老年2型糖尿病颈动脉粥样硬化与同型半胱氨酸、胱抑素C、超敏C反应蛋白的关系

摘要

目的：观察老年2型糖尿病（T2DM）患者同型半胱氨酸（Hcy）、胱抑素 C（CysC）和超敏 C 反应蛋白（hs-CRP）浓度与颈动脉粥样硬化（CAS）的关系。方法将110例老年2型糖尿病（DM）患者作为 T2DM组，根据颈动脉内膜中层厚度（IMT）分为 IMT 正常组和 IMT 增厚组，同时随机抽取同期健康体检者32例作为对照组。结果（1）T2DM组 Hcy、hs-CRP、CysC、IMT、低密度脂蛋白胆固醇（LDL-C）、餐后2 h 血糖（2hPP）、糖化血红蛋白（HbA1 c）、血脂（TG）、空腹血糖（FPG）显著高于对照组（均 P ＜0．05），叶酸（FA）、HDL-C 低于对照组（P ＜0．05）；（2）IMT 增厚组 Hcy、hs-CRP、CysC 显著高于 IMT 正常组（均 P ＜0．01），FA 水平低于 IMT正常组（P ＜0．05）。（3）相关分析显示 IMT 与 Hcy、hs-CRP、CysC、LDL-C、FPG、HbA1 c 和2hPP 正相关，与HDL-C 负相关，与年龄、BMI、性别、血压、TC 和 TG 无相关性。血浆 Hcy 与 FA 负相关，与维生素 B12无相关。CysC 水平与 hs-CRP、2hPP、HbA1 c 相关。（4）Logistic 回归分析 Hcy、hs-CRP、CysC 是影响老年 T2DM患者 IMT的独立相关因素（OR ＝1．95、3．614、12．125，均 P ＜0．05）。结论血 CysC、Hcy、hs-CRP 升高与老年2型糖尿病合并 CAS 的发生、发展密切相关。%Objective To observe the relationship between serum homocysteine (Hcy),cystatin C(CysC) and high sensitive C reactive protein (hs-CRP)levels in elderly type 2 diabetes mellitus with carotid atherosclerosis. Method One hundred and ten cases of elderly type 2 diabetes mellitus (DM)patients were collected and divided into IMT normal group and IMT thickening group according to the carotid artery intima-media thickness (IMT),while we selected 32 cases of healthy as control group.Results 1 .The serum Hcy,hs-CRP,CysC,IMT,LDL-C,2hPP, HbA1 c,TG,FPG of T2DMgroup were significantly higher than those of the control group (all P <0.05),the serum FA,HDL-c were lower than the control group.2.The serum Hcy,hs-CRP,CysC IMT of IMT thickening group were significantly higher than those of the normal group (P <0.01 ),serum FA level was lower than those of the normal IMT group (P <0.05).3.The IMT was positive correlated with serum Hcy,hs-CRP,CysC,LDL-C,FPG,HbA1 c and 2hPP,negative correlated with HDL-C,and no correlated with age,BMI,gender,blood pressure,TC and TG in correla-tion analysis.The Hey level of serum was negative correlated with FA and no correlated with Vit B1 2 .The CysC levels was correlated with hs-CRP,2hPP,HbA1 c levels.4.The logistic regression analysis showed that Homocysteine,hs-CRP and CysC were independent risk factors in elderly type 2 diabetes with carotid intimal thickening.Conclusion The serum cystatin C,Hcy and high sensitive C reactive protein are important risk factors in the occurrence and devel-opment of carotid atherosclerosis in elderly type 2 diabetes.