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目的探讨中国北方地区糖尿病合并冠心病者同型半胱氨酸(Hcy)及其代谢相关酶亚甲基四氢叶酸还原酶(MTHFR)C677T及胱硫醚β-合成酶(CBS)844 ins 68基因多态性的特点。方法研究对象均为北方汉族人群,包括无血缘关系的70名糖尿病合并冠心病患者、71名糖尿病患者和85名健康人群。应用荧光偏振免疫法(FPIA)测定Hcy水平,应用微粒子酶免分析免疫法(MEIA)测定血浆叶酸、维生素B12浓度,同时测定血脂。应用聚合酶链反应分析MTHFR C677T与CBS844 ins 68基因多态性。结果糖尿病合并冠心病组(DM+CHD组)Hcy中位数为14.8μmol/L,显著高于DM组(11.1μmol/L)和对照组(11.2μmol/L),(P<0.01),DM组与对照组之间差异无显著性(P>0.05)。DM+CHD组的T等位基因频率(45%)明显高于糖尿病组(26.8%)和对照组(31.2%),(P<0.01)。三组CBS844 ins 68的基因型及等位基因频率差异无显著性(P>0.05)。本研究定义Hcy>15μmol/L为高Hcy血症(HHcy)。Logistic回归分析显示HHcy的OR值为4.547(95%CI1.970～10.496),(P<0.01);MTHFR677携带T基因的OR值为2.369(95%CI1.160～4.841),(P=0.018);CBS844 ins 68基因的OR值为0.384(95%CI0.033～4.423),(P=0.443)。结论HHcy、MTHFR677携带T基因可能是中国北方地区汉族人2型糖尿病合并冠心病发生的危险因素。
Objective To investigate the changes of homocysteine (Hcy) and its metabolite-related enzymes, methylenetetrahydrofolate reductase (MTHFR) C677T and cystathionine β-synthase (CBS) 844 ins 68 in diabetic patients with coronary heart disease in northern China. Polymorphism. Methods Subjects were all Han Han population in the north, including 70 non-diabetic diabetic patients with coronary heart disease, 71 diabetes and 85 healthy people. Hcy levels were determined by fluorescence polarization immunoassay (FPIA). Plasma concentrations of folic acid and vitamin B12 were determined by microparticle enzyme immunoassay (MEIA), and blood lipids were measured. Polymerase chain reaction analysis of MTHFR C677T and CBS844 ins 68 gene polymorphisms. Results The median Hcy in DM + CHD group was 14.8μmol / L, which was significantly higher than that in DM group (11.1μmol / L) and control group (11.2μmol / L) (P <0.01) There was no significant difference between the two groups (P> 0.05). The frequency of T allele (45%) in DM + CHD group was significantly higher than that in diabetes group (26.8%) and control group (31.2%) (P <0.01). There was no significant difference in genotype and allele frequency between the three groups (P> 0.05). This study defines Hcy> 15μmol / L as Hcy (HHcy). Logistic regression analysis showed that OR of HHcy was 4.547 (95% CI, 1.70 ~ 10.496) (P <0.01). The OR of MTHFR677 carrying T gene was 2.369 (95% CI1.160-4.841) (P = 0.018) The OR of CBS844 ins 68 gene was 0.384 (95% CI 0.033-4.423) (P 0.443). CONCLUSION: The HHcy and MTHFR677-carrying T genes may be risk factors for type 2 diabetes with coronary heart disease in Han Chinese in northern China.