糖尿病视网膜病变与高同型半胱氨酸血症的关系

目的研究糖尿病视网膜病变与血浆同型半胱氨酸水平的关系。方法随机选择2型糖尿病患者120例,按有无视网膜病变分为3组：糖尿病无视网膜病变组(NDR)、背景型糖尿病视网膜病变组(BDR)和增殖型糖尿病视网膜病变组(PDR),检测3组患者的血浆同型半胱氨酸水平。结果BDR组与PDR组患者的Hcy水平明显高于NDR组(P＜0．01),PDR组的Hcy水平明显高于BDR组(P＜0．05),差异均有显著性意义(P＜0．05)。结论高同型丰胱氨酸血症不仅促进糖尿病视网膜病变的发生,而且与糖尿病视网膜病变的严重程度有关。     

糖尿病微血管病变患者炎症因子水平、血浆同型半胱氨酸水平及血液流变学指标变化

目的 为探讨糖尿病视网膜病变严重程度与炎症因子、血浆同型半胱氨酸水平及血液流变学的关系.方法 完全随机选择2型糖尿病患者150例,按有无视网膜病变分为3组:糖尿病无视网膜病变组(NDR)48例、背景型糖尿病视网膜病变组(BDR)52例和增殖型糖尿病视网膜病变组(PDR)50例,检测3组病人的炎症因子、血浆同型半胱氨酸(Hcy)水平和血液流变学指标进行分析.结果 与糖尿病无视网膜病变组比较,背景型糖尿病视网膜病变组与增殖型糖尿病视网膜病变组的炎症因子、血浆Hcy水平、血液流变学指标明显升高,差异有统计学意义(P＜0.01);与背景型糖尿病视网膜病变组比较,增殖型糖尿病视网膜病变组的炎症因子、血浆Hcy水平、血液流变学指标明显升高,差异有统计学意义(P＜0.05).结论 炎症反应、高同型半胱氨酸血症及高粘血症参与了糖尿病视网膜病变的发生和发展过程.     

2型糖尿病微血管病变患者血浆同型半胱氨酸的变化及其机制的探讨

目的 了解血浆同型半胱氨酸（Hcy)与2型糖尿病微血管病变（DMAP）间的关系，并分析影响糖尿病（DM）患者Hcy代谢的因素。方法 157例DM患者分为三组：无微血管并发症组（NDC）、糖尿病视网膜病变组（DR）和糖尿病肾病（DN）组；正常对照组（CON）组28例。测定血浆Hcy、叶酸、维生素B12浓度，并以PCR－RFLP技术检测亚甲基四氢叶酸还原酶（MTHFR）C667T突变和蛋氨酸合成酶还原酶（MSR）A66G突变率。结果 DM各组血Hcy浓度及空腹高Hcy血症发生率高于CON组，DN组又高于NDC组（P＜0．05）。DM患者血Hcy浓度与MTHFR BB基因型、BMI、HbAlc、FBG、PBG、二甲双胍的使用呈正相关，与血浆叶酸和VitB12呈明显负相关，与MSR基因型无关。多元逐渐回归分析结果显示，VitB12、HbA1c、MTHFR基因型和叶酸是DM患者血Hcy浓度的影响因素。结论 空腹高Hcy因症是DMAP的危险因子；2型DM中MTHFR基因型、VitB12、叶酸以及代谢紊乱的程度影响Hcy的浓度。     

高同型半胱氨酸血症与老年糖尿病视网膜病变及胰岛素抵抗的关系

目的 探讨高同型半胱氨酸血症与老年糖尿病视网膜病变(DR)及胰岛素抵抗(IR)的关系.方法 ELISA法检测62例老年2型糖尿病(T2DM)患者及30例健康对照者血浆总同型半胱氨酸(Hcy)浓度:依据Hcy水平将糖尿病患者再分为高Hcy组和正常Hcy组,比较两组的临床资料.结果 高Hcy组较正常Hcy组空腹血糖(FBG)、糖化血红蛋白(HbA1c)、胰岛素抵抗指数(HOMA-IR)均明显升高(P＜0.05).多元线性逐步回归分析示:FBG、HbA1c、HOMA-IR均为有统计意义与Hcy密切相关;Logistic回归分析示,DR的发生与Hcy有关.结论 高Hcy水平是老年DR发生发展的危险因子,与IR相关.     

血清vaspin水平与2型糖尿病视网膜病变的相关性

目的探讨内脏脂肪组织起源的丝氨酸蛋白酶抑制剂vaspin水平与2型糖尿病(T2DM)视网膜病变的关系。方法根据有无视网膜糖尿病变(DR)分为无DR组(NDR组),背景期DR组(BDR组),增殖期DR且应用胰岛素治疗组(PDR组),每组40例。同时在体检中心收集健康体检者40例纳入正常对照组(NC组)。采用酶联免疫吸附试验(ELISA)测定血清vaspin水平。结果各组血清vaspin比较:BDR组PDR组NC组NDR组,病程、稳态模型评估的胰岛素抵抗指数(HOMA-IR)和尿白蛋白排泄率(UAER)是影响血清vaspin水平的独立危险因素。结论 T2DM出现视网膜病变时,vaspin水平明显降低,与疾病程度呈负相关。     

血清同型半胱氨酸水平与老年2型糖尿病视网膜病变的关系

目的　探讨血清总同型半胱氨酸 (Hcy)水平与老年人 2型糖尿病视网膜病 (DR)的关系及与其他危险因素的关系。方法　用免疫化学发光法检测 54例老年 2型糖尿病患者和 2 0例非糖尿病对照者的血清 Hcy水平 ,并收集其他相关危险因素资料。结果　 (1 )单因素分析结果显示 :DR组 (2 4例 )糖尿病病程、血浆糖化血红蛋白 (Hb A1 C)、血清甘油三酯 (TG)和 Hcy水平明显高于 2型糖尿病无视网膜病组 (NDR) (30例 )和非糖尿病对照组 (P<0 .0 5) ;(2 )血清 Hcy水平与 Hb A1 C呈正相关 ,与空腹胰岛素 (FINS)水平呈负相关 (P<0 .0 5) ;(3)多元 Logistic回归分析表明 ,血清Hcy水平增高是老年 DR的独立变异危险因素。结论　血清 Hcy水平增高与老年 DR的发病有关。     

血浆同型半胱氨酸与2型糖尿病微血管病变的关系

目的了解血浆同型半胱氨酸（Hcy）与2型糖尿病微血管病变间的关系,并分析影响糖尿病患者Hcy代谢的因素。方法将122例糖尿病患者分为无微血管并发症（NDC）组、糖尿病视网膜病变（DR）组和糖尿病肾病（DN）组3组。酶免疫分析法测定血浆Hcy和血浆血栓调节蛋白（sTM）浓度;发光免疫法测定血清叶酸和VitB12水平。结果DR组和DN组的空腹血浆Hcy浓度明显高于NDC组和对照组（P〈0．01）;高Hcy血症的糖尿病患者DR、DN发生率明显高于无高Hcy血症糖尿病患者（P〈0．01）;相关分析表明,糖尿病患者Hcy水平与sTM、肌酐（Scr）水平呈显著正相关（P〈0．01）,与叶酸、VitB12水平呈显著负相关（P〈0．01）。Logistic回归分析显示空腹Hcy、甘油三酯、VitB12、叶酸、sTM与DN的发生有关;Hcy、FPG、Scr、甘油三酯均为DR的独立危险因素。结论血清叶酸、VitB12、Scr以及代谢紊乱程度影响Hcy的浓度;空腹高Hcy血症是糖尿病微血管病变发生、发展的危险因素之一。     

血浆同型半胱氨酸及糖化血红蛋白在糖尿病视网膜病变诊断中的应用

目的探讨血浆同型半胱氨酸（Hcy）及糖化血红蛋白（HbA1c）在糖尿病视网膜病变（DR）诊断中的应用价值。方法对45例DR患者（DR组）、55例无视网膜病变的2型糖尿病患者（NDR组）及40例健康体检者（对照组）采用双抗体夹心ELISA法和免疫比浊法检测其血浆Hey和HbA1c水平。结果DR组与NDR组患者血浆Hcy和HbA1c水平均高于对照组,（P〈0．05）,DR组血浆Hey和HbA1c水平高于对照组（P〈0．05）。结论检测血浆Hcy和HbA1c水平可早期诊断DR。     

高同型半胱氨酸血症与2型糖尿病慢性并发症的关系

目的　探讨 2型糖尿病患者血浆同型半胱氨酸 (Hcy)水平与慢性并发症的关系。　方法　应用高效液相色谱仪和荧光检测仪测定 2 16例 2型糖尿病患者和 89名正常对照者的血浆总同型半胱氨酸 (tHcy)水平 ,分析患者组血浆tHcy水平与慢性并发症之间的关系。 　结果　 (1)患者组血浆tHcy水平高于正常对照组 [(16 .0± 6 .3) μmol/Lvs (11.7± 2 .2 ) μmol/L ,P <0 .0 1];患者组中35 %存在高Hcy血症 (tHcy >16 .2 μmol/L) ,而正常对照组仅 7% (P <0 .0 1)。 (2 )患者组中的高Hcy组 [n =75 ,tHcy为 (2 3.7± 7.4 ) μmol/L]其慢性并发症的发生率为 6 7% ,而正常Hcy组 [n =14 1,tHcy为 (11.6± 2 .5 ) μmol/L]为 4 0 % (P <0 .0 1)。高Hcy组中高血压、冠心病、脑血管病变、下肢血管病变及肾病的发生率均高于正常Hcy组 ,其中以冠心病发生率差异尤为显著 (43%vs 2 3% ,P <0 .0 0 1) ,而视网膜病变及神经病变的发生率则无明显差异。 (3)相关分析显示 ,2型糖尿病患者血浆tHcy水平与年龄、尿白蛋白排泄率呈正相关 (r =0 .36 ,P =0 .0 0 0 9;r =0 .2 7,P =0 .0 184 ) ,与肌酐清除率、血叶酸水平呈负相关 (r =- 0 .5 3,P =0 .0 0 0 3;r =- 0 .2 5 ,P =0 .0 137)。　结论　高Hcy血症与 2型糖尿病的大血管病变及肾脏病变     

血浆VEGF和PAI-1与糖尿病视网膜病变严重程度关系研究

目的探讨不同程度糖尿病视网膜病变患者血浆中血管内皮生长因子(VEGF)和纤溶酶原激活物抑制物-1(PAT-1)水平的变化规律及其意义。方法收集2007年1月至12月新疆石河子大学医学院第一附属医院内分泌科和眼科就诊的2型糖尿病患者72例。用酶联免疫吸附双抗体夹心法检测血浆VEGF和PAT-1水平。结果(1)糖尿病患者的血浆VEGF质量浓度明显高于正常对照组(NC组)[(17.86±12.25)ng/L],背景期视网膜病变组(BDR组)[(93.41±54.69)ng/L]明显高于无视网膜病变组(NDR组)[(52.17±21.81)ng/L]和增殖期视网膜病变组(PDR组)[(61.24±37.55)ng/L],但PDR组与NDR组比较差异无统计学意义;(2)糖尿病患者血浆PAI-1高于正常对照组,BDR组[(58.29±20.53)μg/L]和PDR组[(66.84±23.81)μg/L]明显高于NDR组[(44.88±16.36)μg/L],但BDR组和PDR组比较差异无统计学意义。结论糖尿病视网膜病变患者存在着血管内皮细胞的损伤和低纤溶状态,检测糖尿病患者血浆中VEGF和PAI-1对糖尿病视网膜病变的早期诊断和及时干预治疗可能具有重要意义。     

糖尿病视网膜病变与血清Ⅳ型胶原和层粘连蛋白以及粘附分子变化的相关性

目的 探讨糖尿病视网膜病变不同时期细胞外间质、血管基膜成分以及血管内皮细胞粘附分子在血循环中的变化，了解他们与血管基膜和血管内皮细胞损伤的相关性。方法 85例(男40例、女45例)2型糖尿病患者分无视网膜病变(NDR)组31例、背景期视网膜病变(BDR)组24例和增殖期视网膜病变(PDR)组30例，采用放射免疫法和ELISA法测其血清Ⅳ型胶原(ⅣC)、层粘蛋白(LN)和血管内皮细胞粘附分子(sVCAM—1)含量，同时设健康体检者20人为对照组。结果 三组糖尿病患者血清LN、ⅣC、sVCAM—1水平均高于对照组。PDR组的血清LN、ⅣC和sVCAM—1水平与对照组比较，差异有非常显著意义(P＜0．01)，与NDR组比较，差异也有非常显著意义(P＜0．01)；BDR组血清LN、ⅣC和sVCAM—1水平与对照组比较，差异有非常显著意义(P＜0．01)；BDR组血清LN、ⅣC和sVCAM—1水平与对照组比较，差异有非常显著意义(P＜0．01)；PDR组与BDR组比较，仅LN、ⅣC差异有非常显著意义(P＜0．01)；BDR组与NDR组比较，仅sVCAM—1差异有显著意义(P＜0．05)。三组糖尿病患者血清三项指标之间无相关性(分别为r＝0．119，r＝0．167和r＝-0．210；P＞0．05)。结论 血清ⅣC、LN和sVCAM—1用于联合检测，能较好地反映糖尿病微血管病变的发展过程，为其早期诊断和治疗提供依据，也可作为糖尿病视网膜病变严重程度的估计和预后判断的指标。     

血红素氧合酶-1和抗血管生长因子与2型糖尿病视网膜病变的相关性研究

目的 探讨血红素氧合酶-1（HO-1）及抗血管生长因子——Avastin与DR的相关性. 方法 选取T2DM无视网膜病变组（NDR） 55例,背景期DR组（BDR） 53例,增殖期DR组（PDR） 56例,老年单纯白内障对照组（Con） 50例.采用ELISA对血液及房水的HO-1、Avastin进行检测. 结果 与Con组比较,BDR组和PDR组血液及房水HO-1[血：（17.47±5.75）、（19.25±6.95） vs（15.32±3.56）ng/ml;房水：（0.77±0.45）、（0.89±0.36）vs（0.52±0.47） ng/ml]、Avastin[血：（5.69±4.11）、（7.32±3.45）vs（1.49±0.86） ng/ml;房水：（32.58±18.74）、（55.12±32.17）vs（7.85±6.73） pg/ml]均升高（P＜0.01）,且随DR严重程度升高更明显. 结论 HO-1、Avastin与DR相关,可能参与了DR的发生发展过程.     

Slightly elevated blood pressure as well as poor metabolic control are risk factors for the progression of retinopathy in early-onset Japanese Type 2 diabetes

Not a few patients in Japan with early-onset type 2 (non-insulin-dependent) diabetes become blind due to proliferative diabetic retinopathy (PDR). However, the risk factors are poorly understood. The aim of this study was to determine the risk factors for background diabetic retinopathy (BDR) and PDR by following 394 Japanese patients with early-onset type 2 diabetes diagnosed before 30 years of age (mean age 27, mean blood pressure at entry 116/73 mm Hg). Of the 322 patients who were free of diabetic retinopathy at entry, 88 developed BDR, giving an incidence of 57.7 (95% CI 55.5-60. 0)/1000 person-years. Cox proportional hazard analysis revealed mean HbA(1c) and duration of diabetes to be significant predictors of development of BDR. Of the 160 patients with BDR, i.e., the 72 patients who had BDR at entry and the 88 who developed BDR during the follow-up, 50 developed PDR, giving an incidence of 17.9 (95% CI 13.6-23.6)/1000 person-years. Cox proportional hazard analysis indicated mean HbA(1c) and diastolic blood pressure to be significant predictors of the progression from BDR to PDR. In conclusion, in early-onset Japanese type 2 diabetic patients, the rates of both development of BDR and of progression from BDR to PDR appear to be potentially high. Not only lifetime exposure to glycemia but also a slightly elevated blood pressure level is an important risk factor for progression to PDR.     

Pancreatic B-cell function in relation to diabetic retinopathy in Asian Indian NIDDM patients

Summary Pancreatic B-cell function in relation to diabetic retinopathy was studied in 195 NIDDM patients with long-standing diabetes. Background diabetic retinopathy (BDR) was present in 95 (48.7%) and proliferative retinopathy (PDR) in 17 (8.7%) of the subjects. There was no significant difference between the BDR, PDR, and non-retinopathy groups with respect to age, age at diagnosis of diabetes and HbA₁ values. Mean duration of diabetes was higher in the PDR group (p<0.05). Serum C-peptide values showed no correlation with the presence of retinopathy or with the duration of diabetes. The C-peptide values were widely scattered in patients with BDR and PDR showing no association between pancreatic B-cell reserve and occurrence or severity of retinopathy in NIDDM patients. Thus, decreased pancreatic B-cell reserve does not appear to be a risk factor for diabetic retinopathy in NIDDM patients.     

Insulin resistance and proliferative retinopathy: a cross-sectional, case-control study in 115 patients with type 2 diabetes

In this cross-sectional, case-control study we explored the association of proliferative diabetic retinopathy (PDR) with insulin resistance (IR) in type 2 diabetics with serum creatinine less than 2.0 mg/dl. For each PDR case, one reference case with background diabetic retinopathy (BDR) and two controls without retinopathy were identified. IR was evaluated by hyperinsulinemic euglycemic clamp; retinopathy was evaluated by indirect ophthalmoscopy and photography. Patients were matched by age, gender, and body mass index. PDR patients (n = 28) had higher IR and low-density lipoprotein cholesterol and triglyceride levels than BDR patients (n = 29), but comparable levels of glycosylated hemoglobin. Compared with patients without retinopathy (n = 58), those with PDR had higher IR, low-density lipoprotein cholesterol, and albuminuria (P < 0.05); those with BDR had higher glycosylated hemoglobin (P < 0.05), but comparable IR. At multivariate regression analysis, IR was the only independent marker of PDR among patients with retinopathy (P = 0.016). IR also retained its independent predictive value at multiple comparison among all groups (by Kruskal-Wallis test, P = 0.019). In type 2 diabetes, IR is an independent specific marker of proliferative retinopathy that may characterize patients at increased risk for blindness who may benefit most from early screening and therapeutic intervention. Longitudinal studies are needed to evaluate the role of IR in the pathogenesis of proliferative retinopathy.     

Hyperhomocysteinemia and related factors in 600 hospitalized elderly subjects

Hyperhomocysteinemia (HHcy) is a metabolic disorder frequently occurring in the elderly population. Recently several reports have suggested abnormalities in homocysteine (tHcy) metabolism implicating HHcy as a metabolic link in the multifactorial processes characterizing many geriatric illnesses-with special emphasis on atherosclerotic vascular diseases and cognitive impairment. The present study was undertaken in a large sample of elderly hospitalized subjects to determine (1) the prevalence of HHcy, (2) the association of HHcy with vascular and cognitive disorders, and (3) the factors independently predicting Hhcy. Six hundred elderly subjects (264 men and 336 women; mean age, 79 +/- 9 years) were randomly chosen from those admitted as inpatients over a period of 3 years. In all patients, body mass index (BMI), mid-upper arm muscle area (MUAMA), plasma cholesterol, triglycerides, total proteins, albumin, lymphocyte count, creatinine, homocysteine (fasting and 4 hours after methionine oral load), serum vitamin B(6), vitamin B(12), and folate concentrations were measured. The presence of disease or use of medications known to affect homocysteine plasma levels were also recorded. The mean fasting tHcy level was 16.8 +/- 12 micromol/L in the whole sample, 18.18 +/- 13.25 micromol/L in men, and 15.86 +/- 12.14 micromol/L in women (P =.005 men v women). The mean Hcy level 4 hours after methionine load was 37.95 +/- 20.9 in the whole sample. Prevalence of hyperhomocysteinemia (fasting Hcy > or = 15 micromol/L or 4 hours after methionine load > or = 35 micromol/L) was 61% (365/600) (67% in men and 56% in women, P <.05). HHcy was rarely (8%) an isolated disorder; in addition to diabetes (20%), renal failure (48.2%), and malnutrition (20.2%), it was often associated with heart failure (30%), malignancies (20.5%), and the use of diuretics (56%) and anticonvulsant drugs (13%). Plasma homocysteine progressively increases across subjects from those with no diabetes, malnutrition, renal failure, obesity, inflammatory bowel disease, heart failure to those with 1, 2, or more concurrent diseases. Multiple stepwise regression analysis showed that 72% of plasma total fasting tHcy variability was explained by age, serum folate, plasma albumin, use of diuretics, and renal function (measured as plasma creatinine clearance). In conclusion, the present study documents that hyperhomocysteinemia, in elderly hospitalized patients is (1) a common finding, (2) frequently associated with vascular and cognitive disorders, and (3) probably a secondary phenomenon in most cases. The major predictor of high plasma homocysteine levels were age, serum folate, plasma albumin, plasma creatinine clearance, and use of diuretic drugs. These variables explain a large proportion of plasma Hcy variability.     

Beer ethanol consumption and plasma homocysteine among patients with type 2 diabetes

We analyzed the association between beer and other type of ethanol consumption and tHcy levels among type 2 diabetic patients. Male type 2 diabetic patients without overt nephropathy were studied (n=242). Ethanol consumptions of the patients were 35.1+/-37.8mL/day for total ethanol, 13.9+/-15.2mL/day for beer ethanol and 21.2+/-32.1mL/day for non-beer ethanol. Both, total and non-beer ethanol consumption correlated with tHcy, whereas beer ethanol consumption showed a trend to inverse association with tHcy (standard regression coefficient, 0.184, 0.283 and -0.110, respectively). Each intake of 30mL/day ethanol consumption was associated with an increase of tHcy of 0.6micromol/L for total ethanol and 1.1micromol/L for non-beer ethanol and a decrease of tHcy of 0.7micromol/L for beer ethanol. Similar trend was observed in the analysis model which included only drinkers, and also in an adjusted analysis model. Plasma tHcy of beer only drinkers was lower than that of non-beer alcohol only drinkers (8.9+/-1.9micromol/L versus 11.5+/-5.5micromol/L, P=0.003). Non-beer ethanol consumption might be less healthy compared with beer ethanol consumption among type 2 diabetic patients in terms of the effects on tHcy.