同型半胱氨酸对2型糖尿病患者大血管并发症的影响

【目的】探讨2型糖尿病（T2DM）患者血清总同型半胱氨酸（total homosysteine ，tHcy）对大血管并发症的影响。【方法】收集上海、北京、广东、南京、辽宁、天津、浙江29家三级医院共1441例 T2DM 患者，检测其空腹血清 tHcy水平。同时进行体格检查、血糖、血脂、维生素B6水平的测定。并通过问卷形式获得糖尿病（DM）并发症等相关信息。【结果】DM大血管并发症的发生率为16．17％（233/1441）。有并发症组中血清tHcy水平为（14．28±8．76）μmol/L显著高于无并发症组的（11．55±5．50）μmol/L（ P＜0．001）。调整年龄和性别后，血清tHcy＞15μmol/L组的DM大血管并发症OR值为2．345（95％ CI 1．665～3．302），冠状动脉并发症OR值为1．932（95％ CI 1．104～3．380），脑血管并发症 OR值为2．056（95％ CI 1．311～3．176），周围血管并发症OR值3．004（95％ CI 1．656～5．450）。【结论】高同型半胱氨酸血症增加 T2DM 患者大血管并发症发生风险。

Study of the Effect of Homocysteine on Macroangiopathy in Patients with Type 2 Diabetes Mel-litus

Objective]To explore the effect of serum total homocysteine （tHcy ） on macroangiopathy in patients with type 2 diabetes mellitus（T2DM ） .Methods] Totally 1441 T2DM patients from 29 tertiary grade A hospitals in Shanghai ,Beijing ,Guangdong ,Nanjing ,Liaoning ,Tianjin and Zhejiang were collected .The Fasting serum tHcy was measured .All patients received physical examination .The levels of blood glucose , blood lipids and vitamin B6 were also measured .The related data of diabetic complications were obtained by questionnaire survey .Results]The incidence rate of diabetic macroangiopathy was 16 .17% （233/1441） .Serum tHcy level of the group with complications was （14 .28 ± 8 .76）μmol/L ,which was significantly higher than that of the group without complications（11 .55 ± 5 .50）μmol/L]（ P 〈0 .001） .After adjustment for age and sex ,the odds ratio（OR） value of diabetic macroangiopathy in the group with serum tHcy 〉15μmol/L was 2 .345（95% CI 1 .665 to 3 .302） ,and that of diabetic coronary artery diseases was 1 .932（95% CI 1 .104～3 .380） ,and that of diabetic cerebrovascular diseases was 2 .056（95% CI 1 .331～3 .176） ,and that of diabetic peripheral vascular diseases was 3 .004（95% CI 1 .656～5 .450） .Conclusion] Hyperhomocysteinaemia can in-crease the risk of macroangiopathy in patients with T 2DM .