2型糖尿病肾病与同型半胱氨酸及血糖波动的相关性分析

目的分析糖尿病肾病与同型半胱氨酸及血糖波动的相关性，为糖尿病肾脏疾病的防治提供依据。方法测定154例2型糖尿病（T2DM）患者的糖化血红蛋白（HbAlc）、空腹血糖（FBG）、空腹C肽、同型半胱氨酸（Hey）、血脂、24h尿微量白蛋白定量（UAlb），行动态血糖监测后测定血糖波动系数。根据UAlb将患者分为高UAlb组8l例和正常UAlb组73例，进行组间比较，并将UAlb与各种因素间进行多元逐步回归分析。结果高UAIb组与正常UAlb组比较，糖尿病病程（9．68±7．31）年与（5．44±3．65）年，t=3．427]、HbAlc（9．61±2．44）％与（8．69±2．35）％，t=2．162]、血糖波动系数（3．06±0．85与2．58±O．91，t=2．437）、低密度脂蛋白胆固醇（LDL—C）（3．46±O．83）mmol／L与（3．01±0．84）mmol／L，t=2．596]、尿微量白蛋白（129．64±118．50）mg／24h与（18．14±3．54）mg／24h，t=6．421]、血尿酸（335．02±90．39）mmoL／L与（287．00±92．03）mmol／L，t=2．541]及同型半胱氨酸（15．55±4．53）mmoL／L与（13．12±4．44）mmol／L，t=2．603]差异均有统计学意义（P〈0．05或P〈0．01）。经Pearson相关性分析，糖尿病病程、LDL—C、血尿酸、同型半胱氨酸及血糖波动系数与2型糖尿病患者尿微量白蛋白成正相关（r值分别为0．363、0．270、0．220、0．252、0．236；P值分别为0．000、0．008、0．033、0．014、0．022），多元逐步回归分析显示UAlb与糖尿病病程、Hcy、血糖波动系数相关（β=0．344，P=0．000；β=0．244，P=0．011；β=0．229，P=0．012）。结论同型半胱氨酸与血糖波动是2型糖尿病肾病的危险因子，降低同型半胱氨酸浓度，减少患者血糖波动可作为预防2型糖尿病肾病的新途径。

Correlation analysis of type 2 diabetic nephropathy with homocysteine and blood glucose fluctuation

Objective To investigate the relationship of homocysteine and blood glucose wavy coefficient with type 2 diabetic nephropathy. Methods Glycosylated hemoglobin A1 c （HbA1 c）, fasting blood glucose （ FBG）, fasting C-peptide, homocysteine （ Hcy）, blood-fat and 24h urinary albumin quantitative （UAlb） of 154 patients with type 2 diabetes were determined , and the blood glucose wavy coefficient were calculated after blood glucose monitored by a continuous glucose monitoring system （CGMS）. The patients were divided into two groups according to the quantity of UAlb ：high UAlb group（ n = 81 ） and normal UAlb group（n = 73）. Then the difference were compared between two groups and multiple regression analysis was done between UAlb and a variety factors. Results The course of disease in high UAlb group were significantly longer than that in normal UAlb group （ （9.68 ± 7.31 ） years vs （5.44 ± 3.65 ） years, t = 3.427, P 〈 0. 05 ）. There were significant difference on HbAlc （ 9. 61± 2.44 ） % vs （ 8. 69 ± 2. 35 ） %, t = 2. 162 ], blood glucose wavy coefficient （3.06 ±0. 85） vs （2. 58±0. 91 ） ,t =2. 437] ,low density lipoprotein-cholesterol （LDL-C） （3.46 ±0. 83） mmol/L vs （ 3.01± 0. 84 ） mmol/L, t = 2. 596 ], UAlb （ 129. 64± 118. 5 ） mg/24 h vs （ 18.14±3.54 ） mg/24 h,t=6.421） ,UA （（335.02 ±90.39）mmol/L vs （287.00±92.03）mmol/L,t =2.541） and Hcy （ 15.55 ± 4. 53 ） mmol/L vs （ 13.12 ± 4. 44） mmol/L, t = 2. 603 ] between the two groups （ P 〈 O. 05 or P 〈 0. 01 ）. Pearson analysis showed that the courses of disease, LDL-C, UA, Hcy and blood glucose wavy coefficient were positively correlated with UAlb （ r = 0. 363,0. 270,0. 220,0. 252,0. 236 respectively; P = 0. 000,0. 008, 0. 033,0. 014,0. 022, respectively）. And the muhiple regression analysis indicated that UAlb was related with courses of disease （ β = 0. 344, P = 0. 000）, Hcy （β = 0. 244, P = 0. 011 ） and blood glucose wavy coefficient （β= 0. 229, P = 0. 012）. Conclusion The elevation of serum Hcy and blood glucose wavy coefficient are risk factors to type 2 diabetic nephropathy. Lowering Hcy concentration and reducing the glucose variability may be a new way to prevent the occurrence of type 2 diabetic nephropathy.