同型半胱氨酸在糖尿病大血管病变中的意义及危险因素分析

摘要

目的 探讨血清同型半胱氨酸(HCY)水平在糖尿病大血管病变中的意义,并对相关危险因素进行分析.方法 病例对照研究.选取从2015年5月至2016年2月在上海中山医院就诊的糖尿病患者279例,男168例,女111例,年龄59.6(55.0~67.0)岁.根据心脑血管病史及颈动脉内膜中层厚度将患者分为颈动脉病变组(137例),心血管病变组(197例)及脑血管病变组(29例).采集患者静脉血标本检测HCY、糖化白蛋白、空腹血糖、总胆红素、丙氨酸氨基转移酶、天门冬氨酸氨基转移酶、碱性磷酸酶、L-γ-谷氨酰转移酶、尿素氮、肌酐、尿酸、胆固醇、三酰甘油、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、糖化血红蛋白水平,并测定尿液标本的尿白蛋白、尿肌酐.组间比较采用Mann-Whitney U检验和χ2检验;采用Pearson相关性分析判断HCY与其他指标的相关性;采用logistic回归模型分析糖尿病大血管病变及其亚类的危险因素;利用ROC曲线分析HCY、尿酸对糖尿病大血管病变的诊断价值.结果 糖尿病大血管病变患者组的HCY水平为10.40(8.50~12.48) μmol/L,糖尿病非大血管病变患者组的HCY水平为9.10(7.50~10.70) μmol/L,存在统计学差异 (Z=3.188, P<0.01);HCY水平不同的患者,其糖尿病大血管病变(χ2=7.030, P=0.030)及颈动脉病变(χ2=7.258, P=0.027)的发病率存在差异;HCY与尿素氮、肌酐、尿酸、尿白蛋白/肌酐及估算的肾小球滤过率(eGFR)水平的相关系数分别为0.340、0.248、0.278、0.133、-0.369(P<0.05);HCY是糖尿病大血管病变、颈动脉斑块、心血管病变的危险因素, HCY、年龄、尿酸是部分糖尿病大血管病变的独立危险因素(P<0.05);HCY、尿酸对于糖尿病大血管病变具有一定的诊断价值(P<0.05).结论 血清HCY是发生糖尿病大血管病的危险因素,检测HCY水平对于疾病的诊断与预防有着一定的帮助.%Objective To investigate the significance of serum homocysteine (HCY) level in the patients with diabetic macroangiopathy, and analyze the related risk factors.Methods Case control study.279 diabetics (male 198, female 111) aged 59.6(55.0-67.0) were selected in Shanghai Zhongshan Hospital from May 2015 to February 2016.According to the medical history and Carotid intima-media thickness, they were divided into carotid artery disease group (137 cases), cardiovascular disease group (197 cases) and cerebrovascular disease group (29 cases).We detected veinal blood HCY , fasting blood glucose, glycated albumin, total bilirubin, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, L-, gamma glutamyl transferase, urea nitrogen, creatinine, uric acid, cholesterol, three triglyceride, high density lipoprotein cholesterol, low density lipoprotein cholesterol, glycosylated hemoglobin and albumin , creatinine in urine.The groups were compared with Mann-Whitney U test and χ2 test;Pearson correlation analysis was used to determine the correlations between HCY and other indicators;logistic regression model was used to analyze the risk factors of diabetic macroangiopathy and its subclasses;ROC curve was used to analyze the diagnostic value of HCY and uric acid in diabetic macroangiopathy.Results HCY in diabetic with macroangiopathy group was significant hiher than that in diabetic without macroangiopathy group 10.40(8.50-12.48) μmol/L 9.10(7.50-10.70) μmol/L, P<0.01).The incidence of diabetic macroangiopathy (χ2=7.030, P=0.030) and carotid artery lesions (χ2=7.258, P=0.027) was different in patients with different HCY levels.The correlation coefficients of HCY with urea nitrogen, creatinine, uric acid, urinary albumin/creatinine and estimated glomerular filtration rate (eGFR) were 0.340, 0.248, 0.278, 0.133,-0.369 (P<0.05), respectively.HCY was a risk factor for diabetic macroangiopathy, carotid plaque and cardiovascular disease;HCY, age and uric acid were independent risk factors for some of the diabetic macroangiopathy (P<0.05);HCY and UA had a certain diagnostic value for diabetic macroangiopathy(P<0.05).Conclusions Serum HCY is a risk factor for diabetic macroangiopathy, and detection of HCY levels will contribute to the diagnosis and prevention of the disease.