Chiarelli F, Pomilio M, Mohn A, Tumini S, Vanelli M, Morgese G, Spagnoli A, Verrotti A
Department of Medicine, Division of Pediatrics, University of Chieti, Chieti, Italy.
J Pediatr. 2000 Sep;137(3):386-92. doi: 10.1067/mpd.2000.108103.
To assess plasma homocysteine levels in adolescents and young adults with type 1 (insulin-dependent) diabetes with and without microvascular complications.
Homocysteine levels were measured during fasting and after methionine loading in plasma of 61 patients with onset of diabetes before the age of 12 years and duration of disease longer than 7 years. They had an albumin excretion rate (AER) between 20 and 200 microg/min in 2 of 3 overnight urine collections in a period of 6 months and/or retinopathy. Patients with persistent microalbuminuria were divided into 2 groups: subjects with AER of 20 to 70 microg/min and patients with AER of 70 to 200 microg/min. Adolescents (n = 54) without signs of diabetic retinopathy or nephropathy and matched control subjects (n = 63) were also studied.
Homocysteine concentrations before and after methionine load were higher in adolescents with diabetic complications than in healthy subjects (fasting values: 12. 4 +/- 7.9 micromol/L vs 7.8 +/- 4.2 micromol/L; P <.01; after methionine load: 28.1 +/- 13.2 micromol/L vs 16.6 +/- 7.3 micromol/L; P <.005). Values of 11.9 micromol/L or higher were considered to constitute fasting hyperhomocysteinemia. The increase of homocysteine concentrations was particularly evident in young diabetic patients with AER >70 microg/min (fasting values: 14.7 +/- 5.6 micromol/L; after methionine load: 34.2 +/- 12.6 micromol/L) and in patients with proliferative retinopathy (fasting values: 15.1 +/- 5.0 micromol/L; after methionine load: 36.8 +/- 12.5 micromol/L).
Increased plasma homocysteine concentrations may contribute to increased morbidity and death from cardiovascular disease in adolescents and young adults with diabetic retinopathy and nephropathy.
评估患有和未患有微血管并发症的1型（胰岛素依赖型）糖尿病青少年及青年的血浆同型半胱氨酸水平。
对61例12岁前发病且病程超过7年的糖尿病患者，在空腹及蛋氨酸负荷后测定其血浆同型半胱氨酸水平。在6个月期间的3次过夜尿液收集样本中，有2次白蛋白排泄率（AER）在20至200微克/分钟之间和/或患有视网膜病变。持续性微量白蛋白尿患者被分为2组：AER为20至70微克/分钟的受试者和AER为70至200微克/分钟的患者。还对无糖尿病视网膜病变或肾病迹象的青少年（n = 54）及匹配的对照受试者（n = 63）进行了研究。
患有糖尿病并发症的青少年在蛋氨酸负荷前后的同型半胱氨酸浓度高于健康受试者（空腹值：12.4±7.9微摩尔/升对7.8±4.2微摩尔/升；P <.01；蛋氨酸负荷后：28.1±13.2微摩尔/升对16.6±7.3微摩尔/升；P <.005）。11.9微摩尔/升或更高的值被认为构成空腹高同型半胱氨酸血症。同型半胱氨酸浓度的升高在AER>70微克/分钟的年轻糖尿病患者（空腹值：14.7±5.6微摩尔/升；蛋氨酸负荷后：34.2±12.6微摩尔/升）和增殖性视网膜病变患者（空腹值：15.1±5.0微摩尔/升；蛋氨酸负荷后：36.8±12.5微摩尔/升）中尤为明显。
血浆同型半胱氨酸浓度升高可能导致患有糖尿病视网膜病变和肾病的青少年及青年心血管疾病发病率和死亡率增加。
