2型糖尿病肾病患者血清同型半胱氨酸与尿白蛋白及胰岛素敏感性的关系

目的探讨2型糖尿病肾病(DN)患者空腹血清同型半胱氨酸(Hcy)水平与尿白蛋白及胰岛素敏感性之间的关系。方法98例2型糖尿病患者按UAER值分为正常UAER组(UAER<30mg/d为A组)、早期DN组(30mg/d≤UAER<300mg/d为B组)、临床DN组(UAER≥300mg/d为C组),以30例健康者为对照组;分别测定Hcy、空腹血糖(FPG)、空腹胰岛素(FINS)、糖化血红蛋白(HbA1c)、尿微量白蛋白排泄率(UAER),计算胰岛素敏感指数(ISI)。结果A、B、C组糖尿病病人的血浆Hcy水平,均高于对照组,有显著性差异(p<0.05);三组不同UAER值糖尿病病人间的血浆Hcy水平,也有显著性差异(p<0.05);Hcy与UAER呈显著正相关,与ISI呈显著负相关(p<0.01)。结论2型DN患者高Hcy血症与尿白蛋白呈正相关,并与胰岛素敏感性下降有关,控制尿微量白蛋白,增强胰岛素敏感性可通过调节血Hcy水平对糖尿病微血管并发症起一定预防作用。

THE RELATIONS OF SERUM HOMOTYPE CYSTEINE WITH URINE ALBUMIN AND INSULIN SENSITIVITY IN PATIENTS WITH DIABETES TYPE 2

Objective To study the relationship between fasting serum levels of homocysteine and urine albumin ,sensitivity of insulin in patients with type 2 diabetic nephropathy. Methods 98 cases with type 2 diabetic mellitus were subdivided into 4 groups according the level of urine albumin excretion rate,just group A(UAER<30 mg/24 h),group B (30 mg/24 h≤UAER<300 mg/24 h) and group C(UAER≥300 mg/24 h). 30 healthy cases were defined group CON. Hcy,FPG,FINS,HbA1c,UAER and insulin sensitivity index of every group were evaluated. Results The level of serum Hcy of A,B and C was significantly higher than that of group CON(p<0.05),and the level of serum Hcy among different UAER value in three groups of diabetic patients: group C higher than group A and B,group B higher than group A,the differences were significant(p<0.05). There was markedly positive correlation between Hcy and UAER and negative correlation between Hcy and ISI(p<0.01).Conclusion There was markedly positive correlation between Hcy and UAER in patients with type 2 DN,the high level of Hcy correlated with descending of sensitivity of insulin. To control the UAER and enhance sensitivity of insulin can regulate level of Hcy,then preventing the capillary complication of diabetes.