Saeed Bakri O, Nixon Stephen J, White Amanda J, Summerfield Geoffrey P, Skillen Andrew W, Weaver Jolanta U
Department of Clinical Biochemistry, Queen Elizabeth Hospital, Gateshead, UK.
Clin Chim Acta. 2004 Mar;341(1-2):27-32. doi: 10.1016/j.cccn.2003.10.034.
Whether hyperhomocysteinemia is associated with diabetic retinopathy is still being debated. We measured homocysteine and thrombomodulin, a marker of endothelial cell damage, in patients with type 1 diabetes mellitus and retinopathy (n=25) and in a well-matched group of diabetic patients without retinopathy (n=23). All patients had normal serum creatinine and no macroalbuminuria.
Fasting homocysteine levels were higher in the group with retinopathy than in the group without retinopathy (8.75+/-1.9 vs. 7.69+/-1.6 micromol/l, P<0.05). Microalbuminuria was more prevalent in the group with diabetic retinopathy and it correlated with homocysteine levels in this group (p<0.05). Microalbuminuria was the most powerful independent determinant of homocysteine levels in multiple regression analysis in the group with retinopathy (p<0.01). Thrombomodulin levels were not different in the two groups (36.6+/-9.7 vs. 34.9+/-11.1, p>0.1) and there was no correlation between homocysteine and thrombomodulin levels in either group.
The slight rise in homocysteine levels in patients with diabetic retinopathy was possibly caused by the early nephropathy as indicted by microalbuminuria. This small rise in homocysteine levels was not associated with endothelial dysfunction, as measured by serum thrombomodulin levels.
高同型半胱氨酸血症是否与糖尿病视网膜病变相关仍存在争议。我们检测了1型糖尿病合并视网膜病变患者（n = 25）及一组匹配良好的无视网膜病变糖尿病患者（n = 23）的同型半胱氨酸和内皮细胞损伤标志物血栓调节蛋白。所有患者血清肌酐均正常且无大量蛋白尿。
视网膜病变组的空腹同型半胱氨酸水平高于无视网膜病变组（8.75±1.9对7.69±1.6 μmol/l，P<0.05）。微量白蛋白尿在糖尿病视网膜病变组更常见，且与该组同型半胱氨酸水平相关（p<0.05）。在视网膜病变组的多元回归分析中，微量白蛋白尿是同型半胱氨酸水平最有力的独立决定因素（p<0.01）。两组的血栓调节蛋白水平无差异（36.6±9.7对34.9±11.1，p>0.1），且两组中同型半胱氨酸与血栓调节蛋白水平均无相关性。
糖尿病视网膜病变患者同型半胱氨酸水平的轻微升高可能是由微量白蛋白尿所提示的早期肾病所致。同型半胱氨酸水平的这种小幅升高与通过血清血栓调节蛋白水平所测量的内皮功能障碍无关。
