糖尿病肾病早期同型半胱氨酸检测及临床意义

目的探讨血清中同型半胱氨酸(HCY)在2型糖尿病肾病早期诊断中的临床意义。方法对85例临床确诊为2型糖尿病(DM)的患者分为两组:一组为无微血管并发症组(NDC)43例,另一组为糖尿病肾病组(DN)42例;健康对照组(CON)75例。采用化学发光技术检测血清中同型半胱氨酸(HCY)含量,采用免疫比浊法测定尿微量清蛋白(mAlb)含量。结果 (1)糖尿病组HCY高于健康对照组,有微血管病变组又高于无微血管病变组。(2)正常HCY组的糖尿病微血管病变发生率为23.33%,而高HCY组的糖尿病微血管病变发生率为63.33%,是正常HCY组的2.71倍,差异具有统计学意义(χ2=34.89,P0.010)。(3)尿微量清蛋白组(DN1)与尿中有大量清蛋白组(DN2)相比,DN2组HCY为14.81μmol/L,DN1组的HCY为11.02μmol/L,DN2组HCY明显高于DN1组HCY(P=0.026);而且高HCY发生率大于DN1组(P=0.016)。结论高HCY血症是糖尿病肾脏病变的危险因素,为糖尿病肾脏病变患者病情程度的评估提供了一个新的指标。

Detection of homocysteine in early diabetic nephropathy and its clinical significance

Objective To study the relationship between homocysteine （HCY） and early nephropathy in type 2 diabetes mellitus（DM）.Methods We divided 85 patients with type 2 DM into two groups：43 cases in non diabetic microangiopathy（NDC） group and 42 cases in diabetic nephropathy（DN） group,with 75 healthy people as control.We detected plasma levels of HCY by chemiluminescence.We measured urine microalbum by immunity dispersion nephelometry.Results （1）The plasma HCY level in DN group was significantly higher than that in healthy control group,and which in DM group with microvascular lesions obviously increased compared with NDC group.（2）In the group with normal HCY level,the incidence of microvascular lesions was 23.33%,while which in the group with hyperhomocysteinemia （HHCY） was 63.33%,more than 2.71 times of normal group＇s （χ2=34.89,P0.010）.（3） Comparing the microalbuminuria group （DN1） group and a large number of albuminuria （DN2） group,the plasma HCY level of DN2 group（14.81 μmol/L） was significantly higher than DN1 group＇s（11.02 μmol/L）.The HHCY incidence was higher than that in DN1 group（P=0.016）.Conclusion HHCY is an independent risk factor of diabetic nephropathy,which could contribute to the evaluation of the degree of early nethropathy in DM patients.