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目的 观察空腹血浆总同型半胱氨酸 (Hcy)水平与 2型糖尿病视网膜病变发生发展的关系。方法 研究对象为 5 5例 2型糖尿病 (DM)和 19例 (男 12例 ,女 7例 )非DM健康对照者 (CON)。DM组分为两个亚组 :无微血管并发症 (NDC)组 39例 (男 17例 ,女 2 2例 ) ,糖尿病视网膜病变 (DR)组16例 (男 8例 ,女 8例 )。所有患者肾功能和尿白蛋白 /肌酐 (Alb/Cr)均正常。根据眼底荧光造影判断视网膜病变的严重程度。应用高效液相 反相色谱分析和荧光检测的方法测定空腹血浆总Hcy水平。结果 DR组、NDC组和CON组间的血浆总Hcy浓度差异有显著性 (F =2 4 0 5 ,P =0 0 31) ,DR组血浆总Hcy水平 [(14 7± 5 2 8) μmol/L]显著高于NDC组 [(11 3± 4 94) μmol/L]和CON组 [(9 6 5± 2 6 6 )μmol/L]。NDC组与CON组比较差异无显著性。在DR组 ,增殖性视网膜病变 (PDR)亚组总Hcy水平显著高于背景性视网膜病变 (BDR)亚组 (t=2 4 0 5 ,P =0 0 31)。本研究中 ,总Hcy超过 14 97μmol/L即为高同型半胱氨酸血症 ,其中PDR亚组有 4例 ,BDR亚组为 1例。结论 伴视网膜病变的 2型DM患者血浆总Hcy水平高于正常人 ,其中PDR组的血浆总Hcy浓度高于BDR组。空腹血浆同型半胱氨酸水平可能是 2型糖尿病视网膜病变的重要危险因素之一。
Objective To observe the relationship between fasting plasma homocysteine (Hcy) level and the development of type 2 diabetic retinopathy. METHODS: Fifty-five DM patients and 19 non-DM healthy controls (CON) were enrolled in this study. The DM group consisted of two subgroups: 39 patients (17 males and 22 females) with no microvascular complications (NDC) and 16 patients (8 males and 8 females) with diabetic retinopathy (DR). All patients had normal renal function and albumin / creatinine (Alb / Cr). According to fundus fluorescein angiography to determine the severity of retinopathy. Fasting plasma total Hcy levels were determined by high performance liquid chromatography and fluorescence detection. Results There was a significant difference in total Hcy concentration between DR group, NDC group and CON group (F = 24.05, P = 0 0 31), and total Hcy level in DR group [(14 7 ± 528) μmol / L] was significantly higher than that in NDC group [(11 3 ± 4 94) μmol / L] and CON group [(96 65 ± 26 6) μmol / L]. There was no significant difference between NDC group and CON group. In the DR group, the total Hcy level in the proliferative retinopathy (PDR) subgroup was significantly higher than that in the subgroup of the retinopathy of background (BDR) (t = 2450, P = 0 031). In our study, total Hcy over 14 97 μmol / L was hyperhomocysteinemia, with 4 cases in the PDR subgroup and 1 case in the BDR subgroup. Conclusions Plasma total Hcy levels in patients with type 2 diabetes mellitus with retinopathy are higher than those in normal controls. The plasma total Hcy levels in PDR patients are higher than those in BDR patients. Fasting plasma homocysteine levels may be one of the important risk factors for type 2 diabetic retinopathy.