2 型糖尿病患者抑郁与血同型半胱氨酸、血脂 及颈动脉粥样硬化的关系研究

目的 探讨2 型糖尿病（T2DM）患者抑郁与血同型半胱氨酸（Hcy）、血脂及颈动脉粥样硬化（CAS） 之间的关系。方法 选取2015 年11 月-2016 年11 月华北理工大学附属唐山市工人医院住院治疗的146 例 T2DM 患者，根据汉密顿抑郁量表及抑郁症诊断标准将其分为T2DM 非抑郁组105 例和T2DM 合并抑郁组 41 例，分别测定两组空腹血糖（FBG）、Hcy、总胆固醇（TC）、三酰甘油（TG）、低密度脂蛋白胆固醇（LDL-C）、 高密度脂蛋白胆固醇（HDL-C）、载脂蛋白A1（ApoA1）、载脂蛋白B1（ApoB1）、脂蛋白a（LP-a）水平，应 用彩色多普勒超声仪行颈动脉内膜- 中层厚度检查，记录有无颈动脉硬化发生。结果 ① T2DM 合并抑郁组 颈动脉硬化检出率75.6%（31 例）较T2DM 非抑郁组55.2%（58 例）高。②与T2DM 非抑郁组比较，T2DM 合并抑郁组Hcy、TG 均有升高，而LDL-C、LP-a 低于T2DM 非抑郁组。两组患者FBG、TC、ApoA1、 ApoB1 差异无统计学意义（P >0.05）。③ Logistic 多因素回归分析示Hcy 和TG 为T2DM 患者合并抑郁的独 立相关因素。④ Spearman 相关性分析示T2DM 患者Hcy 和TG 与HAMD 量表评分呈正相关。结论 医务人 员应重视T2DM 患者血脂和同型半胱氨酸水平，评估颈动脉硬化情况，积极预防糖尿病患者抑郁的发生，促 进其心理健康。

Relationships of depression with homocysteine, blood lipids and carotid atherosclerosis in patients with type 2 diabetes mellitus

Objective To discuss the relationships of depression with homocysteine (Hcy), blood lipids and carotid atherosclerosis (CAS) in patients with type 2 diabetes mellitus (T2DM). Methods A total of 146 patients with T2DM who were treated in the Affiliated Hospital of North China University of Science and Technology from Noverber 2015 to Noverber 2016 were selected. According to the score of Hamilton Depression Scale (HAMD) and the depression diagnostic criteria, they were divded into T2DM non-depression group including 105 cases and T2DM depression group including 41 cases. The levels of fasting blood glucose (FBG), Hcy, total cholesterol (TC),triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), apolipoprotein A1 (ApoA1), apolipoprotein B1 (ApoB1) and lipoprotein a (LP-a) were measured in the two groups. Color Doppler ultrasonography was used to measure the carotid intima-media thickness (CIMT) and record the presence of carotid atherosclerosis. Results The detection rate of carotid atherosclerosis in the T2DM depression group was 75.6% (31/41), which was higher than that (55.2%, 58/105) of the T2DM non-depression group (P < 0.05). Compared with the T2DM non-depression group, Hcy and TG were significantly increased, while LDL-C and LP-a significantly decreased in the T2DM depression group (P < 0.05). However, there was no significant difference in the level of PBG, TC, ApoA1 or ApoB1 between the two groups (P > 0.05). Logistic multivariate regression analysis showed that Hcy and TG were the independent related factors for depression in the T2DM patients. Spearman correlation analysis showed that Hcy and TG were positively correlated with the scores of HAMD in the patients with T2DM. Conclusions In order to prevent depression in the patients with type 2 diabetes and promote their mental health, medical personnel should pay attention to the blood lipid and homocysteine levels and carotid atherosclerosis in the patients.