Coagulation and inflammation in overt diabetic nephropathy: association with hyperhomocysteinemia

BACKGROUND: Diabetic nephropathy, especially when advanced, is associated with high prevalence of atherosclerotic cardiovascular disease in which inflammation and coagulation may play pathogenic roles. We investigated the relationships between diabetic nephropathy and coagulation, fibrinolysis, or inflammation in patients with Type 2 diabetes. METHODS: We evaluated markers of inflammation and coagulation in 105 Type 2 diabetic patients with various grades of nephropathy and 49 healthy control subjects, in association with plasma total homocysteine (tHcy) measurements. RESULTS: Plasma tHcy concentrations were significantly higher in diabetic patients than in controls (8.96 +/- 3.04 vs. 6.92 +/- 1.36 micromol/l, P < 0.0001). Plasma concentrations of interleukin (IL)-6 were significantly higher in diabetic patients than in control subjects (P < 0.0001). In diabetic patients, plasma tHcy correlated positively with urinary albumin, fibrinogen, IL-6 and plasmin-alpha2-antiplasmin complex (PAP), while plasma tHcy correlated negatively with creatinine clearance (Ccr) and protein C activity. After adjustment for Ccr, IL-6 and protein C activity were significantly associated with plasma tHcy. Plasma tHcy concentrations were significantly higher in patients with overt albuminuria than in those with normoalbuminuria or microalbuminuria, as were plasma concentrations of fibrinogen, prothrombin F1+2, and interleukin-6. CONCLUSIONS: Diabetic nephropathy is associated with elevated markers for both coagulation and inflammation. High plasma homocysteine may be a link between diabetic nephropathy and both chronic inflammation and hypercoagulability, increasing cardiovascular risk.     

Correlation between the intima-media thickness of the carotid artery and aortic pulse-wave velocity in patients with type 2 diabetes. Vessel wall properties in type 2 diabetes.

OBJECTIVE: The aim of this study was to assess the relationship between atherotic (structural) and sclerotic (functional) changes in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS: Aortic distensibility and carotid intimal-media thickness (IMT) were evaluated using carotid-femoral aortic pulse-wave velocity (a-PWV) and high-resolution B-mode ultrasonography in 271 patients with type 2 diabetes and 285 age-matched control subjects. RESULTS: a-PWV and carotid IMT were significantly higher in the patients than in the control subjects in all age-groups (P < 0.0001, respectively). The carotid IMT and a-PWV were significantly correlated with age in both the patients with type 2 diabetes and control subjects. There was a significant positive relationship between the carotid IMT and a-PWV in both the patients (r = 0.482, P < 0.0001) and control subjects (r = 0.424, P < 0.0001). The slope of the regression line for the carotid IMT to the a-PWV was significantly steeper in the diabetic patients than in the control subjects (P < 0.05). Multiple regression analysis in all subjects showed that age, diabetic state, and cigarette smoking were independently common risk factors for the increase in carotid IMT and a-PWV. In the diabetic patients, the independent risk factors associated with the carotid IMT were age, hyperlipidemia, and duration of diabetes (R2 = 0.232, P < 0.0001), while those associated with a-PWV were age and duration of diabetes (R2 = 0.334, P < 0.0001). CONCLUSIONS: The results indicated that diabetic patients showed more advanced changes in atherosis than that in sclerosis as compared with age- and sex-matched control subjects. Such atherotic changes in diabetic patients may be associated with hyperlipidemia.     

Serum interleukin-18 levels are associated with nephropathy and atherosclerosis in Japanese patients with type 2 diabetes

OBJECTIVE: Interleukin (IL)-18 is a proinflammatory cytokine secreted from mononuclear cells. Serum concentration of IL-18 is a strong predictor of death in patients with cardiovascular diseases. Recent studies have shown that microinflammation is involved in the pathogenesis of diabetic nephropathy as well as of cardiovascular diseases. This study aimed to test the hypothesis that the serum level of IL-18 is a common predictor of nephropathy and atherosclerosis in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS: Eighty-two Japanese patients with type 2 diabetes and 55 age- and sex-matched healthy control subjects were enrolled. Patients with renal dysfunction (creatinine clearance <1 ml/s) were excluded. We assessed clinical parameters and measured serum and urinary IL-18 levels, serum IL-6 levels, carotid intima-media thickness (IMT), and brachial-ankle pulse wave velocity (baPWV) in all patients. Further, we evaluated changes of urinary albumin excretion rate (AER) after 6 months in 76 diabetic patients. RESULTS: Serum and urinary IL-18 levels were significantly elevated in patients with type 2 diabetes as compared with control subjects (serum IL-18 179 +/- 62 vs. 121 +/- 55 pg/ml, P < 0.001; urinary IL-18 97 +/- 159 vs. 47 +/- 54 pg/ml, P = 0.035). Univariate linear regression analysis showed significant positive correlations between serum IL-18 and AER (r [correlation coefficient] = 0.525, P < 0.001), HbA(1c) (r = 0.242, P = 0.029), high-sensitivity C-reactive protein (hs-CRP) (r = 0.240, P = 0.031), and urinary beta-2 microglobulin (r = 0.235, P = 0.036). Serum IL-18 levels also correlated positively with carotid IMT (r = 0.225, P = 0.042) and baPWV (r = 0.232, P = 0.040). We also found a significant correlation between urinary IL-18 and AER (r = 0.309, P = 0.005). Multivariate linear regression analysis showed that AER (standard correlation coefficients [B] = 0.405, P < 0.001) and hs-CRP (B = 0.207, P = 0.033) were independently associated with serum IL-18 levels. AER was also independently associated with urinary IL-18 levels (B = 0.295, P = 0.005). Moreover, serum and urinary IL-18 levels correlated positively with AER after 6 months (r = 0.489, P < 0.001 and r = 0.320, P = 0.005) and changes in AER during the follow-up period (r = 0.268, P = 0.018 and r = 0.234, P = 0.042). CONCLUSIONS: Serum levels of IL-18 might be a predictor of progression of diabetic nephropathy as well as cardiovascular diseases.     

Cigarette smoking and plasma total homocysteine levels in young adults with type 1 diabetes

OBJECTIVE: The purposes of this study were to compare plasma total homocysteine (tHcy) levels, a recognized cardiovascular risk factor, in nondiabetic subjects and type 1 diabetic patients, and to evaluate whether chronic cigarette smoking had a deleterious effect on plasma tHcy levels in type 1 diabetic patients. RESEARCH DESIGN AND METHODS: Plasma tHcy concentrations were measured in 60 young type 1 diabetic patients without clinical evidence of macroangiopathy and in 30 healthy control subjects who were matched for age, sex, BMI, and smoking habit. RESULTS: Plasma tHcy levels were significantly higher in type 1 diabetic patients than in control subjects (12.5 +/- 4.8 vs. 10.3 +/- 2.2 micromol/l, P = 0.01). After stratification by smoking status, diabetic smokers had values for age, sex, BMI, lipids, creatinine, blood pressure, glycometabolic control, diabetes duration, and microvascular complications that were superimposable on their nonsmoking counterparts. Nevertheless, plasma tHcy levels were markedly elevated in diabetic smokers versus nonsmokers (15.5 +/- 5.7 vs. 10.6 +/- 3 pmol/l, P < 0.0001) in a dose-dependent fashion (P < 0.0001, by analysis of variance when subjects were categorized for the number of cigarettes smoked daily). CONCLUSIONS: Chronic cigarette smoking seems to adversely affect plasma tHcy levels in young adults with type 1 diabetes.     

Elevated C-reactive protein associates with early-stage carotid atherosclerosis in young subjects with type 1 diabetes

OBJECTIVE: To evaluate whether low-grade inflammation contributes to early-stage advanced carotid atherosclerosis in young subjects with type 1 diabetes. RESEARCH DESIGN AND METHODS: The mean and maximum (max) intima-media thicknesses (IMT) of the carotid artery were assessed using ultrasound B-mode imaging in 55 patients with type 1 diabetes (22 men and 33 women, aged 22.1 +/- 3.6 years (+/- SD), duration of diabetes 14.2 +/- 5.7 years) and 75 age-matched healthy nondiabetic subjects (28 men and 47 women). High-sensitive C-reactive protein (hs-CRP) levels were measured with a latex-enhanced immunonephelometer. RESULTS: The patients with type 1 diabetes had significantly higher hs-CRP levels (median 0.35, range 0.05-1.47 mg/l vs. median 0.14, range 0.05-1.44 mg/l; P = 0.001) as well as significantly higher mean IMT and max IMT than the nondiabetic subjects (mean IMT 0.76 +/- 0.09 vs. 0.72 +/- 0.04 mm, P = 0.003; max IMT 0.84 +/- 0.11 vs. 0.77 +/- 0.06 mm, P < 0.0001). Hs-CRP levels were significantly correlated with the mean and max IMT of patients with type 1 diabetes and with the max IMT of nondiabetic patients. Multivariate regression analyses for both diabetic and nondiabetic subjects as a single group showed that hs-CRP levels are independently correlated with the mean IMT and max IMT levels (P = 0.002 and P = 0.023, respectively) as well as with diastolic blood pressure, sex, and duration of diabetes. CONCLUSIONS: Our data indicate that hs-CRP levels are elevated in young patients with type 1 diabetes, possibly corresponding with early-stage advanced carotid atherosclerosis.     

初诊2型糖尿病患者微量白蛋白尿与早期动脉硬化的相关性研究

目的观察初诊2型糖尿病患者尿白蛋白排泄率（uAER）与早期血管动脉硬化的关系。方法对86例初诊2型糖尿病患者,留尿测定尿UAER,并根据UAER分为两组,同时用高分辨率超声检测颈动脉内膜厚度（IMT）,进行组间比较,对两者关系进行统计分析。结果初诊2型糖尿病患者颈动脉IMT与尿UAER、高敏C反应蛋白（hs-CRP）显著相关。结论尿UAER增高是初诊2型糖尿病患者早期大血管病变的独立危险因素。     

老年2型糖尿病颈动脉粥样硬化与同型半胱氨酸、胱抑素C、超敏C反应蛋白的关系

目的观察老年2型糖尿病(T2DM)患者同型半胱氨酸(Hcy)、胱抑素C(Cys C)和超敏C反应蛋白(hs-CRP)浓度与颈动脉粥样硬化(CAS)的关系。方法将110例老年2型糖尿病(DM)患者作为T2DM组,根据颈动脉内膜中层厚度(IMT)分为IMT正常组和IMT增厚组,同时随机抽取同期健康体检者32例作为对照组。结果 (1)T2DM组Hcy、hs-CRP、Cys C、IMT、低密度脂蛋白胆固醇(LDL-C)、餐后2 h血糖(2h PP)、糖化血红蛋白(Hb A1c)、血脂(TG)、空腹血糖(FPG)显著高于对照组(均P0.05),叶酸(FA)、HDL-C低于对照组(P0.05);(2)IMT增厚组Hcy、hs-CRP、Cys C显著高于IMT正常组(均P0.01),FA水平低于IMT正常组(P0.05)。(3)相关分析显示IMT与Hcy、hs-CRP、Cys C、LDL-C、FPG、Hb A1c和2h PP正相关,与HDL-C负相关,与年龄、BMI、性别、血压、TC和TG无相关性。血浆Hcy与FA负相关,与维生素B12无相关。Cys C水平与hs-CRP、2h PP、Hb A1c相关。(4)Logistic回归分析Hcy、hs-CRP、Cys C是影响老年T2DM患者IMT的独立相关因素(OR=1.95、3.614、12.125,均P0.05)。结论血Cys C、Hcy、hs-CRP升高与老年2型糖尿病合并CAS的发生、发展密切相关。     

Increased intimal-medial thickness in newly detected type 2 diabetes: risk factors.

OBJECTIVE: To examine carotid intimal-medial thickness (IMT) and its determinants in newly detected type 2 diabetic subjects, classified according to the new criteria of the American Diabetes Association, in comparison with age- and sex-matched control subjects with normal glucose tolerance. RESEARCH DESIGN AND METHODS: This study was case-controlled, with matched pairs for 71 newly diagnosed type 2 diabetic individuals. Subjects aged 40-70 years were recruited from a risk population for diabetes seen in the Risk Factors in IGT for Atherosclerosis and Diabetes (RIAD) Study. Standard risk factors, 75-g oral glucose tolerance test with real insulin, proinsulin, and C-peptide, and ultrasound measurement of the IMT of the common carotid artery were performed. RESULTS: The diabetic subjects, both men and women, displayed carotid intimal-medial thickening, even in the subgroup with fasting plasma glucose between 7.0 and 7.8 mmol/l. HbA1c was significantly increased in the diabetic patients (6.33 vs. 5.48%). Insulin, proinsulin, and C-peptide were also significantly higher. Among the coronary risk factors, triglycerides and plasminogen activator inhibitor were significantly increased. After age and sex adjustment. IMT in the diabetic group was correlated to triglycerides and the total-to-HDL cholesterol ratio. In the total group, IMT was significantly correlated to blood pressure, 2-h glucose in oral glucose tolerance testing, triglycerides, albuminuria, and the total-to-HDL cholesterol ratio, and inversely correlated to HDL cholesterol. No independent determinant of IMT was found in the diabetic group by multivariate analysis. CONCLUSIONS: Newly detected type 2 diabetic patients exhibit a higher degree of early atherosclerosis than normal glucose-tolerant subjects matched for age and sex. Our data suggest that hyperglycemia, together with a clustering of risk factors, and in particular dyslipidemia, may cause intimal-medial thickening in the early phases of diabetes.     

Coronary artery disease and carotid artery intima-media thickness in Japanese type 2 diabetic patients

OBJECTIVE: To investigate the association between carotid atherosclerosis, measured as intima-media thickness (IMT), and cardiovascular morbidity in type 2 diabetic patients. RESEARCH DESIGN AND METHODS: We investigated the relationship between IMT and coronary artery disease (CAD) in 40 type 2 diabetic patients and 40 control subjects. Diabetic patients with CAD determined by coronary angiography were consecutively recruited, whereas the control subjects were recruited from among diabetic outpatients without CAD at the same institution. IMT was measured in both carotid arteries using B-mode ultrasonography. RESULTS: Carotid IMT was significantly greater in the diabetic patients than in the control subjects (1.27 +/- 0.07 vs. 1.03 +/- 0.04 mm, P < 0.05). IMT was associated with CAD by logistic regression analysis using all independent variables (P = 0.062). When the 40 patients with CAD were divided into a group of 20 patients with coronary artery bypass grafting (CABG) and another 20 patients without CABG, the IMT was significantly greater in the CABG group than in the non-CABG group (1.47 +/- 0.11 vs. 1.07 +/- 0.07 mm, P < 0.05). CONCLUSIONS: These results indicate that the presence of carotid atherosclerosis implies a high probability of coronary involvement in Japanese nonobese subjects with type 2 diabetes.     

急性脑梗死患者血清基质金属蛋白酶-9超敏C-反应蛋白与颈总动脉内膜中层厚度的相关性

目的 通过观察急性脑梗死(ACI)患者血清基质金属蛋白酶-9(MMP-9)、超敏C-反应蛋白(hs-CRP)水平变化,探讨其与颈总动脉内膜中层厚度(IMT)的相关性.方法 分别采用酶联免疫吸附法(ELISA)及超敏乳胶增强免疫比浊法检测185例ACI患者和45例健康对照组血清MMP-9、hs-CRP水平.结果 (1)ACI患者血清MMP-9、hs-CRP水平显著高于健康对照组(P＜0.01);颈动脉斑块形成组显著高于颈动脉内膜增厚组及颈动脉内膜正常组(P＜0.01);颈动脉内膜增厚组显著高于颈动脉内膜正常组(P＜0.01);颈动脉内膜正常组显著高于健康对照组(P＜0.01).且血清MMP-9、hs-CRP水平随着IMT值增大而升高.(2)ACI患者血清MMP-9、hs-CRP与IMT值呈显著正相关(r=0.357、0.409,P＜0.01),且血清MMP-9与hs-CRP呈显著正相关(r=0.415,P＜0.01),其相关性良好.结论 联合检测血清MMP-9、hs-CRP水平,可作为判断ACI患者疾病严重程度、临床疗效及评估预后的重要参数.     

不同糖耐量的老年高血压患者颈动脉粥样硬化与胰岛素抵抗及炎性因子的相关性

目的探讨不同糖耐量老年高血压患者颈动脉粥样硬化与胰岛素抵抗(IR)及炎性因子的相关性。方法 94例老年高血压患者进行葡萄糖耐量实验(OGTT),根据OGTT结果分为糖耐量正常组(NGT组)30例、糖耐量异常组(IGT组)32例、2型糖尿病组(DM组)32例,同时选取30例健康体检者为对照组。4组患者均行超声检查颈动脉内膜-中层厚度(IMT),测定空腹血糖(FPG)、空腹胰岛素(FIns)、血脂、hs-CRP及TNF-α等指标,采用自我平衡模型分析法(HOMA)计算胰岛素抵抗指数(HOMA-IR)。结果 HOMA-IR、hs-CRP、TNF-α及IMT等指标DM组明显高于其余3组,IGT组明显高于NGT组及对照组,NGT组明显高于对照组(P<0.01),相关性分析显示IMT与HOMA-IR、hs-CRP、TNF-α水平呈正相关(r分别为0.406、0.420、0.396,P<0.05)。结论在老年高血压患者中存在IR和炎性反应,老年高血压患者的HOMA-IR、hs-CRP、TNF-α与颈动脉IMT密切相关。     

血浆同型半胱氨酸水平、颈动脉内膜中层厚度与内瘘闭塞的关系

目的 探讨维持性血液透析（MHD）患者血浆总同型半胱氨酸（tHcy）浓度与颈动脉内膜中层厚度（IMT）之间的相关性及其在动静脉内瘘栓塞发生中的作用。方法 选择上海市静安中心医院和解放军第455医院MHD患者120例，根据其在半年内是否有过1次或1次以上的动静脉内瘘栓塞事件，将其分为动静脉内瘘栓塞组（AVFT）和动静脉内瘘非栓塞组（NAVFT），所有患者采用Phllips Iu22彩色多普勒超声仪测量IMT，于透析日抽空腹血测定血浆tHcy、叶酸（FA）、VitB12、肌酐（Scr）、尿素氮（Bun）、血糖（glu）、血浆白蛋白（Alb）、胆固醇（Ch）、三酰甘油（TG）、高密度脂蛋白（HDL）、低密度脂蛋白（LDL）。结果 MHD患者高同型半胱氨酸血症（HHcy）发生率为90％，是正常人的34．6倍，其血浆tHcy水平（27．6±8．3）μmol／L明显高于正常对照组（7．5±1．7）μmol／L，P〈0．01。AVFT组tHcy血浆浓度、IMT平均值明显高于NAVFT组，P〈0．01，tHcy〉40μmol／L的患者数也明显多于NAVFT组，P〈0．05；MHD患者血浆tHcy浓度与IMT呈明显正相关，r=0．362，P〈0．01。结论 MHD患者普遍存在HHcy，HHcy可能是动静脉内瘘栓塞的重要原因之一。     

2型糖尿病及合并冠心病糖尿病患者脂联素水平观察

目的：观察脂联索(adiponectin)在2型糖尿病(DM)及DM合并冠心病时的浓度变化．并探讨影响2型糖尿病患血浆脂联索水平的因素。方法：用ELISA方法在2型糖尿病组(无或合并冠心病)、非糖尿病正常对照组测定血浆脂联索水平。结果：无冠心病的糖尿病组血浆脂联索水平较非糖尿病正常对照组明显降低．合并冠心病的糖尿病组更低。结论：2型糖尿病中血浆脂联索水平的明显下降可作为冠心病的危险标志。     

Vascular stiffness in familial hypercholesterolaemia is associated with C-reactive protein and cholesterol burden

BACKGROUND: Familial hypercholesterolaemia (FH) is characterized by very high serum cholesterol and premature coronary atherosclerosis. Arterial stiffness and atherosclerosis are two major underlying pathophysiologies of arterial disease that are predictive of future cardiovascular events. The aims of this study were to quantify atherosclerosis and arterial stiffness and to evaluate their relationship with high sensitive C-reactive protein (hs-CRP) and the level of exposure to high serum cholesterol in FH patients. Materials AND METHODS: We measured traditional risk factors, hs-CRP, intima-media thickness (IMT) of carotid artery, and brachial-ankle pulse wave velocity (baPWV) in 35 heterozygous FH subjects and 17 healthy control subjects. Cholesterol-year score (CYS) was calculated to estimate the lifetime cholesterol burden in FH subjects. RESULTS: FH subjects had significantly elevated total cholesterol, low-density lipoprotein cholesterol, and carotid IMT compared with those without mutations. Among FH patients, the baPWV and carotid IMT were higher in cases with high cholesterol burden than those without. Similarly, the baPWV and carotid IMT were also higher in cases with elevated hs-CRP (> 1 mg L(-1)) than those without. Multiple linear regression analysis demonstrated CYS and hs-CRP were significant independent predictors of baPWV and IMT in FH patients. CONCLUSIONS: Both high cholesterol burden and vascular inflammation are not only associated with atherosclerosis, but also contribute to the development of arterial stiffness in FH patients. Early detection of hypercholesterolaemia in FH patients is warranted to prevent the untoward pathophysiologies.     

原发性高血压患者颈动脉硬化与炎症因子及血脂的相关性

【目的】探讨原发性高血压患者颈动脉硬化与炎症因子及血脂的相关性。【方法】选取原发性高血压患者91例及血压正常者42例,应用彩色多普勒超声检测颈动脉内膜-中层厚度（IMT）及斑块情况,根据颈动脉超声检测结果将高血压组分为伴颈动脉硬化组（IMT≥0．9mm）40例和无颈动脉硬化组（IMT〈0．9mm）51例。测定超敏c反应蛋白（hsCRP）、白细胞介素1（IL-1）、肿瘤坏死因子-α（TNF—α）及血脂。【结果】①高血压组收缩压、舒张压、TC、LDL-C及颈动脉斑块发生率明显高于对照组（P〈0．05）,②高血压组hs—CRP、IL—1、TNFa、颈动脉IMT值均明显高于对照组,且高血压患者中颈动脉硬化组hs—CRP、IL-1、TNF-α、颈动脉IMT值均明显高于无颈动脉硬化组（P〈O．05）,③在高血压患者,颈动脉IMT与hs—CRP（r=0．426;P〈0．05）、IL-1（r=0．327;P〈0．05）、TNF-α（r=0．284;P〈0．05）呈正相关。多元逐步回归分析表明：在高血压患者中,收缩压、hsCRP及LDL-C是影响高血压患者颈动脉IMT增厚的主要危险因素。【结论】高血压患者颈动脉硬化的形成与血压增高、炎症因子及血脂异常有关。     

4项指标联合检测诊断冠心病的临床价值

目的探讨同型半胱氨酸（tHey）、超敏C反应蛋白（hs-CRP）、脂蛋白（a）[Lp（a）]和D-二聚体（DD）与冠心病的关系。方法检测160例冠心病患者血清tHey、hs-CRP、Lp（a）和血浆DD水平,并选择健康人群80例作为对照组。结果冠心病患者血清tHey、hs-CRP、Lp（a）和血浆DD水平显著高于健康对照组（P〈0．05）。结论联合检测血清tHey、hs-CRP、Lp（a）和血浆DD水平的变化,对冠心病的预防和早期诊断及动态监测有着十分重要的临床价值。     

2型糖尿病患者脉搏波传导速度、踝臂指数和颈动脉粥样硬化的相关性研究

目的 探讨2型糖尿病人群大动脉顺应性和颈动脉粥样硬化的情况及相关性.方法 随机抽取我院2型糖尿病患者以及正常对照各80例作为研究对象.使用动脉硬化诊断装置VP-1000检测肱踝脉搏波传导速度(BaPWV)和踝臂指数(ABI),采用多普勒彩色超声观察颈总动脉内膜-中层厚度(IMT)以及斑块形成情况,比较两组合并颈动脉斑块时脉搏波传导速度的变化情况,分析颈动脉IMT与BaPWV和ABI的相关性.结果 糖尿病组BaPWV[(1752±213)cm/s]较正常对照组[(1279±159)cm/s]升高(t=28.09,P＜0.01);糖尿病组ABI(0.95±0.13)与正常对照组(1.28±0.17)相比差异有统计学意义(t =32.11,P＜0.01).糖尿病组颈动脉IMT增厚率(45.0％)及斑块发生率(35.0％)与正常对照组(分别为27.5％和10.8％)相比差异有统计学意义(x2值分别为4.16、4.14,P均＜0.01);糖尿病组合并颈动脉斑块者BaPWV[(1810±296)cm/s]较无颈动脉斑块[(1480±304)cm/s]者升高(t=15.86,P＜0.01).糖尿病患者BaPWV与颈总动脉IMT呈正相关(r=0.271,P＜0.05),ABI与IMT呈负相关(r=-0.406,P＜0.05).结论 BaPWV与糖尿病患者颈动脉IMT呈正相关,ABI与IMT呈负相关,BaPWV和ABI可作为评估糖尿病外周动脉硬化情况有效且简便易行的指标.     

2型糖尿病患者血浆同型半胱氨酸水平与周围神经病变关系的研究

目的探讨2型糖尿病患者血浆同型半胱氨酸(Hcy)水平与糖尿病周围神经病变的关系。方法分别测定2型糖尿病有周围神经病变患者32例、无周围神经病变患者36例和正常对照组20例血浆Hcy水平以及血糖、血脂、糖化血红蛋白等指标。结果2型糖尿病患者血浆Hcy水平显著高于正常对照组;2型糖尿病有周围神经病变组Hcy水平高于无周围神经病变组;血浆Hcy水平与血糖、糖化血红蛋白呈显著正相关。结论高Hcy与2型糖尿病伴发周围神经病变相关。     

Impact of insulin resistance and nephropathy on homocysteine in type 2 diabetes

OBJECTIVE: To assess the impacts of insulin resistance and renal function on plasma total homocysteine (tHcy) levels in patients with type 2 diabetes with a wide range of nephropathy. RESEARCH DESIGN AND METHODS: Plasma tHcy levels were measured using the enzyme immunoassay method in 75 patients with type 2 diabetes and compared with those in 54 healthy control subjects. Insulin sensitivity indexes were assessed in patients with type 2 diabetes by hyperinsulinemic-euglycemic clamp using artificial pancreas. RESULTS: Plasma tHcy levels and their log-translormed values (log tHcy) were significantly higher in all patients with diabetes than in control subjects (tHcy, 12.0 +/- 0.7 [SE] vs. 8.7 +/- 0.3 micromol/l, P < 0.0001; log tHcy, 1.040 +/- 0.021 vs. 0.920 +/- 0.016 micromol/l, P < 0.0001). Plasma tHcy levels in patients with diabetes were significantly increased according to degree of nephropathy (P < 0.0001). On simple regression analyses, log tHcy correlated with insulin sensitivity indexes (r = -0.319, P = 0.005) as well as creatinine clearance (r = 0.634, P < 0.0001) in all patients with diabetes. Multiple regression analyses showed that insulin sensitivity indexes (beta = -0.245) as well as creatinine clearance were independent contributors to log tHcy in all patients with diabetes (R2 = 0.750, P < 0.0001). For the 59 patients with diabetes with creatinine clearance >60 ml/min, insulin sensitivity indexes were also shown to be a significant contributor to log tHcy (beta = -0.438, R2 = 0.561, P < 0.001). CONCLUSION: Insulin resistance and renal function are independent determinants of tHcy levels in patients with type 2 diabetes.     

Preclinical atherosclerosis and inflammation in 61-year-old men with newly diagnosed diabetes and established diabetes

OBJECTIVE: The aim of this study was to investigate the occurrence of subclinical atherosclerosis and underlying mechanisms in men with newly diagnosed diabetes and established diabetes compared with healthy control subjects. RESEARCH DESIGN AND METHODS: In a population-based study of 61-year-old Caucasian men (n = 271) with established diabetes (n = 50) and newly diagnosed diabetes (n = 24) and healthy control subjects (n = 197), standard risk factors and highly sensitive (hs) C-reactive protein (CRP) were measured. Ultrasound measurements of intima-media thickness (IMT) were performed bilaterally in the common carotid artery, and a composite measure was calculated from common carotid and carotid bulb IMT (composite IMT). The plaque status was assessed. RESULTS: Composite IMT and carotid plaque size increased gradually among the healthy control subjects, newly diagnosed diabetic patients, and established diabetic patients (P for trend < or =0.001, respectively). CRP was higher in newly and established diabetes (NS between diabetes groups) compared with healthy control subjects (P < 0.001). Total cholesterol levels were lower in newly diagnosed diabetes (5.51 +/- 1.13 mmol/l, P < 0.05) and established diabetes (5.45 +/- 1.15 mmol/l, P < 0.01) compared with those of healthy control subjects (5.77 +/- 1.03 mmol/l). In men with diabetes (n = 74), diabetes onset status (newly diagnosed versus established), waist-to-hip ratio (WHR), and serum triglycerides, but not CRP, explained 16% of the variance in composite IMT. CONCLUSIONS: This is the first study to show increased preclinical atherosclerotic changes (IMT and plaque size) and increased inflammation (hs-CRP) in men with newly diagnosed diabetes as well as in patients with established diabetes compared with healthy control subjects. WHR, diabetes onset status (newly diagnosed versus established), and triglycerides, but not CRP, were independent correlates of carotid artery IMT in men with diabetes.