血浆甘丙肽水平对2型糖尿病性视网膜病变的诊断价值

Diagnosis value of plasma galanin in type 2 diabetic retinopathy patients

目的:探讨血浆甘丙肽水平与2型糖尿病性视网膜病变的相关性及诊断价值。方法:245例2型糖尿病患者按照眼底检查结果分为2型糖尿病无视网膜病变组(NDR组)95例,2型糖尿病非增殖性视网膜病变组(NPDR组)78例和2型糖尿病增殖性视网膜病变组(PDR组)72例,另选择65例同期体检中心体检的健康人群作为对照组,统计4组受试对象临床资料,常规检查血糖、血脂等临床指标,酶联免疫吸附测定法检测血浆甘丙肽水平。Logistic回归分析影响NPDR和PDR的危险因素,利用受试者工作曲线(ROC)预测甘丙肽对NPDR或PDR的诊断价值。结果:与对照组比较,NDR组、NPDR组、PDR组收缩压(SBP)、舒张压(FBG)、糖化血红蛋白(HbA1c)、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高敏C反应蛋白(Hs-CRP)、胰岛素抵抗指数(HOMA-IR)、血浆甘丙肽明显升高,高密度脂蛋白胆固醇(HDL-C)明显降低,差异有统计学意义(P<0.05)。与NDR组比较,NPDR组、PDR组糖尿病病程、SBP、HOMA-IR、Hs-CRP、血浆甘丙肽明显升高,差异有统计学意义(P<0.05)。与NPDR组比较,PDR组糖尿病病程、Hs-CRP、血浆甘丙肽明显升高,差异有统计学意义(P<0.05)。NPDR和PDR患者血浆甘丙肽与糖尿病病程、FBG、HbA1c、TC、HOMA-IR和Hs-CRP呈正相关(均P<0.05)。Logistic回归分析显示,HbA1c、HOMA-IR、Hs-CRP、甘丙肽水平是影响NPDR的独立危险因素;糖尿病病程、HbA1c、HOMA-IR、Hs-CRP、甘丙肽水平是影响PDR的独立危险因素(均P<0.05)。甘丙肽诊断NPDR的最佳临界值为21.94ng/L,敏感度为72.0%,特异度为91.6%,ROC曲线下面积(AUC)为0.894(95%CI:0.838~0.936,P<0.05)。甘丙肽诊断PDR的最佳临界值为24.92ng/L,敏感度为69.4%,特异度为86.1%,AUC为0.835(95%CI:0.764~0.892,P<0.05)。结论:血浆甘丙肽是影响NPDR和PDR的独立危险因素,通过检测血浆甘丙肽水平能够为诊断NPDR和PDR提供参考。

Objective：To explore the correlation between plasma galanin levels and type 2 diabetic retinopathy and its diagnostic value.Method：A total of 245 cases of type 2 diabetic patients were divided into no diabetes mellitus retinopathy group（NDR）95 cases,nonproliferative DR group（NPDR）78 cases and proliferative DR group（PDR）72 cases according to the results of fundus examination,another 65 healthy persons who underwent physical examination in medical examination center at same period were selected as the control group,the clinical data of four groups were statistically analyzed.Blood glucose,blood lipids and other clinical indicators were routine examinated,plasma galanin levels were measured by enzyme linked immunosorbent assay.The risk factors of NPDR and PDR were analyzed by Logistic regression,the diagnostic value of galanin and other indicators for NPDR or PDR were used by receiver operating curve（ROC）.Result：Compared with control group,the SBP,FBG,HbA1 c,TG,LDL-C,HOMA-IR,Hs-CRP and galanin in NDR,NPDR and PDR group were significantly increased,HDL-C was significantly lower,and the difference was statistically significant（P〈0.05）.Compared with NDR group,the duration of diabetes,SBP,HOMA-IR,Hs-CRP and galanin in NPDR and PDR group were significantly increased,and the difference was statistically significant（P〈0.05）.Compared with NPDR group,the duration of diabetes,Hs-CRP and galanin in the PDR group was significantly increased,and the difference was statistically significant（P〈0.05）.The plasma level of galanin was significantly positive correlated with diabetes duration,FBG,HbA1 c,TC,HOMA-IR and Hs-CRP（all P〈0.05）.Logistic multivariate regression analysis showed that HbA1 c,HOMA-IR,Hs-CRP and galanin were risk factors for NPDR patients,and duration of diabetes,HbA1 c,HOMA-IR,Hs-CRP and galanin were risk factors for PDR patients（all P〈0.05）.The optimal cut-off value of plasma galanin as an indicator for NPDR diagnosis was projected to be 21.94 ng/L,which yielded a sensitivity was 72.0% and a specificity was 91.6%,with an area under the curve（AUC）was 0.894（95%CI：0.838-0.936,P〈0.05）.The optimal cut-off value of plasma galanin as an indicator for PDR diagnosis was projected to be 24.92 ng/L,which yielded a sensitivity was 69.4% and a specificity was 86.1%,with an area under the curve（AUC）was 0.835（95%CI：0.764-0.892,P〈0.05）.Conclusion：The level of galanin may be a risk factor for NPDR and PDR,and detection of galanin plasma level could provide a reference for the diagnosis of NPDR and PDR.