| Objective:To ivestigate the relations between homocysteine and diabetic nephropathy and the effect of methylcobalamin and folic acid treatment on plasma homocysteine level of patients with type 2 diabetes mellitus.Methods:1. Study on the relations between homocysteine and type2 diabetic nephropathy.[0]30 healthy volunteers (control group),40 type2 DM patients without DN and 20 type2 DM patients with DN were recruited in the study. DM patients were in-patients from the first affiliated hospital of Fujian Medical University who met the selecting standard. The blood samples and Urine were obtained and Blood fat, function of liver and kidney, blood sugar, HbAlc, Hcy, and urine albumen were determined in above-mentioned selected groups.Plasma Hcy levels were measured by Polarization Immunoassay. Hcy level of different groups and its relations with blood pressure, blood sugar and blood fat were observed. Risky factors of diabetic nephropathy were screened out by Logstic Regress Model.2. Observing the effect of methylcobalamin and folic acid treatment on plasma homocysteine level of patients with type 2 diabetes mellitus.80 patients with type 2 DM ,who were out-patients from the first affiliated hospital of Fujian Medical University,were divided into four groups randomly,each 20 patients. Patients in group 1 received no intervention, group 2 were given folic acid orally (5mg/d), group 3 were supplemented with methylcobalamin orally (500ug,tid), group 4 were treated with methylcobalamin (500ug, tid) in addition to folic acid (5mg/d). In all groups, plasma total Hcy,Vitamin B12 and folic acid were assayed at baseline and after 8-week treatment. Comparison of Hcy, Vitamin B12 and folic acid level between pre-treatment and post-treatment was done. The effect of methylcobalamin and folic acid treatment on Hcy level of patients with type 2 diabetes mellitus was evaluated and compared.Results:1. Plasma Hcy level of normal group, type 2 DM group and DN group increased in turn and had statistical difference.2. Plasma APO-B level of normal group, type2 DM group and DN group increased gradulately but no obvious difference respectively were found. Age,SBP, TG of DN group were higher than those of healthy and DM group. HDL and APO-A1 of DN group were lower than those of healthy group but compared with DM group,there were no statistical difference.3. Logistic regress analysis made on basis of dependent variable DN and independent variable Hcy, SBP, DBP, TG, TCHO, HDL, LDL, Apoa and APO-B showed SBP and Hcy were independent risky factors of DN.4. [0]Correlation analysis of Hcy in DM patients showed that Hcy had positive correlation with SBP, TG,FBG, urine albumen, BUN, APO-B and Vldl, negative correlation with HDL, VitB12 and folic acid but no statistical difference was found with folic acid.5. [0]Change of Hcy, VitB12 and folic acid before and after intervention:Compared to pre-treatment, Hcy levels decreased obviously in the three groups receiving treatment (P<0.05) but [0]no change was found in non-intervened group. The decrease value of hcy level between combined treatment group of methylcobalamin and folic acid and separate treatment group manifested no statistical difference.Conclusion:1. Plasma Hcy level of DM patients is higher than that of healthy group (P<0.05). In DM patients, plasma Hcy level in DN patients is higher than those who do not has DN.2. It is indicating that Hcy might be an etiological agent in the development of DN and is an independent risky factor of DN.Plasma Hcy level of type 2 DM patients correlates with the level of SBP,TG, FBG, urine ALB/Cr, BUN, APO-B, VLDL, VitB12 and folic acid.3. Combined treatment of methylcobalamin and folic acid , separate treatment of methylcobalamin or folic acid all can decrease plasma Hcy level of DM patients. Compared to the separate treatment of methylcobalamin or folic acid, combined treatment of methylcobalamin and folic acid may be more effective on decreasing the level of plasma hcy in diabetes. |
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