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Plasma
Homocysteine Concentrations in Diabetic Foot Ulcer Patients
Mamdouh El-Nahas(1), Hanan Gawish(1), Manal
Tarshoby(1), Omnia State(1) & Mohamed Atwa(2)
Departments of Internal Medicine(1)
& Clinical Pathology(2), Faculty of Medicine, Mansoura
University, Egypt
Tanta Med. Sc. J 2009; 4(3):60-69
ICID: 903261
Article type: Original articleIC™ Value: 4.54
| Abstract provided by Publisher |
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Background/Aim: Ischemic heart diseases and arterial occlusive
diseases are important causes of morbidity and mortality among
diabetic foot ulcer patients. Hyperhomocysteinemia has emerged as a
possible risk factor for the development of macrovascular diseases
in the general population with even greater risk in persons with
diabetes mellitus. However, there are no previous reports on the
relationship of hyperhomocysteinemia with diabetic foot ulcers. The
aim of this work was to study plasma homocysteine levels together
with some other conventional risk factors for atherosclerosis in
diabetic foot ulcer (DFU) patients in comparison to diabetic
patients without foot ulceration. Patients & methods: The study
included 81 patients with type 2 diabetes (42 with DFU and 39
without DFU) and 30 healthy normal subjects of matched age and sex.
We investigated plasma levels of total homocysteine (tHcy) by enzyme
immunoassay, factors involved in homocysteine metabolism (serum
folic acid and vitamin B12 by radioassay) and some conventional risk
factors for atherosclerosis. Results: Fasting tHcy levels were
elevated in diabetic patients compared to the control subjects
(18.499+/-3.907 vs. 10.943+/-1.732 micromol/l, P<0.05). DFU patients
had higher levels of tHcy in comparison to non-DFU patients
(20.097+/-3.636 vs. 16.494+/-3.639 micromol/l, P<0.05). Serum folate
was lower in diabetic patients in comparison to the control subjects
(4.669 +/- 0.866 vs. 6.064 +/- 0.519 ng/ml, p < 0.05). DFU patients
had lower levels of folic acid in comparison to non-DFU patients
(4.269 +/-0.832 vs. 5.123 +/- 0.691 ng/ml, p < 0.05). Serum levels
of vitamin B12 were similar in DFU, non-DFU and control subjects
(192.543 +/- 49.382, 193.136 +/- 44.536 and 198.756+/-39.115 pg/ml
respectively). Urinary albumin excretion was significantly higher in
the DFU patients in comparison to non-DFU patients (262.238
+/-67.591 vs. 184.128 +/- 113.098 mg/24-h urine, p<0.05). Non
significant differences in age, BMI, waist circumference, waist to
hip ratio, HbA1c, total serum cholesterol, LDL-cholesterol,
HDL-cholesterol or serum triglycerides were found in DFU patients in
comparison to non-DFU patients. Conclusion: DFU patients had higher
levels of homocysteine and lower levels of folic acid in comparison
to diabetic patients without DFU. Hyperhomocysteinemia may partially
explain the increased risk of macrovascular complications in DFU
patients.
ICID 903261
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