2型糖尿病患者高同型半胱氨酸血症与早期肾脏疾病的相关性

doi:10.3969/j.issn.1004-583X.2023.01.004

摘要/Abstract

摘要：

目的探讨2型糖尿病(type 2 diabetes mellitus, T2DM)住院患者高同型半胱氨酸血症对早期肾脏疾病患病风险的影响。方法本研究为回顾性研究。选取南京江北医院2020年10月至2022年6月收住的T2DM患者306例。根据糖尿病肾脏疾病(diabetic kidney disease, DKD)诊断标准分为单纯T2DM组( $n$ =252)和早期DKD组( $n$ =54),比较两组临床资料。结果 T2DM患者早期肾脏疾病患病率为17.6%。与单纯T2DM组相比,早期DKD组年龄较大、糖尿病病程较长、同型半胱氨酸水平较高、高同型半胱氨酸血症和高血压占比较大,差异有统计学意义(均 $P$ <0.05)。多因素Logistic回归分析显示,高同型半胱氨酸血症使T2DM患者早期肾脏疾病患病风险显著增加5.361倍( $O R$ :6.361, 95% $C I$ : 3.043-13.296, $P$ <0.05),且同型半胱氨酸水平与T2DM早期肾脏疾病患病风险呈剂量-反应关系,同型半胱氨酸水平每增加1 μmol/L,T2DM早期肾脏疾病患病风险增加14.1%( $O R$ : 1.141, 95% $C I$ : 1.061-1.227, $P$ <0.05)。结论 T2DM患者高同型半胱氨酸血症显著增加早期肾脏疾病的患病风险,且同型半胱氨酸水平与早期肾脏疾病患病风险增加呈剂量-反应关系。

关键词: 糖尿病,2型, 糖尿病肾病, 高同型半胱氨酸血症

Abstract:

Objective To study the effect of hyperhomocysteinemia on the risk of early renal disease in hospitalized patients with type 2 diabetes mellitus (T2DM). Methods It was a retrospective study involving 306 T2DM patients admitted to Nanjing Jiangbei Hospital from October 2020 to June 2022. According to the diagnostic criteria of diabetic kidney disease (DKD), they were assigned into simple T2DM group ( $n$ =252) and early DKD group ( $n$ =54). The clinical data of the two groups were compared. Results The prevalence of early DKD in T2DM patients was 17.6%. Compared with those of simple T2DM group, T2DM patients in early DKD group were significantly older, with longer duration of T2DM, higher level of homocysteine, and higher proportions of hyperhomocysteinemia and hypertension (all $P$ <0.05). Multivariate logistic regression analysis showed that hyperhomocysteinemia significantly increased the risk of early DKD in T2DM patients by 5.361 times ( $O R$ =6.361, 95% $C I$ : 3.043-13.296, $P$ <0.05), and the level of homocysteine was dose-dependently correlated with the risk of early DKD in T2DM patients, that was, for every 1 μmol/L increase in homocysteine level, the risk of early DKD in T2DM patients increased by 14.1%( $O R$ =1.141, 95% $C I$ : 1.061-1.227, $P$ <0.05). Conclusion Hyperhomocysteinemia in T2DM patients significantly increases the risk of early DKD, and the level of homocysteine has a dose-response relationship with the increased risk of early DKD.

Key words: diabetes mellitus, type 2, diabetic nephropathies, hyperhomocysteinemia

中图分类号:

R587.1

王翠, 林昊, 武萍萍, 张雅丽, 任建, 徐婷, 董国玉, 宰国田. 2型糖尿病患者高同型半胱氨酸血症与早期肾脏疾病的相关性[J]. 临床荟萃, 2023, 38(1): 42-45.

Wang Cui, Lin Hao, Wu Pingping, Zhang Yali, Ren Jian, Xu Ting, Dong Guoyu, Zai Guotian. Correlation between hyperhomocysteinemia and early renal disease in patients with type 2 diabetes mellitus[J]. Clinical Focus, 2023, 38(1): 42-45.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2023.01.004

https://huicui.hebmu.edu.cn/CN/Y2023/V38/I1/42

图/表 2

表1 两组一般资料和实验室资料比较

Tab.1 Comparison of general data and laboratory data between groups

组别		例数	年龄 (岁)		男性 [例(%)]		糖尿病病程 (年)		目前饮酒 [例(%)]		目前吸烟 [例(%)]		高Hcy血症 [例(%)]		高血压病史 [例(%)]		心脏病病史 [例(%)]		脑梗死病史 [例(%)]
早期DKD组		54	62.00±15.74		35(64.8)		10.54±5.80		7(13.0)		11(20.4)		22(40.7)		46(85.2)		3(5.6)		17(31.5)
单纯T2DM组		252	55.49±13.16		166(65.9)		7.30±6.71		41(16.3)		65(25.8)		24(9.5)		157(62.3)		28(11.1)		51(20.2)
统计值			$t$ =3.18		χ²=0.02		$t$ =3.29		χ²=0.37		χ²=0.70		χ²=33.93		χ²=10.43		χ²=1.51		χ²=3.25
$P$ 值			0.001		0.882		0.001		0.544		0.403		0.000		0.001		0.220		0.071
组别	BMI (kg/m²)			FPG (mmol/L)		HbA₁c (mmol/L)		SBP (mmHg)		DBP (mmHg)		TC (mmol/L)		HDL-C (mmol/L)		LDL-C (mmol/L)		TG (mmol/L)		Hcy (μmol/L)
早期DKD组	25.81±4.16			9.31±3.88		9.37±2.05		140.50±15.87		78.41±10.83		4.42±1.36		1.13±0.46		2.51±1.00		2.28±2.24		16.01±13.15
单纯T2DM组	25.53±4.45			9.32±2.76		9.48±2.17		135.83±17.78		80.38±10.99		4.62±1.26		1.07±0.24		2.77±0.94		1.91±1.73		11.11±4.29
统计值	$t$ =0.42			$t$ =0.03		$t$ =0.32		$t$ =1.78		$t$ =1.20		$t$ =1.07		$t$ =0.80		$t$ =1.80		$t$ =1.13		$t$ =2.71
$P$ 值	0.678			0.979		0.748		0.076		0.230		0.287		0.427		0.073		0.264		0.009

表1 两组一般资料和实验室资料比较

Tab.1 Comparison of general data and laboratory data between groups

组别		例数	年龄 (岁)		男性 [例(%)]		糖尿病病程 (年)		目前饮酒 [例(%)]		目前吸烟 [例(%)]		高Hcy血症 [例(%)]		高血压病史 [例(%)]		心脏病病史 [例(%)]		脑梗死病史 [例(%)]
早期DKD组		54	62.00±15.74		35(64.8)		10.54±5.80		7(13.0)		11(20.4)		22(40.7)		46(85.2)		3(5.6)		17(31.5)
单纯T2DM组		252	55.49±13.16		166(65.9)		7.30±6.71		41(16.3)		65(25.8)		24(9.5)		157(62.3)		28(11.1)		51(20.2)
统计值			$t$ =3.18		χ²=0.02		$t$ =3.29		χ²=0.37		χ²=0.70		χ²=33.93		χ²=10.43		χ²=1.51		χ²=3.25
$P$ 值			0.001		0.882		0.001		0.544		0.403		0.000		0.001		0.220		0.071
组别	BMI (kg/m²)			FPG (mmol/L)		HbA₁c (mmol/L)		SBP (mmHg)		DBP (mmHg)		TC (mmol/L)		HDL-C (mmol/L)		LDL-C (mmol/L)		TG (mmol/L)		Hcy (μmol/L)
早期DKD组	25.81±4.16			9.31±3.88		9.37±2.05		140.50±15.87		78.41±10.83		4.42±1.36		1.13±0.46		2.51±1.00		2.28±2.24		16.01±13.15
单纯T2DM组	25.53±4.45			9.32±2.76		9.48±2.17		135.83±17.78		80.38±10.99		4.62±1.26		1.07±0.24		2.77±0.94		1.91±1.73		11.11±4.29
统计值	$t$ =0.42			$t$ =0.03		$t$ =0.32		$t$ =1.78		$t$ =1.20		$t$ =1.07		$t$ =0.80		$t$ =1.80		$t$ =1.13		$t$ =2.71
$P$ 值	0.678			0.979		0.748		0.076		0.230		0.287		0.427		0.073		0.264		0.009

表2 T2DM患者早期DKD危险因素的Logistic回归分析

Tab.2 Logistic regression analysis of risk factors of early DKD in T2DM patients

因素	回归系数	标准误	Waldχ²值	$P$ 值	$O R$ 值	95% $C I$
因素	回归系数	标准误	Waldχ²值	$P$ 值	$O R$ 值	下限	上限
高Hcy血症	0.365	0.376	24.191	0.000	6.361	3.043	13.296
高血压病史	0.211	0.430	3.544	0.060	2.247	0.967	5.222
Hcy	0.132	0.037	12.575	0.000	1.141	1.061	1.227
糖尿病病程	0.064	0.026	5.902	0.015	1.066	1.012	1.123
年龄	0.015	0.014	1.131	0.288	1.015	0.988	1.043

表2 T2DM患者早期DKD危险因素的Logistic回归分析

Tab.2 Logistic regression analysis of risk factors of early DKD in T2DM patients

因素	回归系数	标准误	Waldχ²值	$P$ 值	$O R$ 值	95% $C I$
因素	回归系数	标准误	Waldχ²值	$P$ 值	$O R$ 值	下限	上限
高Hcy血症	0.365	0.376	24.191	0.000	6.361	3.043	13.296
高血压病史	0.211	0.430	3.544	0.060	2.247	0.967	5.222
Hcy	0.132	0.037	12.575	0.000	1.141	1.061	1.227
糖尿病病程	0.064	0.026	5.902	0.015	1.066	1.012	1.123
年龄	0.015	0.014	1.131	0.288	1.015	0.988	1.043

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