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目的 :探讨空腹血浆总同型半胱氨酸 (tHcy)水平与 2型糖尿病 (DM)微血管病变的关系及其影响因素。方法 :10 8例 2型DM患者和 4 5例正常对照者 (C组 ) ,DM组分为无并发症组 (NDC组 )、视网膜病变组 (DR组 )和肾病组 (DN组 ) ,酶免疫分析法测定血浆tHcy浓度 ;发光免疫法测定血清叶酸 (FA)和VitB1 2 水平。结果 :DR组和DN组的空腹血浆tHcy浓度明显高于NDC组和C组 (P <0 .0 1) ;高Hcy血症的DM患者DN、DR发生率明显高于无高Hcy血症DM患者 (P <0 .0 1) ;VitB1 2 、FA、和血清肌酐 (Scr)、餐后 2h血糖 (2hPBG)均为DM患者tHcy的决定因素 (均P <0 .0 1) ;Logistic回归分析显示空腹tHcy、体质量指数 (BMI)、胆固醇 (TC)、FA、VitB1 2 与DN的发生有关 ;空腹tHcy、2hPBG、TC、Scr均为DR的独立危险因素。结论 :空腹高tHcy血症是糖尿病微血管病变的危险因素 ;血清VitB1 2 、FA、Scr以及代谢紊乱程度影响tHcy的浓度。
Objective: To investigate the relationship between fasting plasma total homocysteine (tHcy) and type 2 diabetes mellitus (DM) microangiopathy and its influencing factors. Methods: A total of 108 patients with type 2 diabetes mellitus and 45 normal controls (group C) were enrolled in this study. DM patients were divided into two groups: non-complication group (NDC group), retinopathy group (DR group) and nephropathy group Plasma tHcy concentration was measured by immunoassay. The levels of serum folic acid (FA) and VitB1 2 were determined by luminescence immunoassay. Results: The fasting plasma tHcy concentrations in DR group and DN group were significantly higher than those in NDC group and C group (P <0.01). The incidence of DN and DR in patients with hyperhomocysteinemia was significantly higher than that without hyperhomocysteinemia (P <0.01); VitB1 2, FA, and serum creatinine (Scr), 2h postprandial blood glucose (2hPBG) were the determinants of tHcy in DM patients (all P <0.01); Logistic regression analysis The fasting tHcy, body mass index (BMI), cholesterol (TC), FA and VitB1 2 were correlated with the occurrence of DN. The fasting tHcy, 2hPBG, TC and Scr were independent risk factors for DR. CONCLUSION: Fasting hyperhomocysteinemia is a risk factor for diabetic microangiopathy. Serum levels of VitB1 2, FA, Scr and metabolic disorders affect the concentration of tHcy.