血清同型半胱氨酸水平对2型糖尿病患者视网膜及肾脏病变的影响

摘要

目的 探讨血清同型半胱氨酸(Hcy)与2型糖尿病视网膜病变及肾脏病变的关系.方法 选取2017年1月至2018年5月在本院治疗的2型糖尿病患者150例,其中单纯2型糖尿病患者64例(DM组),糖尿病视网膜病变患者35例(DR组),糖尿病肾病患者31例(DN组),糖尿病视网膜病变合并肾病患者20例(DR+DN组),同时选取健康志愿者50例作为对照组,检测各组Hcy、空腹血糖(FBG)、胰岛素抵抗指数(HOMA-IR)等.结果 DM组、DR组、DN组和DR+DN组FBG分别为(8.91±0.99)mmol/L、(9.02±1.03)mmol/L、(9.00±1.03) mmol/L、(8.98±0.97) mmol/L,差异均无统计学意义(均P＞ 0.05);DR+DN组Hcy、糖化血红蛋白(HbA1c)、血管内皮生长因子(VEGF)、HOMA-IR和尿白蛋白排泄率(UAE)明显高于DM组、DR组、DN组和对照组(均P＜0.05);增殖期视网膜病变(PDR)患者Hcy和HbA1c分别为(16.55±2.15) mmol/L、(9.01±0.98)％,明显高于非增殖期视网膜病变(NPDR)患者(13.49±3.03) mmol/L、(8.00±1.20)％(均P＜0.05);Hcy与FBG、HbA1c、VEGF、HOMA-IR以及UAE呈正相关(r=-0.341、0.322、0.415、0.352和0.481,均P＜0.05).结论 血清Hcy水平与2型糖尿病患者视网膜及肾脏病变有一定关系,可能成为有价值的生物学标志物.%Objective To investigate the relationships between plasma homocysteine (Hcy) on one hand and type 2 diabetic retinopathy and renal disease on the other hand.Methods From January,2017 to May,2018,150 patients with type 2 diabetes were treated in our hospital,including 64 patients with simple type 2 diabetes (DM group),35 diabetic retinopathy (DR group),31 diabetic nephropathy (DN group),and 20 diabetic retinopathy and nephrotic patients (DR+DN group).50 volunteers were set as a control group.The levels of Hcy,fasting blood glucose (FBG),insulin resistance index (HOMA-IR),and so on were detected.Results The FBG in the DM group,the DR group,the DN group,and the DR+DN group were (8.91±0.99) mmol/L,(9.02±1.03) mmol/L,(9.00±1.03) mmol/L,and (8.98±0.97) mmol/L,respectively,with no statistical differences (P ＞ 0.05).The Hcy,glycosylated hemoglobin (HbAlc),vascular endothelial growth factor (VEGF),HOMA-IR,and urinary albumin excretion rate (UAE) were obviously higher in the DR+DN group than in the DN group,the DR group,the DM group,and the control group (P ＜ 0.05).The Hcy and HbAlc in the patients with proliferative retinopathy (PDR) were (16.55±2.15) mmol/L and (9.01±0.98)％,which were significantly higher than those in the patients with non-proliferative retinopathy (NPDR) [(13.49±3.03) mmogL and (8.00±1.20)％],P ＜ 0.05.The Hcy positively correlated with FBG,HbAlc,VEGF,HOMA-IR,and UAE (r=0.341,0.322,0.415,0.352,and 0.481,all P ＜ 0.05).Conclusions Plasma Hcy level correlates with retinopathy and kidney disease in type 2 diabetic patients,and may be a valuable biological marker.