2型糖尿病患者血浆同型半胱氨酸水平及相关因素分析

刘湘茹 李玥 杨斌 冯耀然 梁勇前

[摘要]目的 探討2型糖尿病患者血浆同型半胱氨酸（Hcy）水平及其相关影响因素。方法 选取2016年8月～2017年10月我院收治的150例2型糖尿病患者作为2型糖尿病组，并以同期进行健康体检的60例健康者作为对照组。2型糖尿病组患者根据Hcy是否大于15 μmol/L分为两组，分别为高Hcy组（n=62，Hcy>15 μmol/L）和正常Hcy组（n=88，Hcy≤15 μmol/L）。比较两组受试者Hcy、身体测量指标、血糖、胰岛素、肌酐、血脂、尿酸等水平的差异，并采用多因素Logistic回归分析，探讨2型糖尿病患者血浆Hcy水平的影响因素。结果 2型糖尿病组患者的BMI、尿酸、Hcy、FPG、2 h PG、HOMA-IR、肌酐高于对照组，差异均有统计学意义（P<0.05）。高Hcy组患者的男性比例、年龄、尿酸、HOMA-IR、肌酐水平均显著高于正常Hcy组，差异均有统计学意义（P<0.05）。Logistic回归分析结果显示，2型糖尿病患者中，男性、血尿酸、HOMA-IR是发生高Hcy血症的危险因素（P<0.05）。结论 2型糖尿病患者血浆Hcy水平显著高于健康者，性别、血尿酸、胰岛素抵抗水平均为2型糖尿病患者发生高Hcy血症的危险因素。

[关键词]2型糖尿病；同型半胱氨酸；相关因素分析

[中图分类号] R543.5 [文献标识码] A [文章编号] 1674-4721（2018）5（b）-0057-03

Analysis of plasma homocysteine level and related factors in patients with type 2 diabetes

LIU Xiang-ru1 LI Yue1 YANG Bin2 FENG Yao-ran1 LIANG Yong-qian1

1.Department of Endocrine Medicine，Shunde Hospital of Southern Medical University （the First People′s Hospital of Shunde District in Foshan City），Guangdong Province，Foshan 528300，China；2.Department of Rheumatology and Immunology Medicine，Shunde Hospital of Southern Medical University （the First People′s Hospital of Shunde District in Foshan City），Guangdong Province，Foshan 528300，China

[Abstract]Objective To investigate the level of plasma homocysteine （Hcy） and its related factors in patients with type 2 diabetes.Methods A total of 150 patients with type 2 diabetes treated in our hospital from August 2016 to October 2017 were selected as type 2 diabetes group，and 60 healthy persons underwent physical examination in the same period were selected as the control group.The patients in type 2 diabetes group were divided into two groups according to whether Hcy was greater than 15 μmol/L，for the high Hcy group （n=62，Hcy>15 μmol/L） and the normal Hcy group （n=88，Hcy≤15 μmol/L）.The difference of Hcy，body measurement，plasma glucose，insulin，serum creatinine，blood lipid and uric acid were compared between the two groups.The influencing factors of plasma Hcy level in patients with type 2 diabetes were analyzed by multivariate Logistic regression analysis.Results The BMI，uric acid，Hcy，FPG，2 h PG，HOMA-IR and creatinine in type 2 diabetes group were higher than those in the control group，the differences were statistically significant （P<0.05）.The male proportion，age，uric acid，HOMA-IR and creatinine levels of the patients in the high Hcy group were significantly higher than those in the normal Hcy group，and the differences were statistically significant （P<0.05）.Logistic regression analysis showed that in patients with type 2 diabetes，male，blood uric acid and HOMA-IR were risk factors for high Hcy hyperlipidemia （P<0.05）.Conclusion Plasma Hcy level in patients with type 2 diabetes is significantly higher than healthy person.Male，blood uric acid and insulin resistance are risk factors for high Hcy hyperlipidemia in patients with type 2 diabetes.

[Key words]Type 2 diabetes；Homocysteine；Realated factors analysis

大量研究证实同型半胱氨酸（homocysteine，Hcy）是心血管疾病的独立危险因素[1-2]，而2型糖尿病患者的血浆Hcy水平高于非糖尿病患者[3]。当前我国患2型糖尿病的人数已超过1亿[4]，了解2型糖尿病患者中Hcy的影响因素，是对其进行针对性干预、降低患者心血管发生风险的基础。因此，本研究通过开展队列研究，探讨2型糖尿病患者的Hcy水平并分析其影响因素，现报道如下。

1资料与方法

1.1一般资料

选取2016年8月～2017年10月我院收治的150例2型糖尿病患者作为2型糖尿病组，所有患者均根据WHO糖尿病诊断及分型标准确定诊断[5]。排除标准：①糖尿病急性代谢并发症患者；②存在显性蛋白尿（>0.15 g/d）及肌酐升高患者；③近期服用维生素B6、B12、叶酸等影响Hcy水平的药物者；④患有甲状腺机能亢进、恶性肿瘤及其他影响尿酸代谢疾病的患者。并……