血清视黄醇结合蛋白4在2型糖尿病视网膜病中的价值

Serum retinal binding protein 4 in type 2 diabetic retinopathy

目的 通过测定正常糖调节者、合并与未合并糖尿病视网膜病(DR)的2型糖尿病(T2DM)患者血清视黄醇结合蛋白4(RBP4)浓度以及视黄醇结合蛋白4/甲状腺素转运蛋白(RBP4/TTR)比值探讨RBP4在DR中的意义.方法 选取2008年1月至9月苏州大学附属第一医院内分泌科收治的72例2型糖尿病住院患者,应用酶联免疫法和全自动生化分析仪检测35例合并DR的T2DM患者(DR组)血清RBP4、TTR、真胰岛素、C肽、糖化血红蛋白等,并与37例非DR的2型糖尿病患者(NDR组)和30名正常糖调节者(NGR组)作横断面对照.所有入选对象均符合以下标准:(1)排除肝肾疾病,并且入院后生化检查无肝酶、胆红素、白蛋白及球蛋白异常;尿蛋白/尿肌酐＜0.2,肾小球滤过率＞90 ml/min;(2)无营养不良及体重指数(BMI)＜19 kg/m2;(3)无感染及应激状态,且血清超敏C反应蛋白＜3.0 mg/L;(4)1个月内未服用维生素A、铁剂及影响其代谢的药物.采用方差分析、t检验、二元Logistic回归等进行统计学分析.结果 DR组RBP4/TTR较NDR组及NGR组显著增高(0.12±0.06、0.09±0.04、0.072±0.021,F=9.562,P＜0.05).DR组RBP4与NGR组比较差异有统计学意义[(16±4)、(13±3)mg/L,t=3.74,P＜0.05],但与NDR组无统计学差异[(15±4)、(15±3)mg/L,t=1.73,P＞0.05].分别将RBP4和RBP4/TTR引入二元Logistic回归分析,发现RBP4(B=0.214,OR=1.239,P＜0.05)和RBP4/TTR(B=0.718,OR=2.051,P＜0.05)均为DR的危险因素.结论 血清RBP4可能在T2DM发生DR的过程中起作用;血清RBP4/TTR比值在评估DR危险因素时的价值要优于血清RBP4浓度.

Objective To study the meaning of serum retinal binding protein 4 in type 2 diabetes with diabetic retinopathy. Methods Serum RBP4 and transthyretin (TTR) of 35 patients with diabetic retinopathy (DR) were crosssectionally measured by enzyme linked immunosorbent assay (ELISA). Thirtyseven diabetic patients without diabetic retinopathy (NDR) and 30 nondiabetic subjects (NGR) were enrolled as controls. In each subject, fasting values of glucose, insulin, total cholesterol ( TC), triglyceride (TG), low density lipoprotein (LDL), high density lipoprotein (HDL), C-reactive protein (CRP), and HbA1c were determined. Results Serum RBP4 level in patients with DR was significantly higher than that in NGR( ( 15 ± 4 ) mg/L, ( 13 ± 3 ) mg/L, t = 3.74, P ＜ 0.05 ), but there was no difference between patients with and without DR ( ( 15 ± 4) mg/L, ( 15 ± 3 ) mg/L, t = 1.73, P = 0.073 ). However, the RBP4/TTR ratio in patients with DR was markedly increased than that NDR and NGR (0.12 ±0.06,0.09 ±0.04 and 0.072 ± 0.021, F = 9.562, both P ＜ 0.05 ). In addition, RBP4 and the RBP4/TTR ratio were analyzed respectively according to Binary Logistic Backward·RBP4 ( B = 0.214, OR = 1.239, P ＜ 0.05 ) and RBP4/TTR ratio ( B = 0.718, OR = 2.051, P ＜ 0.05 ) were found to be the risk factors for diabetic retinopathy, and the RBP4/TTR ratio was more contributive than serum RBP4 concentration in type 2 diabetes companied with diabetic retinopathy. Conclusions The RBP4/TTR ratio is more valuable than serum RBP4 concentration to evaluate risk factor of diabetic retinopathy, and RBP4 may be a novel causative agent for diabetic retinopathy of type 2 diabetes mellitus.