目的 探讨含甜菜碱型甲基营养素对伴有高同型半胱氨酸(HHcy)血症的糖尿病肾病(DKD)患者肾功能及尿微量 白蛋白(MA)的作用。 方法 选取 2019 年 9 月至 2021 年 1 月就诊的 64 例 DKD 合并 HHcy 患者,随机分为甲基营养素组( n =32)和叶酸甲钴胺组(n = 32),干预 16 周后,比较两组间血糖、血脂、肾功能以及 MA 等指标的差异。 干预效果采用意向性治疗 分析集(ITT)进行分析。 结果 与叶酸甲钴胺组相比,含甜菜碱型甲基营养素组尿素氮(UN)、血肌酐( Scr)、尿酸(UA)、胱抑 素 C(Cys C)、同型半胱氨酸(Hcy)、尿肌酐(UCr)、MA、β2 微球蛋白(Uβ2-MG)、N-乙酰氨基葡萄糖苷酶(NAG)、尿总蛋白 (TP-U)水平及尿白蛋白/ 肌酐比值(ACR)均较对照组下降,均有统计学差异;甲基营养素组估算肾小球滤过率( eGFR)及叶 酸(FA)水平上升幅度优于叶酸甲钴胺组,结果均有统计学差异。 结论 HHcy 可能是影响 2 型糖尿病患者肾功能的因素之一, 含甜菜碱型甲基营养素的合理应用可降低 Hcy 水平、有效保护肾功能,减少 MA 水平。

Objective To explore the effect of betaine-containing methyl nutrients on renal function and urinary microalbuminuria MA in patients with diabetic kidney disease DKD accompanied by hyperhomocysteinemia HHcy . Method Sixty-four patients with DKD and HHcy were recruited from Shenzhen Traditional Chinese Medicine Hospital between September 2019 to January 2021. They were randomly divided into methyl nutrient group n = 21 and folate methylcobalamin group n = 32 . After 16 weeks of intervention the differences in blood glucose blood lipids renal function and MA and other indicators between the two groups were studied. The treatment effect was represented by intention-to-treat analysis. Result Compared with the folate methylcobalamin group urea nitrogen UN serum creatinine Scr uric acid UA cystatin C Cys C homocysteine Hcy urine creatinine UCr MA β2 microglobulin Uβ2 -MG N- acetylglucosaminidase NAG total urinary protein TP -U and urinary albumin / creatinine ratio ACR were significantly decreased in methyl nutrient group containing betaine. The increase of estimated glomerular filtration rate eGFR and folic acid FA in estimated glomerular filtration rate in the methyl nutrient group containing betaine were better than the folate methylcobalamin group with significantly significant differences. Conclusion HHcy may be one of the factors affecting the renal function of patients with T2DM. The reasonable application of betaine-containing methyl nutrients can reduce Hcy levels effectively protect renal function and reduce MA levels.