伴微量白蛋白尿的初诊2型糖尿病患者血浆同型半胱氨酸水平及影响因素

目的]探讨伴有微量白蛋白尿的初诊2型糖尿病（T2DM）患者血浆同型半胱氨酸（Hcy）水平的变化及相关影响因素.方法]本院初诊T2DM患者66例,按24小时尿白蛋白排泄率（24hUAE）分为单纯糖尿病组（DM组）34例,糖尿病伴微量白蛋白尿组（DM＋UAE组） 32例,同期50例健康体检者为正常对照组（NC组）.比较三组间体重指数（BMI）、血压（Bp）、血糖（FBG及2hPPG）、血脂（TG、TC、LDL、HDL）、糖化血红蛋白（HbAlc）、血清C肽水平（空腹及2小时C肽）、C-反应蛋白（CRP）、Hcy的差异,并分析其与24hUAE之间的关系.结果]①DM组和DM＋UAE组中Hcy、FBG、2hPPG、HbAlc、TG、TC 、空腹及2小时C肽、CRP均明显高于正常对照组（P〈0.05）,DM＋UAER组Hcy、FBG、2hPPG、HbAlc显著高于DM组（P〈0.05）.②Pearson相关分析显示：24hUAE与血浆Hcy成正相关（r=0.612,P〈0.05）;Hcy与CRP呈正相关（r=0.704,P〈0.05）,与FBG、2hPPG 、HbAlc均无相关.结论]Hcy可能是初诊2型糖尿病出现微量白蛋白尿的原因之一,可能是通过激发氧化应激过程导致早期患者的肾小球内皮细胞损伤.

Level of Plasma Homocysteine in Newly Diagnosed Type 2 Diabetic Patients with Microalbuminuria and Its Influential Factors

Objective] To explore the change of plasma homocysteine in newly diagnosed type 2 diabetic patients with microalbuminuria and its influential factors. Methods] According to quantitative 24-hour urine microalbumin（24hUAE）, 66 newly diagnosed patients with type 2 diabetes mellitus（T2DM） in our hospital were divided into simple diabetes mellitus group（DM group, n = 34） and diabetes mellitus with microalbumin uria group（DM＋ UAE group, n= 32）. At the same time, 50 healthy subjects were selected as normal control group（NC group）. Body mass index（BMI）, blood pressure（Bp）, blood glucose（FBG and 2hPPG）, lipids （TG, TC, LDL, HDL）, glycosylated hemoglobin（HbAlc）, serum C-peptide（fasting and 2h C-peptide）, C reactive protein（CRP） and plasma homocysteine （Hcy） were compared among 3 groups. Their relationship with 24hUAE was analyzed. Results] The levels of Hcy, FBG, 2hPPG, HbAlc, TG, TC, fasting and 2h C- peptide and CRP in DM group and （DM＋UAE） group were significantly higher than those in control group （ P〈0.05）. The levels of Hcy, FBG, 2hPPG and HbAlc in DM＋UAE group were significantly higher than those in DM group（ P〈0. 05）. Pearson correlation analysis showed that 24hUAE was positively correlated with plasma Hcy（r=0. 612, P〈0.05）. The level of Hcy was positively correlated with CRP（r=0. 704,P〈0.05）. The levels of FBG, 2hPPG and HbAlc had no significant correlation with Hcy. Conclusion] Hcy may be one of the reasons that newly diagnosed T2DM patients have microalbuminuria. And it may stimulate oxida-tive slress to early damage glomerular endothelial cells in newly diagnosed T2DM.