Aydin E, Demir H D, Ozyurt H, Etikan I
Department of Ophthalmology, Gaziosmanpasa University Faculty of Medicine, Tokat, Turkey.
Eur J Ophthalmol. 2008 Mar-Apr;18(2):226-32. doi: 10.1177/112067210801800210.
The aim of this study was to assess the association of macular edema (ME) with plasma homocysteine, vitamin B6, vitamin B12, and folic acid levels in patients with Type 2 diabetes.
Sixty-five diabetic subjects with no retinopathy and nonproliferative diabetic retinopathy (NPDR) (no DR, without ME, with ME: 16, 25, 24, respectively), 28 with proliferative diabetic retinopathy (PDR) (with and without ME: 14, 14, respectively), and 19 healthy subjects as control were recruited in this cross-sectional study. Plasma homocysteine, vitamin B12, vitamin B6, and folate levels were determined after 8-hour of fasting for all subjects. The levels of serum homocysteine and vitamin B6 were measured using high performance liquid chromatography (HPLC) with fluorescence detection, and the levels of serum vitamin B12 and folic acid were measured by electrochemiluminescence immunoassay.
When diabetic groups with ME were compared with diabetic groups without ME for homocysteine, vitamin B12, vitamin B6, and folic acid, the only significant difference was detected in homocysteine levels (p=0.001). There was no significant difference between NPDR with ME group compared with NPDR without ME group and no DR group for plasma homocysteine, vitamin B12, vitamin B6, and folic acid (p=0.200, p=0.660; p=0.999, p=0.678; p=1.0, p=0.248; p=1.0, p=0.982, respectively). On the other hand, when PDR with ME group was compared with PDR without ME group, there was only significant difference in homocysteine levels (p=0.023).
Mild to moderate elevation of homocysteine may explain the role of vascular dysregulation and endothelial dysfunction in patients with DR. The present study suggests hyperhomocysteinemia may be one of the crucial risk factors for development of ME.
本研究旨在评估2型糖尿病患者黄斑水肿（ME）与血浆同型半胱氨酸、维生素B6、维生素B12和叶酸水平之间的关联。
在这项横断面研究中，招募了65名无视网膜病变和非增殖性糖尿病视网膜病变（NPDR）的糖尿病患者（无糖尿病视网膜病变、无ME、有ME的患者分别为16例、25例、24例），28例增殖性糖尿病视网膜病变（PDR）患者（有和无ME的患者分别为14例、14例），以及19名健康受试者作为对照。所有受试者在禁食8小时后测定血浆同型半胱氨酸、维生素B12、维生素B6和叶酸水平。血清同型半胱氨酸和维生素B6水平采用带荧光检测的高效液相色谱法（HPLC）测定，血清维生素B12和叶酸水平采用电化学发光免疫分析法测定。
将有ME的糖尿病组与无ME的糖尿病组在同型半胱氨酸、维生素B12、维生素B6和叶酸方面进行比较时，仅在同型半胱氨酸水平上检测到显著差异（p = 0.001）。NPDR合并ME组与NPDR不合并ME组以及无糖尿病视网膜病变组在血浆同型半胱氨酸、维生素B12、维生素B6和叶酸方面无显著差异（p分别为0.200、0.660；0.999、0.678；1.0、0.248；1.0、0.982）。另一方面，将PDR合并ME组与PDR不合并ME组进行比较时，仅在同型半胱氨酸水平上存在显著差异（p = 0.023）。
同型半胱氨酸的轻度至中度升高可能解释了血管调节异常和内皮功能障碍在糖尿病视网膜病变患者中的作用。本研究表明高同型半胱氨酸血症可能是ME发生的关键危险因素之一。
