The Change And Clinical Significance Of Serum Total Homocysteine In Diabetic Nephropathy

Objective To investigate the change of serum total homocysteine in type 2 diabetes mellitus with incipient diabetic nephropathy and its clinical significance.Methods Serum tHCY levels were measured by Fluorescence Polarization Immunoassay(FPIA) in 60 patients with type 2 diabetes and 30 healthy control subjects. Patients were divided into normoalbuminuria group(<20ug/min) and microalbuminuria group(20 ~ 200ug/min) according to UAER. FPG, HbAlc, FINS. SCr, TG, TC and UA were determined simultaneously. CCr were calculated according to the Cockcroft-Gault formula. Insulin sensitivity index were assessed by Homa IR .Results (1) The serum tHCY level was higher in patients with type 2 diabetes mellitus with mkroulbuminuria than that in patients with normoalbuminuria (11.62 4.26umol/L vs 9.73 2.41umol/L, P=0.013 ) and that in control subjects(l 1 .(,2 4.26umol/L vs 9. 34 2.64umol/L, P=0.024 ), while the serum tHCY level in patients with normoalbuminuria was similar to that in concol subjects(9.73 2.41umol/Lvs9.34 2.64umol/L , P =0.644). (2)The serum tHCY level was significantly higher in diabetic patients \vith lower CCr than that in diabetic patients with normal CCr(p<0.01). (3) There was no significant difference in tHCY level between patients with microalbuminuria and patients with normoalbuminuria both in group with normal CCr and ingroup with lower CCr (P=0.198 , P=0.075). (4) By univariate analyses, the tHCY level in type 2 diabetes was positively related to age, TG, UA, SCr and UAER, and negatively related to CCr. By stepwise regression analysis, CCr and TG were independent contributors to serum tHCY level in type 2 diabetes , while serum tHCY and durations of DM were independent contributors to UAER in type 2 diabetes.Conclusions (1) Patients with type 2 diabetes with microalbuminuria had an elevated tHCY level, but patients with normoalbuminuria had a similar tHCY level to that in control subjects. (2) CCr were independent contributor to serum tHCY level in type 2 diabetes . (3)Hyperhomocysteinemia was related to the development of incipient diabetic nephropathy.