| Objective: Through the different glucose tolerance crowd of plasma Homocysteine(Hcy) and urinary albumin excretion rate(UAER), to study whether plasma Hcy can serve as a risk factor for UAER increasing, and provide a new method to prevent the occurrence and delay progress of diabetic nephropathy( DN).Methods:We recruited Inpatient and outpatient patients in treating at the Baoding first center hospital in Hebei province from January 2014 to December 2014. All patients were taken 75 g glucose for oral Glucose Tolerance test(OGTT) in the morning on an empty stomach condition.We devided patients according to the 1999 world health organization(WHO) on type 2 Diabetes(T2DM)WHO diagnostic, the new Diabetes group( DM group), sugar Regulation Impaired group(IGR group), Glucose Tolerance of Normal control group(NGT group),respectively. We investigated the subjects of general clinical data, including gender, age, smoking history, drinking history, past medical history, history of hypertension and drug utilization,measured the height, weight, calculated body mass index(BMI), collected fasting blood samples determination of Hcy, glycosylated hemoglobin( Hb A1c), total cholesterol(TC), triglyeride(TG), low density lipoprotein cholesterol(LDL-C), high density lipoprotein cholesterol(HDL-C),serum creatinine(SCR), blood urea nitrogen(BUN), fasting plasma glucose(FPG),fasting insulin(FINS),calculated HOMA β-cell function index(HOMA-β),Homeostasis model assessment of insulin Resistance(HOMA-IR), Insulin Sensitivity Index(ISI),and collected 24 hour urine to test UAER.Application of SPSS 17.0 software for statistical analysis. The measurement data of normal distribution with mean ± standard deviation( x ± s),analysising abnormal distribution of measurement data after converting natural logarithm normal distribution data, comparing the two the SNK-q test,compareing not neat data of variance between groups with the Kruskal-Wallis H nonparametric test. Enumeration data used χ2 test to compare.Analysis of risk factors of UAER by Logistic regression, Spearman correlation analysis between each index and Hcy. For the difference was statistically significant(P < 0.05) judgment.Results:1 The comparison of clinical features and biochemical characteristics of three groupsNGT group a total of 38 cases, 20 cases of men, and 18 cases of women,the average age was(51.74 ±8.42); IGR group a total of 32 cases, 23 cases of men, nag 9 cases of women, the average age was(50.56 ±12.27); DM group of 42 cases, 29 cases of men, 13 cases of women, the average age was(52.64±10.90). the average BMI in IGR group and DM group is significantly higher than NGT group(P <0.05), IGR group and DM group comparison between the two groups, the average BMI of the DM group is lower than the IGR group, but there was no significant difference(P > 0.05). HDL-C in IGR group and DM group were lower than NGT group(P < 0.05), the IGR group and DM there was no statistically significant difference(P > 0.05). TG in NGT group, the IGR group, DM group increased, and IGR group, the difference between DM group with NGT group significantly(P< 0.05), but the difference between the two has no statistical significance(P> 0.05). Fasting plasma Hcy levels in IGR group and DM group was obviously higher than NGT group(P < 0.05), IGR Hcy level slightly higher than the DM group,there was no statistically significant difference(P > 0.05). UAER in NGT group, the IGR group, DM group increased, the difference among three groups was statistically significant(P < 0.05), two more significant difference(P <0.05).2 The comparison of IR and islet beta cell function Between the groupsHOMA- IR, the ISI, HOMA-β are abnormal distribution data, after takenits natural logarithm transformation into a normal distribution data, then comparised the data. Ln(HOMA- IR) increased between the three groups,two comparative difference was statistically significant(P<0.05). Ln(ISI)gradually decline between the three groups, two more significant difference(P<0.05). Ln(HOMA-β) in NGT group, the IGR group, DM group three were gradually decline, DM group respectively with IGR, NGT group have significant difference(P<0.05), there was no statistically significant difference IGR with NGT group.3 By Logistic regression analysis showed that TG, Hb A1 c, Hcy are risk factors of UAER(P< 0.05). The Spearman correlation analysis showed that TG, LDL-C, Hb A1 c, HOMA- IR, UAER and Hcy were positively related;Negatively correlated with ISI, HOMA-β and Hcy, the difference was statistically significant(P< 0.05).Conclusions:1 Hcy levels have begun to rise in the early diabetes, a new diagnosis of T2 DM and IGR serum Hcy were significantly higher than NGT crowd, but Hcy slightly higher than T2 DM patients in the IGR phase.2 As the blood glucose metabolic state from NGT gradually developed to T2 DM, the degree of insulin resistance and impaired islet beta cells gradually increase, its associated with glucose tolerance abnormal plasma Hcy levels.3 TG, Hb A1 c, Hcy are risk factors of UAER, that control the occurrence and development of diabetic nephropathy, including blood sugar, blood fat,and the Hcy. |
PDF Full Text Request