Effects Of Hyperhomocysteinemia On Sympathetic Nervous Function Of Type2Diabetic Mellitus

Objective:This test researched the effect of Hhcy on type2DM sympathetic nerve function through skin sympathetic reflection (SSR) detection technology, the purpose is to further explore the relationship between Hhcy and diabetic automatic neuropathy(DAN), which may give a new approach for the therapy of diabetic peripheral neuropathy (DPN)Method:According to total homocysteine (tHcy), selected patients of type2DM:52cases with Hhcy、50cases with no Hhcy as control. All participants were measured fasting blood glucose (FBG)、glycated hemoglobin (HbAl c)、total cholesterol (TC)、triglyceride (TG)、creatinine(Scr)、blood folic acid and VitB12level. By Danish Keypoint.net electromyography apparatus all patients with limbs were determined SSR, recorded and compared SSR wave average latencies、amplitudes、 SSR abnormal incidence and SSR ratios of upper to lower limbs between the2groups, analysised the correlation of SSR abnormal incidence and other factors.Results:The general clinical and biochemical data were compared:blood folic acid、VitB12level in Hhcy group [respectively for(2.83±1.28) ng/ml、(187.73±82.73) pg/ml] was obviously lower than that in NHhcy group [respectively for (3.64±1.52ng/m、(271.24±104.25)pg/ml](P<0.05); and other indexes were no significant difference in the2groups. Lower limbs SSR of Hhcy group had longer average latencies than that in NHhcy group [respectively for (2742.71±318.29)ms (2507.15±307.46) ms](P<0.01)、lower average amplitudes than that in NHhcy group [respectively for (0.30±0.13)mV、(0.34±0.15) mV](P<0.05), and upper limbs SSR had not significant between2groups, but Hhcy group had higher abnormal rate of SSR than NHhcy group (86.54%vs70.00%, P<0.05). Furthermore, SSR latency ratios of upper to lower limbs in Hhcy group was reduced than that in NHhcy group (0.55±0.13、0.60±0.08)(P<0.01); SSR amplitude ratios of upper limbs-lower limbs had not statistical significance in2groups (3.67±1.26、3.40±1.15)(P>0.05). Using spearman related analysis found that abnormal SSR had positive correlation with tHcy (rs=0.947), and negative correlation with blood folic acid、VitB12level (rs=-0.881、rs=-0.851), all are P<0.01. Conclusion:The tHcy level has positive correlation with diabetic nerve lesions, and Hhcy may be a risk factor of type2DM sympathetic nerve lesions, which increases incidence of sympathetic nerve lesions. Hhcy does damage to lower limbs small fiber nerve primarily, and has a length dependence characteristics. Meanwhile, Blood folic acid and VitB12level in Patients of type2DM with Hhcy are reduced significantly. So determining tHcy、blood folic acid and VitB12contributes to preventin and treatment of DAN, and SSR detection is a simple and feasible method of DAN. Searching positively relation between Hhcy and DAN has a vital significance to find early high-risk groups of DPN prevent and stop lesions development.