Turkiye Klinikleri Journal of Medical Sciences

.: ORIGINAL RESEARCH
Tip 2 Diabetes Mellituslu Hastalarda Homosistein Düzeylerinin Mikroalbuminüri ve Retinopati Üzerine Etkisi
THE EFFECT OF HOMOCYSTEINE LEVELS ON MICROALBUMINURIA AND RETINOPATHY IN TYPE 2 DIABETES MELLITUS
Kürşat DALa, Serhat İÇAĞASIOĞLUa, Ferhan CANDANa, Taner ERSELCANb, Serdal KORKMAZa, M. Fatih KILIÇLIa
aİç Hastalıkları AD, bNükleer Tıp AD, Cumhuriyet Üniversitesi Tıp Fakültesi, SİVAS
Turkiye Klinikleri J Med Sci. 2006;26(6):617-22
Article Language: TR
Full Text
ÖZET
 Amaç: Diyabetik hastalarda mikro-makrovasküler komplikasyonlar morbidite ve mortalitenin önemli nedenlerindendir. Diyabetteki vasküler hastalık riski, hiperglisemiye bağlı olabilir ancak obezite, hipertansiyon ve hiperlipidemi vasküler hastalık riski için sayılabilecek diğer faktörlerdir. Çeşitli çalışmalar diyabetik hastalarda plazma homosistein düzeyindeki artışın mikro-makrovasküler komplikasyonlarla ilişkili olduğunu göstermiştir. Ancak Tip 2 diyabetik hastalarda gelişen mikroalbüminüri ve retinopatide hiperhomosisteineminin rolü henüz tam açık değildir. Bu çalışmada amacımız, Tip 2 diyabetik hastalarda, açlık plazma homosistein düzeyi ile mikroalbuminüri ve diyabetik retinopati arasındaki ilişkiyi belirlemektir. Gereç ve Yöntemler: Çalışmaya, Haziran 2004 ile Kasım 2004 tarihleri arasında Cumhuriyet Üniversitesi Tıp Fakültesi İç Hastalıkları Anabilim Dalında Tip 2 diyabet tanısı ile takip edilen 70 hasta (24 erkek, 46 kadın, yaşları 35-80 yıl arasında) alındı. Aynı yaş ve cinsiyet grubundan 20 sağlıklı birey kontrol grubu olarak seçildi ve grup 1 olarak adlandırıldı. Tip 2 Diabetes mellitus tanısı ile takip edilen hasta grubu ise, mikroalbuminüri ve retinopati komplikasyonları açısından 4 gruba ayrıldı. Grup 2'de; mikroalbuminüri ve retinopati gelişmemiş 20 hasta, grup 3'te; mikroalbuminüri olan ancak retinopati gelişmemiş 20 hasta, grup 4'te; retinopati olan mikroalbuminüri olmayan 10 hasta, grup 5'te; mikroalbuminüri ve retinopati birlikte olan 20 hasta vardı. Hasta gruplarının ve kontrol grubunun 12 saatlik açlığı takiben plazma homosistein düzeyleri ölçüldü. Bulgular: Homosistein düzeyleri kontrol grubunda 7.66 ± 1.98 µmol/L olarak saptandı. Grup 2'de 9.65 ± 3.42 µmol/L grup 3'te 10.97 ± 3.71 µmol/L grup 4'te 15.06 ± 9.34 µmol/L, grup 5'te 14.71 ± 5.33 µmol/L bulundu. Sonuç: Tip 2 diyabetik hastalarda plazma homosistein düzeyleri grup 4 ve 5'te istatistiksel olarak anlamlı yüksek bulunurken (p= 0.001), grup 3'te kontrol grubu ve grup 2'ye göre artmış homosistein düzeyleri saptandı, ancak istatistiksel olarak anlamlı değildi (p= 0.5).

Anahtar Kelimeler: Homosistein, albuminüri, hipertansiyon, koroner arter hastalığı
ABSTRACT
 Objective: Micro-and macrovascular complications are the most important cause of morbidity and mortality in diabetic patients. The risk of vascular disease in diabetes is associated with hyperglycaemia and other risk factors such as hyperlipidaemia, hypertension and obesity. Several studies indicated that increase in total plasma homocystein levels were associated with micro-macrovascular disease in diabetic patients. However, the role of hyperhomocysteinemia in the development of type 2 diabetic retinopathy and microalbuminuria are still unknown. In this study, our aim was to determine the relationship between the fasting plasma homocysteine levels and the presence of diabetic retinopathy and microalbuminuria in patients with type 2 diabetes. Material and Methods: A total of 70 patients (24 men, 46 women; aged 35-80 years) followed in Cumhuriyet University Faculty of Medicine, Department of Internal Medicine between June 2004 and November 2004 were enrolled in the study. Twenty healthy individuals of the same age and gender formed the control group and was named group 1. The diabetic population was classified in 4 groups with regard to microalbuminuria and retinopathy complications. Group 2 consisted of 20 diabetic patients without microalbuminuria and rethinopathy complications, group 3 consisted of 20 diabetic patients with microalbuminuria and without rethinopathy complications, group 4 consisted of 10 diabetic patients with rethinopathy and without microalbuminuria complications, and group 5 consisted of 20 diabetic patients with microalbuminuria and rethinopathy complications. Venous blood was obtained between 07.00 a.m and 10.00 a.m after an overnight fast. Homocysteine levels of control and study groups were measured. Results: The homocysteine levels were 7.66 ± 1.98 µmol/L in the control group, 9.65 ± 3.42 µmol/L in the second group, 10.97 ± 3.71 µmol/L in the third group, 15.06 ± 9.34 µmol/L in the fourth group and 14.71 ± 5.33 µmol/L in the fifth group. Conclusion: While plasma homocysteine levels were significantly higher in group 4 and 5 in type 2 diabetic patients (p= 0.001), in group 3 homocysteine levels were higher than in the control group and group 2, but this difference was not statistically significant (p= 0.5).

Keywords: Homocysteine, albuminuria, hypertension, coroner artery disease

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