目的 探讨2型糖尿病(type 2 diabetes mellitus, T2DM)住院患者高同型半胱氨酸血症对早期肾脏疾病患病风险的影响。方法 本研究为回顾性研究。选取南京江北医院2020年10月至2022年6月收住的T2DM患者306例。根据糖尿病肾脏疾病(diabetic kidney disease, DKD)诊断标准分为单纯T2DM组(n=252)和早期DKD组(n=54),比较两组临床资料。结果 T2DM患者早期肾脏疾病患病率为17.6%。与单纯T2DM组相比,早期DKD组年龄较大、糖尿病病程较长、同型半胱氨酸水平较高、高同型半胱氨酸血症和高血压占比较大,差异有统计学意义(均P<0.05)。多因素Logistic回归分析显示,高同型半胱氨酸血症使T2DM患者早期肾脏疾病患病风险显著增加5.361倍(OR:6.361, 95%CI: 3.043-13.296, P<0.05),且同型半胱氨酸水平与T2DM早期肾脏疾病患病风险呈剂量-反应关系,同型半胱氨酸水平每增加1 μmol/L,T2DM早期肾脏疾病患病风险增加14.1%(OR: 1.141, 95%CI: 1.061-1.227, P<0.05)。结论 T2DM患者高同型半胱氨酸血症显著增加早期肾脏疾病的患病风险,且同型半胱氨酸水平与早期肾脏疾病患病风险增加呈剂量-反应关系。

Objective To study the effect of hyperhomocysteinemia on the risk of early renal disease in hospitalized patients with type 2 diabetes mellitus (T2DM). Methods It was a retrospective study involving 306 T2DM patients admitted to Nanjing Jiangbei Hospital from October 2020 to June 2022. According to the diagnostic criteria of diabetic kidney disease (DKD), they were assigned into simple T2DM group (n=252) and early DKD group (n=54). The clinical data of the two groups were compared. Results The prevalence of early DKD in T2DM patients was 17.6%. Compared with those of simple T2DM group, T2DM patients in early DKD group were significantly older, with longer duration of T2DM, higher level of homocysteine, and higher proportions of hyperhomocysteinemia and hypertension (all P<0.05). Multivariate logistic regression analysis showed that hyperhomocysteinemia significantly increased the risk of early DKD in T2DM patients by 5.361 times (OR=6.361, 95%CI: 3.043-13.296, P<0.05), and the level of homocysteine was dose-dependently correlated with the risk of early DKD in T2DM patients, that was, for every 1 μmol/L increase in homocysteine level, the risk of early DKD in T2DM patients increased by 14.1%(OR=1.141, 95%CI: 1.061-1.227, P<0.05). Conclusion Hyperhomocysteinemia in T2DM patients significantly increases the risk of early DKD, and the level of homocysteine has a dose-response relationship with the increased risk of early DKD.