| Objective:Through the observation of plasma homocysteine (homocysteine, Hey) in type2diabetic patients with peripheral neuropathy (diabetic peripheraleuropathy, DPN) in patients with Hey related influence factors, analysis, in order to investigate the effect of Hey on type2diabetic peripheral neuropathy and related mechanism; to provide new ideas for clinical prevention and treatment of diabetic peripheral neuropathy.Methods:From2011August to2013December in Tianjin Fifth cetre Hospital hospitalized type2diabetic group meets the conditions of112cases (type2, diabetesmellitus, T2DM) patients, the patients were divided into2groups:diabetes mellitus (PDM) group (48cases, male25cases, female23cases):combined with peripheral neuropathy (DPN) group of64example,(male34cases, female30cases); another50healthy subjects served as control group,(male26cases, female24cases).3groups of subjects blood pressure, height, weight were determined by the standard method, and calculated body mass index (bodymass, index, BMI). With the fluorescence polarization immunoassay (FPIA) fasting plasma Hey concentration,serum folic acid and VitB12levels by radioimmunoassay, simultaneous determination of fasting blood glucose (fastingplasmaglucose, FPG), glycosylated hemoglobin (glycosylated hemoglobin, HbAlc). triglyceride (triglyceride, TG), total cholesterol (total, cholesterol, TC) high density lipoprotein cholesterol (high-density lipoprotein cholesterol, HDL-C), low density lipoprotein cholesterol (low-density1ipoprotein-cholesterol, LDL-C), creatinine (creatinine, Cr). The use of keypoint type EMG/EP instrument for all patients with T2DM were measured median nerve motor and sensory nerve conduction velocity, peroneal nerve motor conduction velocity, sural sensory nerve conduction velocity was measured bilaterally, the average. F wave detection of selected median nerve, tibial nerve reflection detection of selected H.Result:1. With DPN for64cases in112patients with type2diabetes, the incidence of DPN was51.27%.2. Healthy control group, PDM group, DPN group, plasma Hey concentrations were:(7.98±2.85) umol/L,(13.68±2.76) umol/L,(18.52±4.02) umol/L, PDM group, DPN group were higher than the healthy control group,(P<0.05), and higher in DPN group than PDM group,(P＜0.05).3. Healthy control group, PDM group, DPN group, plasma Hcy increased (Hcy≥15.0umol/L) numbers were:3,15,33, Hcy in high incidence rate were6.00%,31.25%,51.56%, between the groups, the difference had statistical significance (P<0.01). In group DPN, according to NSS is divided into:31mild cases,18moderate cases,15severe cases, the concentration of Hey in three groups were (17.35±4.04) umol/L,(20.84±4.57) umol/L,(24.09±5.08) umol/L,. The DPN have significant different severity subgroups of Hey level difference,(P＜0.05).4. Accorrding to the Hey level in type2diabetic patients were divided into high on the plasma Hey levels in group and normal Hey group, the results showed high Hey hyperlipidemia group the proportion of DPN was significantly higher than that in normal Hey group; DPN group of folic acid and VitB12levels than the healthy control group and PDM group was significantly decreased, and DPN increased with the severity of folic acid to reduce, the differences were statistically significant (P＜0.05).5. Pearson correlation analysis showed: Hey and course of disease in diabetic patients (r=0.512, P=0.000), HbAlc (0.424, P=0.009), positive correlation; and negatively correlated with folic acid, VitB12(r=-0.447, r=-0.341, P＜0.01,P＜0.05); and age, sex, FBG, BMI, TG, TC, LDL-c, HDL-c, systolic pressure, diastolic pressure, there was no significant correlation between Cr (P>0.05); plasma Hey and F wave of median nerve, tibial nerve reflex latency of wave H positive correlation (r=0.363、0.283, P＜0.05); and MCV and SCV of median nerve, MCV of common peroneal nerve, SCV of tibial nerve negative correlation(r respectively-0.455、-0.408、-0.521、-0.643, all P＜0.05),6. Logistic multi factor regression analysis showed, the DPN as the dependent variable, age, gender, disease duration, introducing BMI, systolic pressure, diastolic pressure, HbAlc, Hey, folic acid, VitB12, TC, TG, LDL-c, HDL-c, Cr, Hey, results show that the disease correlated with the degree of DPN, OR were1.324,2.589,95%confidence intervals were (1.056～1.598),(1.283-3.259).Conclusion:1. Compared with patients with diabetes, elevated plasma Hey level in patients with DPN, and increased with the severity of DPN increased; Hey and DPN are closely related; hyperhomocysteinemia is an important risk factors of DPN patients, can aggravate the damage degree of DPN.2. DPN group of nerve reflex latency, motor and sensory nerve conduction velocity, and plasma Hey and the parameters related to the plasma Hey and EMG, nerve conduction velocity anomaly correlation, the plasma Hey can be used as a predictive index and risk factors of DPN. |
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