【摘要】目的探讨同型半胱氨酸(Hcy)和胱抑素C(Cys-C)与糖尿病周围神经病变(DPN)的相关性。方法选取2009年1月至2013年10月于我院就诊的T2DM患者248例，根据2010年版《中国2型糖尿病防治指南》诊断标准将对象分为亚临床糖尿病神经病变组(SDPN组)80例，糖尿病神经病变组(DPN组)52例和单纯T2DM组(T2DM组)116例。检测各组Hcy、Cys-C、FPG、HbA1c、TG及TC等水平。结果3组年龄、性别比、BMI、FPG、TG、TC、HDL-C和LDL-C、SBP、DBP及血清肌酐(Scr)差异无统计学意义(P>0.05)。与T2DM组比较，SDPN组和DPN组病程、Hcy和Cys-C升高(P<0.05或P<0.01)，且DPN组Hcy高于SDPN组(P<0.05)。SDPN组和DPN组正中神经运动神经传导速度(MCV)和感觉神经传导速度(SCV)、腓总神经MCV和SCV较T2DM组降低(P<0.05或P<0.01);DPN组中神经MCV和SCV、腓总神经MCV和SCV较SDPN组低(P<0.05或P<0.01)。SDPN组和DPN组正中神经F波潜伏期和腓总神经H反射潜伏期较T2DM组升高(P<0.05或P<0.01);DPN组正中神经F波潜伏期腓总神经H反射潜伏期较SDPN组高(P<0.05或P<0.01)。Logistic回归分析显示，Hcy、Cys-C、病程SBP和HbA1c是DPN的独立影响因素。结论 SDPN组和DPN组神经反射潜伏期延长，MCV和SCV减慢，且血浆Hcy与肌电图各参数相关，提示血浆Hcy与神经传导异常相关，说明血浆Hcy可作为DPN的预测因子与危险因素。DPN及SDPN患者Cys-C浓度升高，且与Hcy水平相关，提示Cys-C可能与Hcy共同作用，加重DPN。

　　【关键词】同型半胱氨酸;胱抑素C;糖尿病周围神经病变;糖尿病，2型

　　[Abstract] Objective To investigate the correlation of homocysteine and cystatin C with diabetic peripheral neuropathy. Methods 248 patients with T2DM treated in our hospital during January 2009 to October 2013 were selected, and were divided into sub-clinical diabetic peripheral neuropathy group (SDPN group，n=80), 52 cases with diabetic neuropathy (DPN group) and 116 cases with simple T2DM group (T2DM group).The levels of Hcy, Cys-C, FPG, HbA1c, TG, and TC were detected in each group. Results Age, sex, BMI, FPG, TG, TC, HDL-C and LDL-C, SBP, DBP, and Scr had no significant difference among the three groups (P > 0.05). Compared with the T2DM group, the disease course, Hcy and Cys-C in SDPN group and DPN group were increased (P < 0.05 or P < 0.01), and Hcy was higher in DPN group than in SDPN group (P < 0.05). Motor nerve conduction velocity (MCV) in median nerve and sensory nerve conduction velocity (SCV), common peroneal nerve MCV and SCV were lower in the SDPN group and DPN group than in the T2DM group (P < 0.05 or P < 0.01). The median nerve MCV and SCV, common peroneal nerve MCV and SCV were lower in DPN group than in the SDPN group (P < 0.05 or P < 0.01). The median nerve F-wave latency and common peroneal nerve H reflex latency were higher in SDPN group and the DPN group than in the T2DM group (P < 0.05 or P < 0.01). The median nerve F-wave latency and common peroneal nerve H reflex latency were higher in DPN group than in SDPN group (P < 0.05 or P < 0.01). Logistic regression analysis showed that Hcy, Cys-C, course of disease, SBP and HbA1c were independent influencing factors for DPN. Conclusion The nerve reflex latency is prolonged and the MCV and SCV slow down in SDPN group and DPN group, and plasma Hcy is associated with various parameters of electromyogram (EMG), suggesting that plasma Hcy is associated with nerve conduction abnormalities, and can be described as a predictor and risk factor for DPN. The concentration of Cys-C in DPN and SDPN group is elevated, and is related with the level of Hcy, suggesting that Cys-C possibly aggravates DPN by joint action with Hcy.

　　【Key words】 Homocysteine; Cystatin C; Diabetic peripheral neuropathy; Diabetes mellitus, type 2