血浆同型半胱氨酸与无肾病 2 型糖尿病患者的非增殖性视网膜病变有关。

Plasma homocysteine is associated with nonproliferative retinopathy in patients with type 2 diabetes without renal disease.

机构信息

Department of Ophthalmology, Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, Zagreb, Croatia.

Department of Diabetes and Endocrinology, Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, Zagreb, Croatia; School of Medicine, University of Zagreb, Zagreb, Croatia.

出版信息

Diabetes Metab Syndr. 2022 Jan;16(1):102355. doi: 10.1016/j.dsx.2021.102355. Epub 2021 Dec 1.

DOI:10.1016/j.dsx.2021.102355

PMID:34920196

Abstract

BACKGROUND AND AIMS

This study aimed to assess the role of plasma homocysteine (Hcy) in the development of nonproliferative diabetic retinopathy (NPDR) in patients with type 2 diabetes (T2DM) without chronic kidney disease.

METHODS

This was a cross-sectional study that included 94 T2DM. Hcy, serum 25-hydroxy (25-OH) vitamin D, vitamin B12, and folate were determined by the CMIA method. NPDR was determined according to the EURODIAB retinal photography methodology and optical coherence tomography (OCT) of the macula.

RESULTS

Compared to patients without NPDR, patients with NPDR had longer diabetes duration (p < 0.001), higher Hcy (p < 0.001), lower vitamin B12 (p = 0.028) and lower estimated glomerular filtration rate (eGFR) (p = 0.004). NPDR was positively associated with diabetes duration (p < 0.001), HbAc (p = 0.049) and Hcy (p < 0.001), and negatively with vitamin B12 (p = 0.027) and eGFR (p = 0.005). Logistic regression analyses showed that diabetes duration (OR = 1.13, p < 0.001), Hcy (OR = 1.06, p = 0.047), and eGFR (OR = 0.96, p = 0.004) were the main predictors of NPDR in T2DM. Stepwise regression analyses showed that the best model for predicting Hcy (R2 = 0.104) included vitamins B12 and D.

CONCLUSIONS

Higher Hcy is associated with NPDR and may play a role as a risk factor for its development in T2DM. Vitamins B12 and D seem to modify this association.

摘要

背景与目的

本研究旨在评估血浆同型半胱氨酸（Hcy）在 2 型糖尿病（T2DM）患者中非增殖性糖尿病视网膜病变（NPDR）发展中的作用，这些患者无慢性肾脏病。

方法

这是一项横断面研究，共纳入 94 例 T2DM 患者。采用化学发光免疫分析法（CMIA）检测 Hcy、血清 25-羟维生素 D、维生素 B12 和叶酸。根据 EURODIAB 视网膜摄影方法和黄斑区光学相干断层扫描（OCT）确定 NPDR。

结果

与无 NPDR 的患者相比，NPDR 患者的糖尿病病程更长（p<0.001），Hcy 更高（p<0.001），维生素 B12 更低（p=0.028），估算肾小球滤过率（eGFR）更低（p=0.004）。NPDR 与糖尿病病程（p<0.001）、HbAc（p=0.049）和 Hcy（p<0.001）呈正相关，与维生素 B12（p=0.027）和 eGFR（p=0.005）呈负相关。Logistic 回归分析显示，糖尿病病程（OR=1.13，p<0.001）、Hcy（OR=1.06，p=0.047）和 eGFR（OR=0.96，p=0.004）是 T2DM 中 NPDR 的主要预测因素。逐步回归分析显示，预测 Hcy 的最佳模型（R2=0.104）包括维生素 B12 和 D。