胰岛素抵抗和肾病对2型糖尿病患者同型半胱氨酸水平的影响。

Impact of insulin resistance and nephropathy on homocysteine in type 2 diabetes.

作者信息

Emoto M, Kanda H, Shoji T, Kawagishi T, Komatsu M, Mori K, Tahara H, Ishimura E, Inaba M, Okuno Y, Nishizawa Y

机构信息

Second Department of Internal Medicine, Institute of Geriatrics and Medical Science, Osaka City University Medical School, Japan.

出版信息

Diabetes Care. 2001 Mar;24(3):533-8. doi: 10.2337/diacare.24.3.533.

DOI:10.2337/diacare.24.3.533

PMID:11289481

Abstract

OBJECTIVE

To assess the impacts of insulin resistance and renal function on plasma total homocysteine (tHcy) levels in patients with type 2 diabetes with a wide range of nephropathy.

RESEARCH DESIGN AND METHODS

Plasma tHcy levels were measured using the enzyme immunoassay method in 75 patients with type 2 diabetes and compared with those in 54 healthy control subjects. Insulin sensitivity indexes were assessed in patients with type 2 diabetes by hyperinsulinemic-euglycemic clamp using artificial pancreas.

RESULTS

Plasma tHcy levels and their log-translormed values (log tHcy) were significantly higher in all patients with diabetes than in control subjects (tHcy, 12.0 +/- 0.7 [SE] vs. 8.7 +/- 0.3 micromol/l, P < 0.0001; log tHcy, 1.040 +/- 0.021 vs. 0.920 +/- 0.016 micromol/l, P < 0.0001). Plasma tHcy levels in patients with diabetes were significantly increased according to degree of nephropathy (P < 0.0001). On simple regression analyses, log tHcy correlated with insulin sensitivity indexes (r = -0.319, P = 0.005) as well as creatinine clearance (r = 0.634, P < 0.0001) in all patients with diabetes. Multiple regression analyses showed that insulin sensitivity indexes (beta = -0.245) as well as creatinine clearance were independent contributors to log tHcy in all patients with diabetes (R2 = 0.750, P < 0.0001). For the 59 patients with diabetes with creatinine clearance >60 ml/min, insulin sensitivity indexes were also shown to be a significant contributor to log tHcy (beta = -0.438, R2 = 0.561, P < 0.001).

CONCLUSION

Insulin resistance and renal function are independent determinants of tHcy levels in patients with type 2 diabetes.

摘要

目的

评估胰岛素抵抗和肾功能对患有广泛肾病的2型糖尿病患者血浆总同型半胱氨酸（tHcy）水平的影响。

研究设计与方法

采用酶免疫分析法测定75例2型糖尿病患者的血浆tHcy水平，并与54例健康对照者的水平进行比较。通过使用人工胰腺的高胰岛素-正常血糖钳夹技术评估2型糖尿病患者的胰岛素敏感性指数。

结果

所有糖尿病患者的血浆tHcy水平及其对数转换值（log tHcy）均显著高于对照组（tHcy，12.0±0.7[标准误]对8.7±0.3微摩尔/升，P<0.0001；log tHcy，1.040±0.021对0.920±0.016微摩尔/升，P<0.0001）。糖尿病患者的血浆tHcy水平根据肾病程度显著升高（P<0.0001）。在简单回归分析中，log tHcy与所有糖尿病患者的胰岛素敏感性指数（r=-0.319，P=0.005）以及肌酐清除率（r=0.634，P<0.0001）相关。多元回归分析显示，胰岛素敏感性指数（β=-0.245）以及肌酐清除率是所有糖尿病患者log tHcy的独立影响因素（R2=0.750，P<0.0001）。对于59例肌酐清除率>60毫升/分钟的糖尿病患者，胰岛素敏感性指数也是log tHcy的一个重要影响因素（β=-0.438，R2=0.561，P<0.001）。