【作者】 邸蕴华；

【导师】 刘国良；

【作者基本信息】 中国医科大学 ， 内科学， 2004， 硕士

【摘要】 目的 血浆同型半胱氨酸(Homocysteine.Hcy)是一种含硫基非必需氨基酸，是蛋氨酸代谢的中间产物。近年研究显示Hcy是一种反映性血管损伤氨基酸，轻中度高Hcy血症被认为是心血管疾病的独立危险因素。2型糖尿病大血管病变是糖尿病致残、致死的主要原因。目前认为糖、脂代谢异常，以及血流动力学改变如高血压是糖尿病大血管病变的主要因素，而有关蛋白质、氨基酸代谢异常在糖尿病大血管病变中作用的研究较匮乏，本研究旨在探讨血浆同型半胱氨酸与2型糖尿病大血管病变间的关系。 方法 一、对象 本研究以健康成人、2型糖尿病患者、2型糖尿病伴大血管病变患者为研究对象，并分为以下三组： 1．健康对照组选择我院门诊体检的健康成人22名，其中男性12名，女性10名。无心、脑、肝、肾疾病。 2．2型糖尿病组共23例，均为我院住院或门诊的2型糖尿病患者，无心脑及外周血管病变。其中男性16例，女性7例。 3．2型糖尿病伴大血管并发症组31例，其中包括2型糖尿病伴冠心病、脑血管病变，外周血管病变。其中男性16例，女性15例。 所有研究对象在近6个月内，均未服用叶酸、VitB12、VitB6。 二、实验方法 本研究应用化学免疫分析法检测血浆Hcy浓度。 三、统计学方法 各组数据以(?)±s表示，两组间均数比较用t检验，组间均数用方差分析，组间率比较用χ2检验，双变量相关分析采用相关分析。所有统计过程用Spss10.0软件处理。飞.!’实·验结果 一、糖尿病各组一般情况和各项指标 各组在年龄、性别、体重指数、腰臀比、血压、肾功均无显著差异，具有可比性。糖尿病各组血浆Hcy高于正常对照组，有大血管病变组又高于无大血管病变组，P值均<0.05，具有统计学意义。以正常对照组血Hcy均值加2个标准差定义为高同型半胧氨酸血症(HHcy)的诊断标准，结果显示，糖尿病伴大血管并发症组HHcy发生率为61 .90%，明显高于正常对照组的4.55%和无大血管并发症组的21 .74%。 二、糖尿病正常Hcy组与高Hcy组的一般情况和各项指标 为了进一步探讨高Hcy血症对糖尿病大血管病变的影响，将糖尿病组分为高Hcy血症组和正常Hcy组。结果显示，两组在年龄、性别、病程、体重指数、吸烟率、血压、血糖、血脂均无显著差异，正常Hcy组的糖尿病大血管发生率为21.74%而高Hcy组的糖尿病大血管病变发生率为61.9%，是正常的2.85倍(61.9%比21.74%，P=0.012)具有统计学意义。 三、血浆Hc}r水平的多因素分析 以空腹血浆HCy水平为应变量，以年龄、病程、体重指数、腰臀比、血压、血脂、肾功、HBAIC、空腹及餐后两小时血糖、胰岛素、C肤为自变量进行多元逐步回归，结果显示血浆Hcy水平仅与空腹胰岛素及C肤呈正相关(r分别为0.516、0.409，P分别为0.000、0.002)与其它一般临床指标无明显相关性，说明空腹胰岛素水平是血Hcy的独立影响因素。 四、糖尿病大血管病变的危险因素 以糖尿病大血管病变作为应变量，以病程、血压、血脂、HBAlc、Hcy作为自变量，进行多元逐步logistic回归分析，结果显示TGP二0 .0犯，HcyP=0 .049，提示血浆Hcy水平增高与糖尿病大血管病变独立显著相关。结论1.空腹高Hcy血症与2型糖尿病大血管病变呈相关关系。2.2型糖尿病空腹胰岛素水平影响Hcy的浓度。更多还原

【Abstract】 Homocysteine ( Hcy) is a kind of non - essential amino acid having sulfate group. It is the intermediary metabolite of acimetion. Recent researches show that Hcy is a king of amino acid which may reflect the injure of blood vessels. Mild to moderate hyperhomocysteinemia has been thought to be an independent risk factor of cardiovascular diseases. The macroangopathy complication of type 2 diabete is the main cause of death and mutilation. At present, it is thought that the main factor of macroangopathy complication of diabete is abnormal metabolism of protein and lipid, hemodynamics alteration, for example hyperten-tion. But there are few research about the effect of abnormal metabolism of protein and amino acid on macroangopathy of diabete. Our research tend to study the correlation of plasma homocysteine ( Hcy ) and macroangopathy in type 2 diabetes.Methods1. Study objects;Group of healthy control: 22 healthy person from out-patient clinic (12 men and 10 women) , who didnt suffering from heart, brain, liver, kidney diseases.Group of type 2 diabetes: including 23 patients (16 men and 7 women) from in - patient or outpatient clinic, who were suffering from type 2 diabetes and without vascular complication of the heart, brain, or peripheral vessels.Group of type 2 diabetes with macroangopathy: 31 patients (16 men and 15 women) who were suffering from coronary heart disease, cerebrovascular lesion,or peripheral vascular diseases. All study objects didnt take folic acid, vitamin B12 vitamin B6 6 months before the experiment.2. Test methods:Plasma Hey levels were measured by medical immunoanalysi assay.3. statistical analysisExperimental data were dealt with SPSS 10. 0 statistical analysis software in order to describe and analyze the t test, analysis of variance, x2 test, and do the correlated analysis of data.Consequence1. General condition and the indexes of diabete group:there are no significant difference in age, sex, body mass index, waist - to - hip ratio, blood pressure and renal function. The plasma Hcy level of diabete group were significantly higher than the normal control, and the plasma Hcy level of the group who were suffering from macrpangopathy compliction were significantly higher than the group who didnt have the complication. The hyperhomo-cysteinemia ( Hhcy) is definited as mean value of Hcy of the normal control plus double standard deviation. The prevalence of Hhcy of the diabete group who had macroangopathy complication was 61.90% , significantly higher than the normal control(4. 55% ) and the diabete group who didnt having macroangopathy (21. 74% ).2. The general condition and indexes of diabete groups having normal Hcy or Hhcy.To study the effect of Hhcy on macroangopathy complication of diabete, we divided the diabete groups into Hhcy group and normal Hcy group. The two groups had no significant difference in age, sex, course of disease, body mass index, prevalence of smoking, blood sugar, blood lipid. The normal Hcy group had a prevalence of macroangopathy of 21.74% , while the Hhcy group 61.9% , just the 2. 85 timese of the normal control.3 Multiple factor analysis of plasma Hcy:Taking Hcy level as dependent variable and age, course of disease, bodymass index, waist - to - hip ratio, blood pressure, blood lipid, renal function, HB ALc, blood sugar of fast and 2 hours after eating, insulin, C peptide as independent variable, we took the multiple stepwise regression. Our result showed that Hcy only positively correlated with fasting insulin and C peptide ( r = 0. 516, 0.409 and p =0.000, 0.002 respectively). The result showed that fasting insulin level was an independent factor of Hcy.4. Risk factors of macroangopathy of diabetetaking macroangopathy complication of diabete as dependent variable and course of disease, blood pressure, blood lipid, HB Alc, Hey as independent variable, we did the mutiple stepwise regression. The result showed that TG P =0. 032, Hcy P =0. 049. It showed that plasma Hcy level in an independent fact更多还原