血浆同型半胱氨酸与2型糖尿病外周神经病变的相关性

目的 探讨血浆总同型半胱氨酸浓度与糖尿病外周神经病变的关系.方法 入选2型糖尿病患者227例,进行横断面研究.用临床表现及肌电图诊断外周糖尿病神经病变,并测定血浆同型半胱氨酸水平及与糖尿病神经病变相关或可能影响血浆同型半胱氨酸水平的指标.结果 糖尿病外周神经病变患者80例,糖尿病无神经病变者147例.糖尿病神经病变组血浆总同型半胱氨酸水平(12.6±3.6)μmol/L,高于糖尿病非神经病变组(8.2±0.9)μmol/L(P＜0.01).在校正外周神经病变传统危险因素(糖尿病病程、糖化血红蛋白)及高同型半胱氨酸浓度的影响因素(年龄、性别、血清叶酸和维生素B12、肾功能状态和双胍类使用)后,同型半胱氨酸与糖尿病神经病变仍相关[OR1.15(1.02～1.28),P＜0.05].在校正每单位上述混杂因素增加后,每增加4.0 μmol/L的血浆同型半胱氨酸也与神经病变发生密切相关[OR 1.17(0.94～1.33),P＜0.05].结论 高血浆总同型半胱氨酸浓度与糖尿病神经病变的发生相关,为糖尿病外周神经病变的独立危险因素.

Abstract：

Objective To explore the relationship between plasma homocysteine levels and diabetic peripheral neuropathy (DPNP). Methods A crossectional analysis was conducted on 227 patients with type 2 diabetes. Peripheral neuropathy was confirmed using electromyography (EMG). The risk factors possibly associated with diabetic neuropathy or plasma homocysteine levels were analyzed in relation to likelihood of occurrence of DPNP. Results Eighty patients with neuropathy and 147 patients without neuropathy were included. Plasma homocysteine levels were significantly higher in patients with diabetic neuropathy [( 12. 6 ± 3.6 ) μmol/ L] than without diabetic neuropathy [( 8. 2 ± 0. 9 ) μmol/L] ( P ＜0. 001 ), and the relationship remained significant after adjusting for duration of diabetes, glycosylated hemoglobin A1c (HbA1c), age, renal status, serum folate acid and vitamin B12, and metformin [OR 1.15( 1.02-1.28 ) ,P ＜ 0. 05]. In addition, per increase of 4. 0 μmol/L plasma homocysteine was closely related to the occurrence of neuropathy after controlling for per unit increase of other confounding factors [OR 1.17(0. 94-1.33), P ＜ 0. 05]. Conclusions Hyperhomocysteinemia was an independent risk factor for the occourence of diabetic peripheral neuropathy.

The relationship between plasma homocysteine levels and diabetic peripheral neuropathy

Objective To explore the relationship between plasma homocysteine levels and diabetic peripheral neuropathy (DPNP). Methods A crossectional analysis was conducted on 227 patients with type 2 diabetes. Peripheral neuropathy was confirmed using electromyography (EMG). The risk factors possibly associated with diabetic neuropathy or plasma homocysteine levels were analyzed in relation to likelihood of occurrence of DPNP. Results Eighty patients with neuropathy and 147 patients without neuropathy were included. Plasma homocysteine levels were significantly higher in patients with diabetic neuropathy [( 12. 6 ± 3.6 ) μmol/ L] than without diabetic neuropathy [( 8. 2 ± 0. 9 ) μmol/L] ( P ＜0. 001 ), and the relationship remained significant after adjusting for duration of diabetes, glycosylated hemoglobin A1c (HbA1c), age, renal status, serum folate acid and vitamin B12, and metformin [OR 1.15( 1.02-1.28 ) ,P ＜ 0. 05]. In addition, per increase of 4. 0 μmol/L plasma homocysteine was closely related to the occurrence of neuropathy after controlling for per unit increase of other confounding factors [OR 1.17(0. 94-1.33), P ＜ 0. 05]. Conclusions Hyperhomocysteinemia was an independent risk factor for the occourence of diabetic peripheral neuropathy.