摘要
目的探讨血清胱抑素C(CysC)和C1q肿瘤坏死因子相关蛋白9(CTRP9)水平对2型糖尿病患者糖尿病视网膜病变(DR)及糖尿病黄斑水肿(DME)的诊断价值。方法采用横断面研究方法,纳入2021年4月至2022年4月在甘肃省人民医院就诊的135例2型糖尿病患者,年龄45~75岁,按照DR分级标准将患者分为无DR(NDR)组、非增生型DR(NPDR)组和增生型DR(PDR)组,每组45例。根据有无DME将NPDR组和PDR组患者分为DME组51例和非DME组39例。另选取45名健康体检者作为正常对照组。采集受检者空腹外周静脉血,检测血清中糖化血红蛋白、空腹血糖、三酰甘油、总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、CysC和CTRP9水平。比较各组CysC和CTRP9表达差异。采用多因素Logistic回归分析模型评估DR及DME的独立影响因素,采用受试者工作特征(ROC)曲线评价血清CysC和CTRP9对DR及DME的诊断价值。结果正常对照组、NDR组、NPDR组和PDR组血清CysC水平分别为0.74(0.67,0.83)、1.03(0.85,1.22)、1.40(0.98,1.63)和1.66(1.31,1.85)mg/L,呈逐渐升高趋势;CTRP9水平分别为(136.90±14.95)、(120.23±16.31)、(109.50±14.71)和(90.99±13.88)pg/ml,呈逐渐降低趋势;组间总体比较差异均有统计学意义(Z=89.430,P<0.001;F=74.242,P<0.001),组间两两比较差异均有统计学意义(均P<0.05)。与非DME组相比,DME组血清CysC水平显著升高、CTRP9水平显著降低,差异均有统计学意义(均P<0.05)。多因素Logistic回归分析结果显示,血清CysC(OR=19.742,95%CI:4.515~86.316,P<0.001)是DR发生的独立危险因素,CTRP9水平(OR=0.937,95%CI:0.908~0.966,P<0.001)是DR发生的保护因素;血清CTRP9水平(OR=0.838,95%CI:0.778~0.903,P<0.001)为DME发生的保护因素。ROC曲线结果显示,血清CysC和CTRP9水平单独及联合诊断2型糖尿病患者并发DR的ROC曲线下面积(AUC)分别为0.798、0.802和0.870,血清CysC和CTRP9水平截断值分别取1.34 mg/L和110.12 pg/ml时可获得最佳诊断效能;其单独及联合诊断DR患者并发DME的AUC分别为0.682、0.923和0.923,血清CTRP9水平的截断值取104.68 pg/ml时可获得最佳诊断效能。结论血清CysC水平升高及CTRP9水平降低是2型糖尿病患者发生DR的危险因素,血清CTRP9水平降低为DR患者发生DME的危险因素之一。
Objective To explore the diagnostic value of serum cystatin C(CysC)and C1q tumor necrosis factor-related protein 9(CTRP9)levels for diabetic retinopathy(DR)and diabetic macular edema(DME)in patients with type 2 diabetes.Methods A cross-sectional study was conducted.A total of 135 patients with type 2 diabetes,aged 45-75 years,who were treated in Gansu Provincial Hospital from April 2021 to April 2022 were included.According to DR grading standard,patients were divided into non-DR(NDR)group,non-proliferative DR(NPDR)group and proliferative DR(PDR)group,with 45 patients in each group.The DR patients were subdivided into DME group(51 cases)and non-DME group(39 cases).A total of 45 healthy subjects were selected as the normal control group.Fasting peripheral venous blood was collected to detect serum glycosylated hemoglobin,fasting blood glucose,triacylglycerol,total cholesterol,high-density lipoprotein cholesterol,low-density lipoprotein cholesterol,CysC and CTRP9 levels.The expression of CysC and CTRP9 levels among different groups were compared.The independent influencing factors of DR and DME were evaluated by multivariate logistic regression analysis model.The diagnostic value of serum CysC and CTRP9 in DR and DME were evaluated by receiver operating characteristic(ROC)curve.This study adhered to the Declaration of Helsinki and the study protocol was approved by the Ethics Committee of Gansu Provincial Hospital(No.2021-301).All patients were informed about the purpose and methods of the study and signed an informed consent form.Results Serum CysC levels in normal control group,NDR group,NPDR group and PDR group were 0.74(0.67,0.83),1.03(0.85,1.22),1.40(0.98,1.63)and 1.66(1.31,1.85)mg/L,respectively,showing a gradually increasing trend,and the serum CTRP9 levels were(136.90±14.95),(120.23±16.31),(109.50±14.71)and(90.99±13.88)pg/ml,respectively,showing a gradually decreasing trend,with statistically significant overall comparison differences among groups(Z=89.430,P<0.001;F=74.242,P<0.001),the comparison within groups was statistically significant(all at P<0.05).Compared with non-DME group,the serum CysC level was significantly increased and serum CTRP9 level was significantly decreased in DME group(both P<0.05).Multivariate logistic regression analysis showed that serum CysC(odds ratio[OR]=19.742,95%confidence interval[CI]:4.515-86.316,P<0.001)was the independent risk influencing factors for the occurrence of DR,and CTRP9(OR=0.937,95%CI:0.908-0.966,P<0.001)was a protective factor for the occurrence of DR.Serum CTRP9 level(OR=0.838,95%CI:0.778-0.903,P<0.001)was a protective factor for DME.The ROC curve showed that the area under ROC curve(AUC)for serum CysC and CTRP9 levels alone and in combination for the diagnosis of DR in patients with type 2 diabetes mellitus complicated by DR were 0.798,0.802 and 0.870,respectively.The cutoff values of serum CysC and CTRP9 levels to obtain the best diagnostic efficacy were 1.34 mg/L and 110.12 pg/ml,respectively.The AUC for serum CysC and CTRP9 level alone and in combination for the diagnosis of DME in DR patients were 0.682,0.923 and 0.923,respectively.The cutoff value of serum CTRP9 level to obtain optimal diagnostic efficacy was 104.68 pg/ml.Conclusions The enhanced expression of serum CysC level and reduced expression of serum CTRP9 level are the risk factors for the development of DR in type 2 diabetes patients.The decrease of serum CTRP9 level is one of the risk factors for the development of DME in DR patients.
作者
张书
景海霞
刘勤
马建军
白惠玲
Zhang Shu;Jing Haixia;Liu Qin;Ma Jianjun;Bai Huiling(Department of Ophthalmology,Gansu Provincial Hospital,Lanzhou 730000,China;The First Clinical Medical College of Gansu University of Traditional Chinese Medicine,Lanzhou 730000,China)
出处
《中华实验眼科杂志》
CAS
CSCD
北大核心
2024年第3期271-278,共8页
Chinese Journal Of Experimental Ophthalmology
基金
兰州市科技计划(2020-ZD-18)
甘肃省卫生行业科研计划(GSWSKY-2019-40)
甘肃省人民医院院内科研基金(20GSSY1-15)。
