Objective: To explore the relationship between non-dipper pattern of blood pressure circadian rhythm and homocysteine (Hcy), carotid atherosclerosis (CAS) in patients with type 2 diabetes mellitus (T2DM). Methods: A total of 240 T2DM patients including 139 male and 101 female were enrolled. According tonocturnal blood pressure falling rates, the patients were divided into 2 groups: Dipper group,n=80 and Non-dipper group,n=160; based on CAS condition, the patients were divided into another set of 2 groups: CAS group,n=119 and Non-CAS group,n=121. Blood levels of Hcy, carotid intima media thickness (CIMT) and 24hSBP, dSBP, nSBP, 24hDBP, dDBP, nDBP were compared between 2 groups in each set; the risk factors of CAS were analyzed. Results: The following indexes were higher in Non-dipper group than Dipper group: Hcy by µmol/L (16.41.0±8.08 vs 12.55±4.07), CIMT by mm (1.00±0.59 vs 0.80±0.30), 24 hSBP by mmHg (138.7±19.2 vs 127.5±15.6), dSBP (139.4±19.2 vs 132.0±16.2), nSBP (136.4±20.0 vs 113.8±15.0), nDBP (74.0±12.0 vs 64.9±9.8), allP<0.01. Multi linear regression analysis indicated that Hcy (β=0.011,P<0.01), nSBP (β=0.021,P<0.01), nDBP (β=0.018,P<0.01) could affect blood pressure circadian rhythm. The following indexes were higher in CAS group than Non-CAS group: CIMT (1.18±0.65 vs 0.69±0.72), age by years (62.33±12.02 vs 59.17±10.80), 24 hSBP (138.2±18.2 vs 131.9±18.9), dSBP (139.5±18.4 vs 134.4±18.5), nSBP (133.9±20.7 vs 123.9±20.9) nDBP (73.3±12.8 vs 68.6±11.0),P<0.05 orP<0.01; while 2 indicators in CAS group were lower than Non-CAS group: SBPF (4.00±7.89 vs 7.66±7.36), DBPF (5.95±8.44 vs 10.19±8.67),P<0.01. Logistic regression analysis showed that age (OR=2.204,P<0.05), nDBP (OR=2.357,P<0.05), SBPF (OR=2.562,P<0.01) were the risk factors for carotid atherosclerosis. Spearman correlation analysis presented that CIMT was positively related to age (0.195,P<0.05) and negatively related to SBPF (r=-0.191,P<0.01). Conclusion: T2DM patients with non-dipper pattern of blood pressure circadian rhythm were usually combining high blood level of Hcy, non-dipper pattern was the independent risk factor for CAS. Restoring blood pressure circadian rhythm is important to prevent atherosclerosis.%目的：探讨2型糖尿病（T2DM）患者非杓型血压节律与血同型半胱氨酸（Hcy）、颈动脉粥样硬化（CAS）之间的关系。方法：纳入T2DM患者240例，其中男性139例，女性101例。（1）根据夜间血压下降率分为杓型血压组（80例）和非杓型血压组（160例）；（2）根据有无CAS，分为硬化者（119例）和非硬化者（121例），比较组间Hcy、颈动脉内膜-中层厚度（CIMT）、24 h平均收缩压（24 hSBP）、昼间平均收缩压（dSBP）、夜间平均收缩压（nSBP）、24 h平均舒张压（24 hDBP）、昼间平均舒张压（dDBP）、夜间平均舒张压（nDBP）的差异，并分析CAS的危险因素。结果：与杓型血压组比较，非杓型血压组Hcy（μmol/L,16.41.0±8.08 vs 12.55±4.07）、CIMT（mm,1.00±0.59 vs 0.80±0.30）、24 hSBP[mmHg（1 mmHg=0.133 kPa）,138.7±19.2 vs 127.5±15.6]、dSBP（mmHg,139.4±19.2 vs 132.0±16.2）、nSBP（mmHg,136.4±20.0 vs 113.8±15.0）、nDBP（mmHg,74.0±12.0 vs 64.9±9.8）均明显升高（P<0.01）；多元线性回归分析提示Hcy（β=0.011；P<0.01）、nSBP（β=0.021；P<0.01）、nDBP（β=0.018；P<0.01）是血压节律改变的影响因素；与非硬化者比较，硬化者CIMT（mm,1.18±0.65 vs 0.69±0.72）、年龄（岁，62.33±12.02 vs 59.17±10.80）、24 hSBP（mmHg,138.2±18.2 vs 131.9±18.9）、dSBP（mmHg,139.5±18.4 vs 134.4±18.5）、nSBP （mmHg,133.9±20.7 vs 123.9±20.9）、nDBP（mmHg,73.3±12.8 vs 68.6±11.0）明显升高（P<0.05或P<0.01），而硬化者夜间收缩压下降率[SBPF（%），4.00±7.89 vs 7.66±7.36）]、夜间舒张压下降率[DBPF（%），5.95±8.44 vs 10.19±8.67）]明显低于非硬化者（P<0.01）； Logistic回归分析提示年龄[比值比（OR）=2.204]；P<0.05）、nDBP（OR=2.357；P<0.05）、SBPF （OR=2.562；P<0.01）是CAS的危险因素；Spearman相关分析CIMT与年龄呈正相关（r=0.195，P<0.05），CIMT与SBPF呈负相关（r=-0.191，P<0.01）。结论：非杓型血压节律的T2DM患者存在高同型半胱氨酸血症，非杓型血压是CAS的独立危险因素，恢复血压节律对预防动脉粥样硬化有重要意义。
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