBG, NAG and plasma level of Hcy all were independent risk factors for incipient dia

关 键 词：糖尿病 非胰岛素依赖型 糖尿病肾病 高同型半胱氨酸血症 

分 类 号：R587.1[医药卫生—内分泌]