血浆同型半胱氨酸浓度与2型糖尿病视网膜病变的关系

目的　观察空腹血浆总同型半胱氨酸 (Hcy)水平与 2型糖尿病视网膜病变发生发展的关系。方法　研究对象为 5 5例 2型糖尿病 (DM)和 19例 (男 12例 ,女 7例 )非DM健康对照者 (CON)。DM组分为两个亚组 :无微血管并发症 (NDC)组 39例 (男 17例 ,女 2 2例 ) ,糖尿病视网膜病变 (DR)组16例 (男 8例 ,女 8例 )。所有患者肾功能和尿白蛋白 /肌酐 (Alb/Cr)均正常。根据眼底荧光造影判断视网膜病变的严重程度。应用高效液相 反相色谱分析和荧光检测的方法测定空腹血浆总Hcy水平。结果　DR组、NDC组和CON组间的血浆总Hcy浓度差异有显著性 (F =2 4 0 5 ,P =0 0 31) ,DR组血浆总Hcy水平 (14 7± 5 2 8) μmol/L]显著高于NDC组 (11 3± 4 94) μmol/L]和CON组 (9 6 5± 2 6 6 )μmol/L]。NDC组与CON组比较差异无显著性。在DR组 ,增殖性视网膜病变 (PDR)亚组总Hcy水平显著高于背景性视网膜病变 (BDR)亚组 (t=2 4 0 5 ,P =0 0 31)。本研究中 ,总Hcy超过 14 97μmol/L即为高同型半胱氨酸血症 ,其中PDR亚组有 4例 ,BDR亚组为 1例。结论　伴视网膜病变的 2型DM患者血浆总Hcy水平高于正常人 ,其中PDR组的血浆总Hcy浓度高于BDR组。空腹血浆同型半胱氨酸水平可能是 2型糖尿病视网膜病变的重要危险因素之一。

The impact of plasma homocysteine level on development of retinopathy in type 2 diabetes mellitus

OBJECTIVE: An increased plasma homocysteine level is an important risk factor for vascular disease in the general population. However, the role of hyperhomocysteinemia in the development of type 2 diabetic retinopathy (DR) is still unknown. Therefore, our aim was to determine the relationship between the fasting plasma homocysteine (Hcy) levels and the presence of diabetic retinopathy in patients with type 2 diabetes. METHODS: The study group consisted of 55 cases of type 2 diabetic patients (DM); 19 healthy persons served as control (CON, 12 men and 7 women). The DM group were subdivided into a group without diabetic complications (NDC, 39 cases, 17 men and 22 women) and a group with DR (16 cases, 8 men and 8 women). The renal function and the ratio of albumin/creatinine (Alb/Cr) were within normal range in all the subjects. The presence and the grade of retinopathy were determined by an ophthalmologist. Plasma total Hcy (tHcy) was measured by automated high-performance liquid chromatography (HPLC) with reverse phase separation and fluorescence detection. RESULTS: Plasma tHcy levels were significantly different among DR, NDC and CON groups (F = 2.405, P = 0.031). Plasma total Hcy was significantly higher in DR group (14.7 +/- 5.28) micromol/L] than in NDC (11.3 +/- 4.94) micromol/L] and CON group (9.65 +/- 2.66) micromol/L]. There was no difference between NDC group and CON group. In DR group, plasma tHcy was significantly higher in proliferative diabetic retinopathy (PDR) group than that in background diabetic retinopathy (BDR) group (t = 2.405, P = 0.031). Hyperhomocysteinemia was defined as tHcy level > 14.97 micromol/L and was seen in 4 patients in PDR group, the rate being significantly higher than that in BDR group. CONCLUSION: It is suggested that hyperhomocysteinemia may be a risk factor for the development and progression of type 2 diabetic retinopathy.