2型糖尿病患者胱抑素C及高敏C反应蛋白与视网膜病变的相关性

Relationship between serum cystatin C,high sensitivity C-reactive protein and retinopathy in the patients with type 2 diabetes

目的分析2型糖尿病视网膜病变(DR)的特点,探讨2型糖尿病患者血清胱抑素C(Cys-C)和高敏C反应蛋白(hs-CRP)的水平与DR的相关性。方法选择325例2型糖尿病患者进行眼底检查或眼底荧光造影,根据2002年国际分级标准将其分为5期,即无明显视网膜病变(1期),轻度非增殖性糖尿病视网膜病变(2期),中度非增殖性糖尿病视网膜病变(3期),重度非增殖性糖尿病视网膜病变(4期),增殖性糖尿病视网膜病变(5期)。记录病程,检测糖化血红蛋白(HbA1c)、hs-CRP、Cys-C、24h尿白蛋白定量(24h-UAE),分析DR各组的特点及相关因素。结果在纳入的病例中,DR的总患病率为47%;与1期相比,2、3、4、5各期的病程,HbA1c,hs-CRP,Cys-C,24h-UAE均显著升高(P<0.05),且依次性升高(P均<0.05);多元回归分析显示,Cys-C、hs-CRP分别是DR患病率及其严重程度的独立危险因素,分别与2型糖尿病患者的患病病程、HbA1c、24h-UAE呈正相关。结论 DR及其病情严重程度与Cys-C、hs-CRP密切相关,Cys-C、hs-CRP有可能成为预测DR发生发展的生物学指标。

Objective To analyze the features of type 2 diabetic retinopathy（DR）,and to explore the relationship between serum cystatin C（Cys-C）,high sensitivity C-reactive protein（hs-CRP） and retinopathy in patients with type 2 diabetes.Method 325 cases of type 2 diabetes patients were recruited to have a fundus examination and fundus fluorescence angiography.Based on the findings,5 groups were establised according to 2002 international classification standard,no obvious retinopathy（group 1）,mild non-proliferating diabetic retinopathy（group 2）,moderately non-proliferating diabetic retinopathy（group 3）,severe non-proliferating diabetic retinopathy（group 4）,and proliferating diabetic retinopathy（group 5）.Clinical courses were monitored,while glycated hemoglobin（HbA1c）,hs-CRP,Cys-C,24-hour urinary albumin quantitative（24h-UAE） were determined.Results In all cases,total DR prevalence accounted for about 47 percent.Compared with the group 1,clinical courses,HbA1c,hs-CRP,Cys-C,24h-UAE in the other four groups were significantly increased（P〈0.05）,in the order from group 2 to 5（P〈0.05）.Multiple regression analysis showed that Cys-C and hs-CRP were independent risk factors for DR prevalence rate and the severity of DR,and were positively correlated with the duration of type 2 diabetes,the sicken HbA1c and 24h-UAE,respectively.Conclusions DR and severity are closely related with Cys-C and hs-CRP.Cys-C and hs-CRP may serve as biological indicators to predict the occurrence and development of DR