High Homocysteine Levels, The Influence Of The Retina In Patients With Diabetes And Kidney Disease

Objectives:To observe the impact of the levels of plasma Hey on the T2DM patients with diabetic nephropathy and diabetic retinopathy. And to study the correlation among the levels of plasma Hcy,VEGF and HOMAIR、ISI.Methods:241cases of diabetic were recruited as subjects according to the1999WHO diagnostic criteria for diabetes. Measured the history of smoking, hypertension, duration of diabetes, height, and weight. Fasting blood were collected to analyse the levels of TC, TG FINS, FPG, HbA1c, plasma Hcy(Rate method),and VEGF(ELISA). Then calculated the BMI,HOMA-IR, and ISI. All of the subjects were analysed the micro-albuminuria, and accepted FFA examination. All of the Type2Diabetic patients were divided into four groups, including29cases of NDC group,123cases of only diabetic retinopathy (DR) group,10cases of only the diabetic nephropathy (DN) group,79cases of DR+DN group in which the patiens were suffered from diabetic retinopathy and diabetic nephropathy.According to the prevention and treatment guidelines of Type2Diabetes,241diabetic patients were divided into3groups, including39cases of no obvious retinopathy,186cases of non-proliferative stage (NPDR),16cases of proliferative phase (PDR), then were divided into2groups, including152cases of the UAE<20μg/min and89cases of UAE≥20μg/min. Statistical analysis used the SPSS19.0software.Results:1.In the DR+DN group, the patients with history of hypertension were significantly more than patients in the other groups, the levels of plasma Hey and TC were higher compared with other groups, and the HOMA-IR was the highest (P<0.05).The age was showed in NDC group,it was younger than that in the other groups (P<0.05). Analysis showed that the duration of diabetes was shortest in the NDC group(P<0.05), while it was longest in the DR+DN group. The levels of HbA1c, in the DR+DN group were higher than that in the other groups(P<0.05), and HbA1c, homa-ir in the CON group were significantly lower versus other group,and ISI is higher(P<0.05).The levels of VEGF showed gradually increased in the NDC group, the DR group, the DN group and the DR+DN group (P<0.05),and there were no significant difference between the NDC group and CON group (P>0.05).2. The comparison of the age, gender, BMI, a history of hypertension and duration of diabetes, history of smoking, Hey, HbA1C,FINS,FIN, TG, TC, HDL-C, LDL-C, HOMA-IR urinary albumin,and VEGF in241cases of T2DM, found that the age, BMI, the history of hypertension and duration of diabetes, HbA1c, HOMA-IR,urinary albumin,and VEGF were positively correlated with the levels of plasma Hey or VEGF, and the levels of ISI reduced as the increased levels of Hey or VEGF; and the history of smokeing were positively correlated with the VEGF.Then the Spearman correlation analysis demonstrated that the levels of plasma Hcy were positively correlated with the levels of VEGF(r=0.498, P<0.01).3. In the groups of diabetic retinopathy and early diabetic nephropathy, it could find that increased duration of diabetes, increased IR,higher levels of HbA1c and VEGF、the levels of plasma Hcy≥10μmol/L might be the risk factors of DR (P<0.05), and only the history of hypertension,high levels of VEGFand Hcy in early DN showed a strong correlation (P <0.05),when analysis the age, gender, BMI, the history of hypertension, smoking and duration of diabetes, plasma Hcy, HbA1c, TG, TC, ISI and VEGF.Conclusion:1. The age,HOMA-IR, BMI, the duration of diabetes, HbA1c were significantly associated with the levels of Hcy; while the age,history of hypertension and smoking, duration of diabetes,BMI, HOMA-IR and HbA1c was positively correlated with the levels of VEGF,and the Spearman correlation analysis demonstrated that the levels of plasma Hcy were positively correlated with the levels of VEGF.2. The increased duration of diabetes, higher leves of HbA1c and VEGF, lower leves of ISI the levels of plasma Hcy might be the risk factors of DR.At the same time, the high levels of plasma Hcy and VEGF increased the incidence of the DR.3. The history of hypertension,higher levels of Hcy and VEGF might be the risk factors of early DN, and with the rise of Hcy and VEGF levels, the early DN condition tended to be worse. and when the levels of plasma Hcy and VEGF were higher, it came to the higher prevalence of early DN.