Total homocysteine levels relation with chronic complications of diabetes, body composition, and other cardiovascular risk factors in a population of patients with diabetes mellitus type 2
Total homocysteine levels relation with chronic complications of diabetes, body composition, and other cardiovascular risk factors in a population of patients with diabetes mellitus type 2
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DOI：
10.1016/j.jdiacomp.2003.12.003
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发表时间：
2005-01-01
影响因子：
3
通讯作者：
Romero, E
中科院分区：
文献类型：
--
作者：
de Luis, DA;Fernandez, N;Romero, E
目的：高同型半胱氨酸血症在2型糖尿病中的意义因考虑肾功能受损和维生素状况的多种方式而进一步复杂化。本研究的目的是分析2型糖尿病患者人群中总同型半胱氨酸（tHcy）与慢性并发症的关系。同时分析tHcy与患者身体成分及其他心血管危险因素的关系。设计图：在一项横断面研究中，共有155名糖尿病患者参加了我们的糖尿病服务（90名女性/65名男性）连续入组。材料与方法：所有入选患者均接受以下检查：（i）生化心血管风险因素，包括总胆固醇、甘油三酯、脂蛋白（a）、低密度脂蛋白（LDL-胆固醇）、高密度脂蛋白（HDL-胆固醇）、葡萄糖、HbA（1c）、纤维蛋白原、同型半胱氨酸、维生素B12、叶酸和微量白蛋白尿。和（ii）通过身体质量指数、体重、脂肪质量百分比和躯干皮褶评估的脂肪质量。结果：患者分为两组（I组：tHcy ≥ 15 mumol/l; II组：tHcy < 15 mumol/l）。两组的吸烟习惯相似。脑血管意外的患病率在总组中为3.3%。两组的患病率无差异（7.4% vs. 2.3%; ns）（OR 3.3; 95% CI 0.49-19.68）。总组的冠心病患病率为5.8%，组间无统计学差异（3.5% vs. 6.3%; ns）（OR 0.57; 95% CI 0.065-4.53）。关于大血管并发症，仅外周血管疾病患病率在I组中较高（16% vs. 3.1%; P < 0.05; OR 5.33; 95% CI 1.18-21.5）。I组中肾病的患病率较高（93.3% vs. 12.8%; P < 0.05; OR 7.15; 95% CI 2.9-17.9）。视网膜病变患病率无统计学差异（全球组41.9%）（42.5% vs. 40.9%，ns）（OR 1.75; 95% CI 0.78-3.9）。此外，两组的周围神经病变相似（7.1% vs. 6.5%; ns）（OR 1.1; 95% CI 0.15-8.2）。同型半胱氨酸与人体测量参数（体重指数、体重、脂肪量百分比、Pat质量和躯干皮褶厚度）之间未检测到相关性。在第I组中检测到纤维蛋白原、脂蛋白（a）、微量白蛋白尿和血压水平升高。结论：本研究表明，2型糖尿病患者血浆tHcy水平升高与外周动脉病变和肾病的患病率较高相关。我们的数据表明，高同型半胱氨酸血症与脂肪量无关，但与高水平的纤维蛋白原、脂蛋白（a）、微量白蛋白尿和血压水平有关。(C)2005年爱思唯尔公司All rights reserved.
Objective: The significance of hyperhomocysteinemia in type 2 diabetes is further complicated by the multiple ways of considering impaired renal function and vitamin status. The aim of our study was to analyze the relationship between total homocysteine (tHcy) in a population of type 2 diabetic patients and chronic complications. We also analyzed the relationship between tHcy and the body composition of these patients and other cardiovascular risk factors. Design: In a cross-sectional study, a total of 155 patients with diabetes mellitus attending in our diabetes service (90 females/65 males) were enrolled in a consecutive way. Material and methods: All enrolled patients underwent the following examinations; (i) biochemical cardiovascular risk factors including total cholesterol, triglyceride, lipoprotein (a), low-density lipoprotein (LDL-cholesterol), high-density lipoprotein (HDL-cholesterol), glucose, HbA(1c), fibrinogen, homocysteine, vitamin B12, folate, and microalbuminuria. and (ii) fat mass assessed by body mass index, weight, percentage of fat mass, and tricipital skinfold. Results: Patients were divided in two groups (Group I: tHcy greater than or equal to 15 mumol/l; Group II: tHcy < 15 mumol/l). Smoking habit was similar in both groups. A prevalence of cerebrovascular accident was present in 3.3% in the total group. This prevalence was not different in both groups (7.4% vs. 2.3%; ns) (OR 3.3; 95% CI 0.49-19.68). The prevalence of coronary heart disease in the total group was 5.8% without statistical differences between groups (3.5% vs. 6.3%; ns) (OR 0.57; 95% CI 0.065-4.53). Concerning macrovascular complications, only peripheral vascular disease prevalence was higher in Group I (16% vs. 3.1%; P < 0.05; OR 5.33; 95% CI 1.18-21.5). A prevalence of nephropathy was higher in Group I (93.3% vs. 12.8%; P < 0.05; OR 7.15; 95% CI 2.9-17.9). No statistical differences were detected in prevalence of retinopathy (global group 41.9%) (42.5% vs. 40.9%, ns) (OR 1.75; 95% CI 0.78-3.9). Also, peripheral neuropathy was similar in both groups (7.1% vs. 6.5%; ns) (OR 1.1; 95% CI 0.15-8.2). No correlation was detected among homocysteine and anthropometric parameters (body mass index, weight, percentage of fat mass, Pat mass, and tricipital skinfold). Elevated levels of fibrinogen, lipoprotein (a), microalbuminuria, and blood pressure were detected in Group I. Conclusion: The present study shows that elevation of plasma tHcy levels in type 2 diabetic patients is associated with a higher prevalence of peripheral arteriopathy and nephropathy. Our data suggest that hyperhomocysteinemia is not associated with fat mass but it is associated with high levels of fibrinogen, lipoprotein (a), microalbuminuria, and blood pressure levels. (C) 2005 Elsevier Inc. All rights reserved.