| Objective: To investigate the changes of serum homocysteine (Hcy) levels andcommon carotid intima-media thickness (CC-IMT) in patients with short-duration type2diabetes mellitus (T2DM) after seven-year intensive multifactorial intervention,including glucose-lowering, blood pressure-lowering, lipid regulation andanti-inflammation. To explore the correlation between serum Hcy and CC-IMT.Patients and methods:1. Study subjects: A total of138type2diabetic patiens with duration of lessthan1year and without arteriosclerotic disease enrolled from the inpatient or outpatientof the endocrine department of the First Affiliated Hospital of Dalian MedicalUniversity from April2002to December2003, were randomized into two groups:(1)intensive multifactorial intervention group (intensive group),70cases,(M36, F34),age49.61±8.39years.(2) conventional intervention group (conventional group),68cases,(M34, F34), age50.67±6.83years. According to the CC-IMT of the last visitand the final macro vascular events, all the patients completed the7-year follow-upwere divided into2groups:(1) atherosclerosis group (Group AS),43cases,(male23,female20), age56.69±5.51years.(2) non-atherosclerosis group (Group Non-AS),95cases,(male49, female46), age57.22±7.98years. T2DM were diagnosed according toAmerican Diabetes Association (ADA) criteria published in1997. All cases presentedno evidence of cardiovascular, cerebrovascular, renovascular disease, any otheratherosclerosis, acute diabetic complications, chronic liver or kidney disease, tumorhistory, autoimmune diseases, pregnancy and lactation.2. Research methods: Patients in intensive group recieved intensive multifactorialintervention targeting ideal blood glucose (BG), glycosylated hemoglobin (HbA1c), blood pressure(BP), serum lipid, and were rcommended a health lifestyle every month,with free drugs were provided. Patients in conventional group received loose outpatientmanagement without intensive intervention targets, and the drugs were not providedfreely. Height, weight, body mass index (BMI); Systolic blood pressure(SBP), diastolicblood pressure (DBP) were record. Fasting plasma glucose (FPG), HbA1c, totalcholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C), lowdensity lipoprotein cholesterol (LDL-C) and Hcy were measured, and all the bloodsamples were gathered from elbow vein blood after overnight fasting for10hours.Ultrasonographic scanning of the common carotid artery was performed by designatedphysicians who were unaware of the clinical characteristics of the subjects. Compare thecharacteristics of each group and explore the correlation between serum Hcy andCC-IMT.3. Statistical analysis methods: Microsoft Excel was used to establish database,SPSS19.0software was used for statistical analysis. Data followed normal distributionwere presented as x±s. Differences between two groups were accessed by Student’sindependent t test. Enumeration data were compared with the chi-square test.Correlation analysis using Pearson correlation analysis and multivariate regressionanalysis were performed to explore the relationgship between CC-IMT and otherbiochemical charateristics. P<0.05was considered as statistically significance.Results:1. After one-year intervention, CC-IMT (0.78±0.14vs0.84±0.15mm), DBP(78.73±9.74vs78.91±7.30mmHg), LDL-C (2.56±0.55vs2.62±0.61mmol/L), HDL-C(1.08±0.33vs1.14±0.25mmol/L), TG (1.55±1.29vs1.62±1.12mmol/L) were lower inintensive group than those in conventional group; BMI (23.48±2.31vs24.15±2.13kg/m2)were higher in intensive group than those in conventional group, there were nosignificant differences (P>0.05). Serum Hcy (4.13±1.99vs8.92±4.11μmol/L), SBP(121.58±14.21vs123.45±12.42mmHg), TC (4.42±0.73vs5.01±1.15mmol/L), HbA1c(5.44±0.56%vs7.81±0.65%), FPG (6.86±1.43vs6.95±1.03mmol/L) were significantlylower in intensive group than those in conventional group (P<0.05).2. After seven-year intervention, DBP (76.20±4.43vs79.44±8.47mmHg), LDL-C(2.75±0.43vs3.03±0.19mmol/L), HDL-C (1.02±0.20vs1.10±0.37mmol/L), TG(1.70±1.23vs1.83±1.06mmol/L), BMI (23.77±2.45vs24.90±2.45kg/m2) levels werelower in intensive group than those in conventional group, there were no significant differences (P>0.05). CC-IMT（0.94±0.15vs1.35±0.15mm）, Serum Hcy (4.26±2.96vs8.82±3.11μmol/L), SBP (120.72±9.61vs127.78±12.13mmHg), TC (4.57±0.84vs5.10±1.21mmol/L), HbA1c (7.13±1.22%vs7.98±1.95%), FPG (7.36±1.37vs8.33±1.23mmol/L) were significantly lower in intensive group than those in conventional group(P<0.05).3. After seven-year intervention, there were43patients in AS group, among which31patients came from conventional group, the prevalance of atherosclerosis was45.59%, and12patients came from the intensive group, the prevalance ofatherosclerosis was17.14%(2=10.23, P<0.005). Serum Hcy levels(3.42±2.59vs7.07±2.36μmol/L) and age (56.22±7.98vs57.69±5.51years) were significantly lower inNon-AS group than those in AS group (P<0.05).4. Pearson correlation analysis indicated that serum Hcy levels were positivelycorrelated with CC-IMT (r=0.359, P=0.025).5. Multivariate regression analysis indicated that CC-IMT was positivelycorrelated with seum Hcy (r=0.022, P=0.008), age (r=0.006, P=0.028), BMI (r=0.024,P=0.020), TC (r=0.118, P=0.006), and negatively correlated with HDL-C (r=-0.303,P=0.034), SBP (r=-0.003, P=0.046).Conclusions:1. The serum levels of Hcy are positively correlated with the CC-IMT in patientswith type2diabetes, and the serum Hcy is an independent risk factor for the CC-IMT inpatients with T2DM.2. Multifactorial intensive intervention in patients with short-duration type2diabetes can delay the progress of CC-IMT accompaned with lowering of the serumHcy levels. |
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