Association Between Homocysteine And Chronic Complications In Patients With Type 2 Diabetes Mellitus

Objective: All through the XXth century, diabetes mellitus (DM) has ranked the third with regard to health and social significance followed cardiovascular diseases and tumor.Progressive vascular disease of the large and small vessels as the diabetic chronic complications is characteristic of the didbetic state and become the major cause of death.In searching for new risk factors of diabetic chronic complications ,special attention has been paid in recent years to hyperhomocysteinaemia. Hyperhomocysteinaemia is very frequent in renal failure,which suggests that the kidney's function is crucial to homocysteine catabolism.The aim of this study was to explore the relationships among Hey, creatinine clearance (Ccr) ,vascular endothelial growth factor (VEGF), nitric oxide(NO) and microalbuminuria in a population with type 2 diabetes.Methods: Fasting serum Hey, VEGF , NO ,serum creatinine, urine microalbumin, and creatinine clearance were determined in 57 type 2 diabetic patients and 32 healthy control subjects. Ccr was calculated using the Cockroft-Gault formula. Serum Hey ,VEGF levels were determined by colorimetric enzyme-linked immunosorbent assay. NO is determined by spetrophotometry.Results: 1. The patients were assigned to two groups based on urinary albumin excretion (UAE): DM group ( UAE <20ug/min , n= 25) DN group ( UAE ^20ug/min , n= 32) ; DN group is assigned to three groups based on UAE and serum creatinine (Cr) : group 1(20 ug/min 200ug/min, n=10); group 3(Cr>136umol/L,n = 6 ). Serum Hey ,VEGF levels were higher in diabetic patients than in controls (p<0.05 ) ,those in group 2and 3 were significantly higher than incontrols (p<0.01 ) . Serum Hey ,VEGF levels were higher in DN group than in DM group (p<0.05 ) . Serum NO is lower in diabetic patients than in controls (p<0.05 ) ,those in DN group is significantly lower than in DM group (p<0.01) .Bivariste correlation analysis show, Serum Hcy,VEGF was significantly correlated with UAE .There was a negative cirrelation between serum Hey and NO in DN group.By stepwise regression analysis, ON UA> Ccr were the independent factors for serum Hey level in type 2 diabetes.2. ?The values of serum Hey and VEGF in T2DM were higher than the control group ( p<0.05 ) ; Those in patients with diabeteic macrovasculopathy were markedly high (p<0.01 ) Serum NO in T2DM without macrovasculopathy were highter than the control group (p<0.05 ) ; That in patients with diabetic macrovasculopathy were less than the former group (p<0.01) Conclusion: Hyperhomocysteinemia exerts its deleterious effects on endothelial function in T2DM with diabetic nephropathy and cardiovascular complications of diabetes through changes the serum concentration of VEGF and NO...