Shargorodsky M, Boaz M, Pasternak S, Hanah R, Matas Z, Fux A, Beigel Y, Mashavi M
Department of Endocrinology, Wolfson Medical Center, Tel Aviv, Israel.
Diabetes Metab Res Rev. 2009 Jan;25(1):70-5. doi: 10.1002/dmrr.902.
Hyperhomocystinaemia is associated with macro- and microangiopathic diabetic complications. However, the role of homocysteine (Hcy), serum folate, and vitamin B12 level in the development of premature vascular damage in type 2 diabetic patients is not clear. The present study was designed to assess the relationship between total Hcy, folate, and vitamin B12 levels and arterial stiffness, an early marker of generalized atherosclerosis.
As many as 86 subjects with type 2 diabetes mellitus were studied. All participants were evaluated for glucose, HbA(1C), lipid profile, hs-CRP, endothelin, Hcy, vitamin B12, and folate. Pulse wave velocity (PWV) and augmentation index (AI) were performed as a non-invasive recording and computer analysis of the two artery sites pressure waveform using SphygmoCor (version 7.1, AtCor Medical, Sydney, Australia).
Hcy was significantly positively associated with age, serum creatinine, and vitamin B12 levels. No association between Hcy and folate was observed. The Hcy concentration was significantly positively associated with PWV (r = 0.540, p < 0.0001) and AI (r = 0.390, p < 0.0001). In a general linear model of PWV, Hcy emerged as an independent predictor of PWV even after controlling for age, creatinine, vitamin B12, and folate levels. In a multiple linear regression analysis, the association between Hcy and arterial stiffness was independent of traditional cardiovascular risk factors. Vitamin B12 levels were significantly inversely associated with tHcy (r = - 0.263, p = 0.015) and marginally associated with PWV(r = - 0.212, p = 0.052). Significant associations between folate levels and PWV were not detected.
The results lend support to the hypothesis that elevated Hcy may have a key role in the development of atherogenesis in diabetic patients. Additionally, vitamin B12 is significantly associated with tHcy concentrations and is identified as a marginally independent correlate of PWV in diabetic patients in the absence of folate deficiency.
高同型半胱氨酸血症与糖尿病大血管及微血管并发症相关。然而，同型半胱氨酸（Hcy）、血清叶酸和维生素B12水平在2型糖尿病患者过早发生血管损伤过程中的作用尚不清楚。本研究旨在评估总Hcy、叶酸和维生素B12水平与动脉僵硬度（全身动脉粥样硬化的早期标志物）之间的关系。
对86例2型糖尿病患者进行研究。对所有参与者进行血糖、糖化血红蛋白（HbA1C）、血脂谱、高敏C反应蛋白（hs-CRP）、内皮素、Hcy、维生素B12和叶酸的评估。使用SphygmoCor（版本7.1，AtCor Medical，悉尼，澳大利亚）对两个动脉部位的压力波形进行无创记录和计算机分析，测量脉搏波速度（PWV）和增强指数（AI）。
Hcy与年龄、血清肌酐和维生素B12水平显著正相关。未观察到Hcy与叶酸之间存在关联。Hcy浓度与PWV（r = 0.540，p < 0.0001）和AI（r = 0.390，p < 0.0001）显著正相关。在PWV的一般线性模型中，即使在控制了年龄、肌酐、维生素B12和叶酸水平后，Hcy仍是PWV的独立预测因子。在多元线性回归分析中，Hcy与动脉僵硬度之间的关联独立于传统心血管危险因素。维生素B12水平与总Hcy显著负相关（r = - 0.263，p = 0.015），与PWV呈边缘性相关（r = - 0.212，p = 0.052）。未检测到叶酸水平与PWV之间存在显著关联。
这些结果支持了以下假设，即升高的Hcy可能在糖尿病患者动脉粥样硬化的发生发展中起关键作用。此外，在没有叶酸缺乏的情况下，维生素B12与总Hcy浓度显著相关，并被确定为糖尿病患者PWV的边缘性独立相关因素。
