Hcy、CysC和VEGF与2型糖尿病微血管病变的关系研究

目的同型半胱氨酸（Hcy）是心血管疾病的独立危险因素,与大血管动脉粥样硬化相关;血管内皮生长因子（VEGF）是作用于内皮细胞的特异性因子,是血管增生的强烈刺激因子,促进新生血管形成;Cys C是一种小分子量的胱氨酸蛋白酶抑制剂,可以非常稳定地反映肾小球滤过率。本研究通过观察血浆Hcy、VEGF和Cys C水平变化探讨其与2型糖尿病微血管病变的关系。方法 2型糖尿病患者71例,其中33例为单纯糖尿病患者,38例微血管病变者,31例健康者作为对照组。应用免疫比浊法检测Hcy、Cys C和酶联免疫分析法（ELISA）检测VEGF,同时检测糖化血红蛋白与肌酐等生化指标。另将糖尿病微血管病变组分为正常白蛋白尿组、微量白蛋白尿组和大量白蛋白尿组。统计分析比较各组间Hcy、Cys C、VEGF水平。结果糖尿病微血管病变组Hcy、Cys C、VEGF显著高于正常对照组和单纯糖尿病组;Hcy、Cys C、VEGF与糖尿病微血管病变相关。VEGF水平：正常白蛋白尿组〈微量白蛋白尿组〈大量白蛋白尿组。结论糖尿病微血管病变患者的Hcy、Cys C、VEGF显著升高,高水平Hcy、Cys C、VEGF是糖尿病微血管病变发生的危险因素。降低Hcy、Cys C、VEGF浓度有益于延缓糖尿病微血管并发症的发生和发展。Cys C水平的增高对糖尿病微血管病变的发生有早期提示作用,对肾脏的损害优于尿微量白蛋白,检测其水平有助于早期防治糖尿病微血管病变。

Relationship between diabetic microangiopathy and plasma levels of Hcy,Cys C and VEGF

Objective To investigate the serum levels of plasma homocysteine（ Hcy）,vascular endothelial growth factor（VEGF） and Cystatin C（CYS C）,and study its relationship with the microangiopathy in patients with type 2 diabetic mellitus. Methods Total 71 cases of type 2 diabetes,including 33 cases of simple diabetes and 38 cases of diabetic microangiopathy,and 31 healthy individuals were enrolled in this study. Immunoturbidimetry was employed to detect the levels of plasma Hcy and CYS C,while enzyme-linked immunosorbent assay（ELISA） to test the level of VEGF. The levels of glycosylated hemoglobin,creatinine and other biochemical indicators were tested at the same time. In addition,the patients in the diabetic microangiopathy group were divided into non-albuminuria group,microalbuminuria group and macroalbuminuria group. The difference in the levels of Hcy,CYS C and VEGF were compared between the two groups. Results The plasma levels of Hcy,CYS C and VEGF in the diabetic microangiopathy group were significantly higher than those in the control group and simple diabetes group. Hcy,CYS C and VEGF were associated with diabetic microangiopathy. The level of VEGF was lowest in the non-albuminuria group,and highest in the macroalbuminuria group. Conclusion The levels of plasma Hcy,CYS C and VEGF in patients with diabetic microangiopathy increased significantly. The elevated Hcy,CYS C and VEGF are the risk factors for diabetic microangiopathy. To reduce the levels of Hcy,CYS C and VEGF should resist the initiation and progression of complications of diabetic microvascular. The increased CYS C level predicts the onset of diabetic microvascular lesion,is better than urine microalbumin in predicting the damages to the kidney. To detect the level of CYS C should be helpful to the early prevention and treatment of diabetic microangiopathy.