Relationship Between Homocysteine And Vascular Complications In Type2 Diabetes Mellitus

Objective: The purpose of this study was to investigate the association between serum homocysteine levels and vascular complications of type 2 diabetes mellitus(diabetic nephropathy,diabetic retinopathy,lower limb arterial plaques,and carotid artery plaques).METHODS: A total of 494 T2DM patients who met the inclusion criteria were selected and divided into three groups according to the serum Hcy level: Hcy-L group(Hcy < 10μmol/L),Hcy-M group(10 μmol/L≤ Hcy ≤15 μmol/L)and Hcy-H group(Hcy > 15μmol/L).The differences of clinical basic data and laboratory indicators among different groups were compared.The patients were divided into two groups according to whether the patients were combined with Diabetic kidney disease(DKD).The differences in clinical data and laboratory indicators between the two groups were compared,and the correlation between the prevalence of DKD and the level of Hcy was investigated by binary Logistic regression analysis.The two groups were divided into two groups based on whether Diabetic retinopathy(DR)was combined and the clinical data and laboratory indicators were compared between the two groups.The patients were divided into two groups according to whether the patients were complicated with diabetic retinopathy(DR),and the clinical data and laboratory indexes were compared between the two groups.The patients were divided into two groups according to the presence or absence of lower limb arterial plaques,and the clinical data and laboratory indexes were compared between the two groups.The patients were divided into two groups according to the presence or not of carotid artery plaque,and the clinical data and laboratory indexes were compared between the two groups.The ROC curve was used to predict the Hcy level of T2DM patients with different vascular complications.Results: 1.There was a correlation between Hcy value and gender in T2DM patients.The number of female in Hcy-L group was greater than that of male,and the number of male in Hcy-M and Hcy-H group was greater than that of female(P < 0.05).The levels of BMI,SUA,SCR and CP were increased with the increase of serum Hcy(P < 0.05),while the levels of HDL-C and GFR were decreased with the increase of serum Hcy(P< 0.05).The proportions of smoking history,history of hypertension,carotid artery plaque and lower limb artery plaque among different Hcy groups were Hcy-M group >Hcy-H group > Hcy-L group,and there were significant differences among the three groups(P < 0.05).2.Compared with the non-DR group,T2DM patients with DR group had higher systolic blood pressure,higher Hb A1 c,longer course of disease,lower CP,and easier to be complicated with DKD(P < 0.05).There was no statistical difference in Hcy value between the two groups(P > 0.05).3.The incidence of DKD increased with the increase of serum Hcy level,and Hcy-H group > Hcy-M group > Hcy-L group(P < 0.05).Compared with the non-DKD group,T2DM patients with DKD group had older age,longer course of disease,higher systolic blood pressure and higher Hcy value(P < 0.05).4.For every 1μmol/L increase in serum Hcy,the risk of DKD in T2DM patients increased by 5%;The risk of DKD in T2DM patients increased by 4.8% for every1μmol/L increase in serum Hcy after the factors such as age,course of disease and BMI were removed.After controlling for hypertension history,systolic blood pressure,TG,HDL-C,DR,carotid artery plaque,lower limb artery plaque and other factors,the risk of DKD in T2DM patients increased by 4.6% for every 1μmol/L increase in serum Hcy.5.Compared with the non-carotid plaque group,T2DM patients with carotid plaque group were older,had longer disease course,had higher systolic blood pressure,higher Hcy,higher SCR,lower TG,lower GFR,and had more people with history of hypertension,and were more prone to DKD,DR and lower limb artery plaques(P <0.05).T2DM patients with lower extremity artery plaque group were older,longer course of disease,higher systolic blood pressure,higher Hcy,higher SCR,lower GFR,and more patients with history of hypertension than those without lower extremity artery plaque group,and were more likely to develop DKD,DR and carotid artery plaque(P < 0.05).6.ROC curve results showed that the critical serum Hcy values of lower limb artery plaque,carotid artery plaque and DKD in T2DM patients were 14.08 μmol/L,14.16μmol/L and 15.29 μmol/L,respectively.CONCLUSIONS: The higher serum Hcy level in T2DM patients,the more likely they are to have vascular lesions(DKD,carotid artery plaque,lower limb artery plaque),but there is no correlation between DR and Hcy value.Hcy may be an independent risk factor for DKD in T2DM patients.When Hcy values exceed 14.08 μmol/L,patients with T2DM should be alert to the risk of vascular complications(lower extremity arterial plaques,carotid artery plaques,DKD).