The Research Of Body Fat Distribution And The Blood Homocysteine Levels In Diabetes With Coronary Atheroscleros Patients

Objective: 1.To study the relationship between type 2 diabetes（T2DM）with coronaryatherosclerotic lesions and homocysteine (Hcy).2 . To explore body fat distribution features inT2DM with coronary atherosclerosis patients and the relationship of body fat distributionfeatures and Hcy.Methods: 1.To select 115 cases of patients in department of endocrinology and cardiology ofShanxi Province People’s Hospital from 2010.10 to 2011.5 , divided into T2DM with coronaryatherosclerosis group 53 patients ,T2DM with non-coronary atherosclerosis group 62 patientsaccording to 64 row helical CT coronary imaging and oral glucose tolerance test. And at thesame time to select 60 cases of healthy persons setted to the normal control group in our healthmedical center. Three groups of age, sex had no statistical difference. Measuring systemic andlocal body fat with dual-energy X-ray absorptiometry and recording the body fat distributionindex Fat Mass/Height2, Android/Gynoid Ratio, %Fat Trunk/% Fat Legs,Trunk/Limb Fat MassRatio,%Fat Trunk;testing Hcy, glycated hemoglobin, fasting insulin ,uric acid,microalbuminuria/creatinine, triglycerides, low density lipoprotein, high density lipoprotein,c-reactiveprotein,fibrinogen and counting insulin resistance index（HOMA-IR）;measuring height,weight,waistline,hip circumference, and counting BMI = weight (kg) / height (m2),waist-hipratio(WHR)= waistline(cm) / hip circumference(cm). Comparing the difference of biochemicalindex and body fat measurement index in three groups，doing the correlation analysis betweenT2DM with Coronary atherosclerotic lesions and Hcy , the correlation analysis between Hcy andbody fat index in T2DM with coronary atherosclerosis group.2.46 T2DM combined with coronary atherosclerosis patients were divided into 4 groupsaccording to body mass index, Hcy level and given corresponding intervention measures: highHcy + obese group (12 cases) : to oral composite folate supplements and give weight losslifestyle guidance. High Hcy group (11 cases) : only to oral composite folate supplements.Simple obesity group (12 cases) : to give weight loss lifestyle guidance. The control group (11cases) : no intervention measures. To observate the change of.body fat distribution, serum Hcylevel and coronary lesions degree after 4 month.Results: 1. HOMA-IR, LnHcy have a statistics difference (P < 0.05), multiple comparisonhave a statistics difference (P﹤0.05). Logistic regression analysis shows Hcy is the independent risk factor of T2DM with coronary atherosclerotic lesions. Hcy level of triple vessel lesion groupobviously higher than the previous three groups (P﹤0.05), And Hcy level of single lesionsgroup, double lesions group a higher than the subgroup. But single lesions group and doublelesions group have no significant differences. HOMA-IR, Hcy is independent risk factors ofGensini integrate(F = 33.169, P = 0.000).Android/Gynoid Ratio,%Fat Trunk/% Fat Legs,Trunk/Limb Fat Mass Ratio in three groupshave statistical difference(χ2=9.584, 15.151, 14.361,P<0.05). Android/Gynoid Ratio,%FatTrunk/% Fat Legs,Trunk/Limb Fat Mass Ratio of T2DM with coronary atherosclerosis group aresignificantly higher than the rest groups, having statistical difference (P<0.05).The three indexesare positively correlated with Hcy level(correlation coefficient r=0.640, 0.452, 0.377). Factors ofHcy is Android/Gynoid Ratio( F=33.81，P<0.05).2. Give intervention after 4m, serum Hcy ,Homa-IR and Gensini integral of high Hcy +obese group, high Hcy group, Simple obese group all fell. Reduced on average value of serumHcy[difference = (6.38±3.26) mmol/L,( 6.28±3.07) mmol/L)] in high Hcy + obese group, high Hcygroup were higher than the simple obesity group and control group, statistically significant (P <0.05). Reduced on average value of Homa-IR (difference = 1.37±1.66)in High Hcy + obesegroup was significantly higher than the high Hcy group, the pure obese group and controlgroup, statistically significant (P < 0.05); Simple obesity group took second place (difference =0.68±0.20). Reduced on average value of Gensini integral (difference = 52.25±22.32)in HighHcy + obese group was higher than the high Hcy group, simpe obese group and control group,statistically significant (P < 0.05).Conclusions: 1.High hcysteine levels are obviously relevant with diabetes cardiovasculardisease, Hcy is the independent risk factor of T2DM with coronary atherosclerotic lesions. Hcyand coronary artery disease extent and severity are relevant in Type 2 diabetes with coronaryatherosclerosis group,coronary artery disease range is wider,and more serious with Hcy levelhigher. 2.T2DM with coronary atherosclerosis patients present centripetal fat distributionmode .Hcy is positively related with Android/Gynoid Ratio , %Fat Trunk/% Fat Legs ,Trunk/Limb Fat Mass Ratio . Android/Gynoid Ratio is factors to Hcy. 3. Give composite folatesupplements or weight loss life guide all can reduce serum Hcy level, improve insulin resistanceand coronary disease severity.The effect of united give composite folate supplements and weightloss life guide is more obvious.