Total homocysteine is associated with nephropathy in non-insulin-dependent diabetes mellitus.
Total homocysteine is associated with nephropathy in non-insulin-dependent diabetes mellitus.
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DOI：
10.1016/s0026-0495(99)90121-x
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发表时间：
1999-09
期刊：
影响因子：
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通讯作者：
S. Stabler;R. Estacio;B. Jeffers;Jeffrey A. Cohen;R. Allen;R. Schrier
中科院分区：
文献类型：
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作者：
S. Stabler;R. Estacio;B. Jeffers;Jeffrey A. Cohen;R. Allen;R. Schrier
非胰岛素依赖型糖尿病(NIDDM)和高同型半胱氨酸血症都与早产儿血管疾病有关。我们验证了同型半胱氨酸与NIDDM患者的血管疾病和其他糖尿病并发症相关的假设。目前的研究是对适当的糖尿病血压控制(ABCD)试验参与者的基线变量进行横断面分析。年龄在40岁到74岁之间、平均舒张压(BP)在80毫米汞柱或以上的NIDDM患者的男性和女性都符合条件。我们测定了452名受试者的血清总同型半胱氨酸(THcy)、胱硫氨酸和甲基丙二酸(MMA)水平，并将这些值与糖尿病并发症的临床和其他实验室指标相关联。男性高于女性，且与高血压病程和收缩压相关。THcy与MMA(r=.35，P&t；.0001)、胱硫氨酸(r=.53，P&t；.0001)显著相关，与血清B12(r=.23，P&t；.0001)、叶酸(r=−.18，P&t；.0001)呈负相关。与血肌酐呈显著正相关(男性r=0.28，P<0.0001，女性r=0.39，P<0.0001)，与内生肌酐清除率呈负相关(男性r=0.19，P<0.005，女性r=−=0.30，P<0.0001)。THcy在心血管疾病和视网膜病变患者中未见升高，但在神经疾病患者(10.3vs9.3molol/L，P<；0.05)和大量白蛋白尿患者(11.0v9.2μmol/L，P<；.005)中升高。在这些受试者中，2.2%的人符合维生素B12缺乏的标准，1%的人符合叶酸缺乏的标准。我们的结论是，这一人群中tHcy的升高似乎是维生素缺乏和肾功能下降的共同结果，似乎不是心血管疾病的预测因素。
Non—insulin-dependent diabetes mellitus (NIDDM) and hyperhomocysteinemia are both associated with premature vascular disease. We tested the hypothesis that homocysteine is associated with vascular disease and other diabetic complications in patients with NIDDM. The current investigation is a cross-sectional analysis of baseline variables for participants in the Appropriate Blood Pressure Control in Diabetes (ABCD) Trial. Men and women aged 40 to 74 years with NIDDM and a mean diastolic blood pressure (BP) of 80 mm Hg or higher were eligible. We measured serum levels of total homocysteine (tHcy), cystathionine, and methylmalonic acid (MMA) and correlated these values with clinical and other laboratory measures of the complications of diabetes mellitus in 452 subjects. tHey was higher in males than in females and correlated with the duration of hypertension and systolic BP. tHcy was significantly correlated with MMA (r = .35, P < .0001) and cystathionine (r = .53, P < .0001) levels and inversely correlated with serum B12(r = −.23, P < .0001) and folate (r = −.18, P < .0001). It was significantly correlated with serum creatinine (r = .28, P < .0001 for males and r = .39, P < .0001 for females) and inversely correlated with creatinine clearance (r = −.19, P < .005 for males and r = −.30, P < .0001 for females). tHcy was not increased in subjects with cardiovascular disease or retinopathy, but it was increased in those with neuropathy (10.3 v 9.3 μmol/L, P < .05) and macroalbuminuria (11.0 v 9.2 μmol/L, P < .005). Of these subjects, 2.2% met the criteria for vitamin B12deficiency and 1% met the criteria for folate deficiency. We conclude that elevations of tHcy in this population appear to be the result of a combination of vitamin deficiency and decreased renal function and do not appear to be a predictor of cardiovascular disease.