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目的探讨2型糖尿病患者(T2DM)血浆同型半胱氨酸(Hcy)水平、影响因素及其与糖尿病周围神经病变(DPN)的关系。方法对本院内分泌科近2年来住院的87例T2DM患者采用高效液相色谱法测定血浆Hcy,使用NicoletVikingIVD肌电图诱发电位仪测定胫神经和腓神经的运动传导速度,肌电图正常者为非DPN(A组,42例),神经电生理异常者为DPN(B组,45例),同时还检测了叶酸、维生素B12以及肾功能等各临床、生化参数,并检测了32名正常对照组人群的血浆Hcy。结果Hcy的水平在糖尿病组与对照组比较无显著差异(P>0.05)。B组与A组间年龄、收缩压(SBP)、舒张压(DBP)、BMI、FBG、GHbA1c、Cr、TG、TC、VitB12差异无统计学意义,但是,在病程、叶酸、血浆Hcy水平和高Hcy血症的发生率在DPN组显著升高。单因素分析中,Hcy与年龄(r=0.464,P<0.01)、SBP(r=0.223,P<0.05)、Cr(r=0.443,P<0.01)呈正相关,与VitB12(r=-0.225,P<0.05)、叶酸(r=-0.237,P<0.05)呈负相关,与病程、BMI、DBP、TG、TC、FBG、HbA1c、无明显相关(P>0.05)。以有无DPN为应变量进行多因素Logistic回归分析显示:Hcy、BMI、GHbA1c、叶酸与DPN的发生独立相关。与其余因素无显著相关。结论本组资料表明,患者的Hcy、叶酸与2型糖尿病周围神经病变的发生可能存在相关性。
Objective To investigate the plasma homocysteine (Hcy) level, its influencing factors and its relationship with diabetic peripheral neuropathy (DPN) in type 2 diabetic patients (T2DM). Methods Eighty-seven patients with T2DM who were hospitalized in the department of endocrinology in the past two years were enrolled in this study. Plasma Hcy was measured by HPLC. NicoletVikingIVD electromyography was used to measure the velocity of tibial nerve and peroneal nerve. Electromyography was normal Non-DPN (group A, n = 42) and neuroelectrophysiological abnormalities were DPN (group B, n = 45). The clinical and biochemical parameters such as folic acid, vitamin B12 and renal function were also examined and 32 normal controls Plasma Hcy in group. Results The level of Hcy was not significantly different between diabetic group and control group (P> 0.05). There were no significant differences in age, SBP, DBP, BMI, FBG, GHbA1c, Cr, TG, TC, VitB12 between group B and group A. However, The incidence of hyperhomocysteinemia was significantly higher in the DPN group. In univariate analysis, Hcy was positively correlated with age (r = 0.464, P <0.01), SBP (r = 0.223, P < (P <0.05), folic acid (r = -0.237, P <0.05) was negatively correlated with disease duration, BMI, DBP, TG, TC, FBG and HbA1c (P> 0.05). Multivariate logistic regression analysis with or without DPN showed that Hcy, BMI, GHbA1c and folic acid were independently associated with DPN. No significant correlation with other factors. Conclusion This group of data shows that patients with Hcy, folic acid and type 2 diabetic peripheral neuropathy may be related to the occurrence.