摘要
目的探讨血清同型半胱氨酸(Hcy)水平与2型糖尿病周围神经病变(DPN)的关系。方法188例2型糖尿病患者,通过症状、体征、量表评分、电生理检查及自主神经功能检测,诊断为DPN101例,根据罗切斯特糖尿病神经病变研究项目(RDNS)将DPN按程度分级为N1、N2、N3级。取受检者空腹静脉血测定血清Hcy、叶酸、VitB12、血脂及肾功能水平,比较分析各组Hcy水平与其他生化指标的差异。结果DPN组较非DPN组高Hcy血症发生率显著增高,分别为60%和44%(P=0.001);DPN组Hcy水平显著高于非DPN组,分别为(21±14)μmol/L和(15±8)μmol/L(P=0.001);随着DPN严重程度增加,血Hcy水平也逐渐增高,而叶酸、VitB12水平逐渐降低,差异有统计学意义;logistic回归显示高Hcy血症、病程、HbA1c、叶酸与DPN严重程度相关,Hcy水平每增加1mmol/L则OR为1.518,95%可信区间为(0.417～4.601),P=0.026;同样,高Hcy血症组DPN发生率较正常组高,分别为60%和40%(P=0.022)。结论高Hcy血症是DPN的危险因素,病程、HbA1c、叶酸也与DPN严重程度相关。
Objective To investigate the relationship between serum level of total homocysteine （Hcy）and peripheral neuropathy in patients with type 2 diabetes（DPN）. Methods A total of 188 type 2 diabetic patients were consecutively enrolled into the study. Among them, 103 patients were diagnosed as DPN according to clinical symptoms, neurological examination, rating scale, electrophysiological sensory testing, and autonomic function testing. They were graded into N1, N2, and N3 stages based on the staged severity in the Rochester diabetic neuropathy study （RDNS）. The serum levels of tHcy, folate, vitamin B12, and lipid, as well as renal function were detected and analyzed among the different groups. Results Homocysteine levels and the frequency of hyperhomocysteinemia were significantly higher in neuropathic patients than in non-neuropathic patients （P = 0. 001）. With the increase of DPN severity, the serum tHcy was increased but the levels of folate and vitamin B12 were decreased significantly. In a logistic regression model using DPN as a dependent variable, hyperhomo- cysteinemia as well as duration of diabetes, levels of HbA1c and folate were significantly associated with the severity of DPN, with odds ratio of 1. 518 （95% confidence interval 0. 417-4. 601, P= 0. 026） for homocysteine per 1 mmol/L increase. In addition, the frequency of DPN was higher in the hyperhomocysteinemia group than in the normo-homocysteinemia group （P=0. 022）. Conclusions Hyperhomocysteinemia is a risk factor for diabetic neuropathy in type 2 diabetic patients. The duration of diabetes, the levels of HbA1c, and folate level are also associated with diabetic neuropathy.
出处
《中国糖尿病杂志》
CAS
CSCD
北大核心
2007年第5期299-302,共4页
Chinese Journal of Diabetes
基金
国家973计划项目(G20000569)子课题基金资助
