Clinical Significance And Relationship Between Hyperhomocysteinemia And Microinflammation, Malnutrition, Atherosclerosis In Patients With Diabetic Nephropathy

Objective:Homocysteine is the intermediate product in the process of methionine metabolism.The level of homocysteine in plasm was affact by many factors.In the body of the patient whose renal function was damageed,there is a strong relation between homocysteine concentration and creatinine level..The view of this article is to investigate the relationship among the plasma levels of homocysteine, microinflammation state,malnutrition and atherosclerosis and the effect of these factors on the morbility,progression,deterioration and prognosis in patients with diabetic nephropathy and to provide the objective study and research evidence to direct clinical diagnosis and treatment.Methods:According to their endogenous creatinine clearance rate(Ccr),73 patients with diabetic nephropathy(everyone has a over 5 years diabetic history) were divided into two groups:36 patients with diabetic nephropathy complicated with chronic renal failure(Ccr＜60ml/min,called V stage diabetic nephropathy),37 patients with clinical proteinuria whose the levels of serum creatinine were in normal range (22-133umol/L),Ccr＞60ml/min,called clinical nephropathy orⅣstage diabetic nephropathy,and 34 normal persons were taken as the normal control group.The plasma levels of homocysteine,high sensitive C-reactive protein(Hs-CRP),erythrocyte sedimentation rate(ESR),heamoglobin(Hb),pre-albumin(PA),alburnin(Alb), intima-media thickness(IMT) in carotid artery,high-density lipoproteins(HDL), triglyceride(TG) and cholesterol(CHO) were detected in three groups.Analysis of statistics with multivariate analysis of variance,t test and correlation analysis.Results:The plasma levels of homocysteine,high sensitive C-reactive protein, heamoglobin,pre-alburnin,albumin and et al were significantly higher in patients with diabetic nephropathy than those in control group(P＜0.0001).The levels of those indexes were significant difference between patients with diabetic nephropathy complicated with chronic renal failure and patients with clinical proteinuria.The plasma levels of homocysteine were significantly higher in patients with diabetic nephropathy complicated with hypoproteinemia than patients with diabetic nephropathy with normal plasma-albumin(P＜0.0001).The plasma levels of homocysteine were significantly higher in diabetic nephropathy with the level of high sensitive C-reactive protein critical increase than that in patients without high sensitive C-reactive protein abnormality(P＜0.0001).The plasma levels of homocysteine were significantly higher in diabetic nephropathy with intima-media thickness critical increase than in patients wihhout intima-media thickness increased(P＜0.0001).The plasma levels of homocysteine were significantly higher in diabetic nephropathy with remnant renal function than the patients without renal function remained(P＜0.0001). Correlation analysis indicated that homocysteine was negative correlated with heamoglobin,albumin,pre-albumin,endogenous creatinine clearance rate (r=-0.50,P＜0.0001;r=-0.43,P＜0.0001;r=0.32,P=0.01;r=0.39,P=0.0007), but positive correlated with high sensitive C-reactive protein,erythrocyte sedimentation rate,intima-media thickness,and cholesterol(r=-0.52,P＜.0001; r=-0.56,P＜0.0001;r=0.54,P＜0.0001;r=0.26,P=0.03),there was not correlation between homocysteine,high-density lipoproteins and triglyceride.Conclusions:Hyperhomocysteinemia,malnutrition,microinflammation state and atherosclerosis exist in the patient with diabetic nephropathy,the factors interact each other.Hyperhomocysteinemia is negative correlated with malnutrition,but positive correlated with microinflammation state and atherosclerosis.Compared with detection of intima-media thickness,the detection of homocysteinemia,high sensitive C-reactive protein,pre-albumin,heamoglobin and albumin in patients with diabetic nephropathy is economic and convenient for assessment to atherosclerosis.The plasma levels of those factors can reflect pathogenetic condition,curative effect and prognosis of patients with diabetic nephropathy.As to lower the plasma levels of homocysteine,there is an rationale for pharmacal intervention to the early occurrence of renal damage in patients with diabetes.