Department of Endocrinology and Metabolic Diseases, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China; Department of Endocrinology and Metabolic Diseases, Affiliated Hospital of Nantong University, Nantong, China.
Department of Endocrinology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Ann Palliat Med. 2021 Jul;10(7):8169-8179. doi: 10.21037/apm-21-1671.
This study sought to investigate the association between plasma homocysteine (HCY) levels and pancreatic islet beta-cell function in type 2 diabetes mellitus (T2DM) patients.
430 hospitalized T2DM patients were enrolled in this cross-sectional study from December 2013 to December 2016. All participants were requested to complete a detailed questionnaire and undergo anthropometric measurements. Blood samples were collected from all participants. A 75-g oral glucose tolerance test (OGTT) was performed to diagnose T2DM in each individual, and an insulin releasing test (IRT) was used to calculate selected parameters for glucose, insulin, and C-peptide. Linear correlation and multivariate regression analyses were performed to assess the association between serum HCY concentration and these parameters.
Patients were divided into the following subgroups based on quartiles of serum HCY levels: Group Q1: <17.03 µmol/L; Group Q2: 17.03-19.50 µmol/L; Group Q3: 19.5-24.7 µmol/L; and Group Q4: >24.7 µmol/L. The levels of fasting blood glucose (FBG), 2 h postprandial blood glucose (2hPBG), glycated hemoglobin A1c (HbA1c), fasting C-peptide and fasting insulin increased significantly as HCY levels increased (P<0.05). The area under the curves (AUCs) of serum glucose and insulin in IRT increased significantly and that of serum C-peptide decreased as HCY levels increased (P<0.05). The levels of Homeostasis Model Assessment-β (HOMA-β), Modified Beta-cell function Index (MBCI), Disposal Index (DI), C-peptide immunoreactivity (CPR), Insulinogenic Index 30 (IGI 30), and Secretory Units of Islets in Transplantation (SUIT) decreased as HCY levels increased. An inverse linear correlation was found between HOMA-β, MBCI, DI, CPR, IGI 30, SUIT 0 h, and HCY plasma concentration (R2, 0.539, 0.569, 0.500, 0.676, 0.579, and 0.588, respectively; P<0.001), and this association was independent of many confounders, such as age, gender, body mass index, glucose and insulin levels, and HbA1c.
Serum HCY levels were inversely related to the parameters for pancreatic islet beta-cell function. Thus, the insulin releasing function of beta cells in the pancreas can be well elucidated by plasma HCY concentration.
本研究旨在探讨 2 型糖尿病（T2DM）患者血浆同型半胱氨酸（HCY）水平与胰岛β细胞功能之间的关系。
本横断面研究于 2013 年 12 月至 2016 年 12 月期间纳入了 430 名住院 T2DM 患者。所有参与者均被要求完成详细的问卷并进行人体测量。采集所有参与者的血样。每位个体均进行 75g 口服葡萄糖耐量试验（OGTT）以诊断 T2DM，并进行胰岛素释放试验（IRT）以计算葡萄糖、胰岛素和 C 肽的选定参数。进行线性相关和多元回归分析，以评估血清 HCY 浓度与这些参数之间的关系。
根据血清 HCY 水平的四分位数将患者分为以下亚组：组 Q1：<17.03µmol/L；组 Q2：17.03-19.50µmol/L；组 Q3：19.5-24.7µmol/L；组 Q4：>24.7µmol/L。随着 HCY 水平的升高，空腹血糖（FBG）、餐后 2 小时血糖（2hPBG）、糖化血红蛋白 A1c（HbA1c）、空腹 C 肽和空腹胰岛素水平显著升高（P<0.05）。IRT 中血清葡萄糖和胰岛素的曲线下面积（AUC）显著升高，血清 C 肽的 AUC 降低（P<0.05）。稳态模型评估-β（HOMA-β）、改良β细胞功能指数（MBCI）、处置指数（DI）、C 肽免疫反应性（CPR）、胰岛素生成指数 30（IGI 30）和胰岛移植单位（SUIT）水平随着 HCY 水平的升高而降低。HOMA-β、MBCI、DI、CPR、IGI 30、SUIT0h 与 HCY 血浆浓度之间呈负线性相关（R2 分别为 0.539、0.569、0.500、0.676、0.579 和 0.588；P<0.001），且这种相关性独立于年龄、性别、体重指数、血糖和胰岛素水平以及 HbA1c 等多种混杂因素。
血清 HCY 水平与胰岛β细胞功能参数呈负相关。因此，通过血浆 HCY 浓度可以很好地阐明胰岛β细胞的胰岛素释放功能。
