血中同半胱胺酸、維生素B6、B12及葉酸濃度與糖尿病視網膜病變

10.6666/ClinMed.202202_89(2).0013

祝梓芸；邱哲琳；楊妹鳳；楊雀戀

維生素B群（vitamin B complex） ； 同半胱胺酸（homocysteine） ； 單碳代謝（one-carbon pathway） ； 糖尿病視網膜病變（diabetic retinopathy）

臨床醫學月刊

89卷2期（2022 / 02 / 25）

75 - 79

繁體中文

糖尿病會引發許多慢性併發症，其中視網膜病變為糖尿病最主要的小血管併發症之一。研究發現，血漿和眼睛玻璃體的同半胱胺酸濃度上升為糖尿病視網膜病變的危險因子。血漿同半胱胺酸濃度升高，也與大腦及血管發炎增加和血流量減少有關，進而導致中樞神經系統的小血管疾病、血管內皮生長因子分泌增加、內皮功能障礙。系統性回顧與統合分析研究指出，糖尿病患者與一般人相比較，血中維生素B6、B12及葉酸濃度較低，血漿同半胱胺酸濃度較高，尤其在糖尿病視網膜病變患者中此現象更為明顯，可知糖尿病視網膜病變可能與較低的維生素B6、B12及葉酸濃度和較高的同半胱胺酸濃度有關。但目前僅有觀察性研究的統合分析，無法確認糖尿病視網膜病變與維生素B6、B12及葉酸缺乏的因果關係，且目前尚無相關證據證明補充維生素B6、B12或葉酸有助於改善或減輕糖尿病視網膜病變的症狀或降低發生率，亦無研究探討是否需針對糖尿病患者提高建議攝取量。因此，對於糖尿病患者的維生素B6、B12及葉酸仍維持美國糖尿病協會（DRIs）的建議攝取量：維生素B6每日1.5-1.6毫克、B12每日2.4毫克及葉酸400微克與一般人無異，此外，降低糖尿病大小血管併發症之首要仍是維持良好的血糖、血壓及血脂控制。

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