同型半胱氨酸和视黄醇结合蛋白4与糖尿病视网膜病变的相关性研究

Correlation analysis of Hcy and RBP4 with diabetic retinopathy

目的检测并分析同型半胱氨酸(homocysteine,Hcy)及视黄醇结合蛋白4(retinol binding protein 4,RBP4)与糖尿病视网膜病变(diabetic retinopathy,DR)的关系,以探讨对特定人群DR的诊断方法。方法选取2014年6月到2015年6月桂林医学院附属医院内分泌科就诊的2型糖尿病患者200例,所有患者进行眼底检查必要时行眼底荧光血管造影(fundus fluorescein angiography,FFA),根据眼底情况分为增殖期糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)组、非增殖期糖尿病视网膜病变(non-proliferative diabetic retinopathy,NPDR)组,以及非糖尿病视网膜病变(non-diabetic retinopathy,NDR)组;检测各组空腹血糖(fasting postprandial glucose,FPG)、餐后2h血糖(2-hour postprandial glucose,2h PG)、糖化血红蛋白(glycosylated hemoglobin,Hb A1c)、血脂、Hcy、RBP4水平。结果 PDR组的Hcy(17.60±4.47)μmol·L^(-1)、RBP4(16.32±3.57)μg·m L^(-1)及NPDR组的Hcy(13.01±2.80)μmol·L^(-1)、RBP4(12.25±2.45)μg·m L^(-1)水平明显高于NDR组的Hcy(6.99±2.33)μmol·L^(-1)、RBP4(8.89±1.90)μg·m L^(-1),且随着DR病情的进展逐渐升高,差异均有统计学意义(均为P<0.05);PDR组病程、2h PG、Hb A1c、TG、LDL-C、Hcy、RBP4水平明显高于NPDR组、NDR组(均为P<0.05)。相关分析显示,2型糖尿病患者的RBP4与病程、年龄、Hb A1c、FPG、2h PG、TC、TG、LDL-C、Hcy呈显著正相关,与HDL-C呈负相关。对DR的危险因素进行多元回归分析结果显示,病程、Hb A1c、RBP4、Hcy是影响DR的主要危险因素。结论测定Hcy及RBP4可及早发现DR,为早期筛查及治疗提供一定的方向。

Objective To investigate the relationship of diabetic retinopathy with homocysteine（Hcy） and retinol binding protein 4（RBP4）. Methods A total of 200 T2D Mpatients were chosen from the Endocrinology Department at Affiliated Hospital of Guilin Medical College during June 2014 and June 2015. According to funds examination or fundus fluorescein angiography（FFA）,all patients were divided into three groups： proliferative diabetic retinopathy（PDR）group,non-proliferative diabetic retinopathy（N PDR） group and non-diabetic retinopathy（NDR） group. All of patients were subjected to measure the fasting postprandial glucose（FPG）,2-hour postprandial glucose（2h PG）,glycosylated hemoglobin（HbA1c）,lipids,Hcy and RBP4. Results The Hcy and RBP4 levels in PDR group were（17. 6 ± 4. 47） μmol·L^（-1）and（16. 32 ± 3. 57） μg·m L^（-1）,NPDR group were（13. 01 ± 2. 8） μmol·L^（-1）and（12. 25 ±2. 45） μg·m L^（-1）,NDR group were（6. 99 ± 2. 33） μmol·L^（-1）and（8. 89 ± 1. 9） μg·m L^（-1）,the Hcy and RBP4 levels gradually increased as D R progressed（all P 〈 0. 05）. The duration and levels of 2h PG,HbA1c,TG,LDL-C,Hcy and RBP4 in PDR group were higher than those in NPDR and NDR groups（all P 〈 0. 05）. Correlation analysis showed that RBP4 were significant positive correlated with duration,age,HbA1 c,FPG,2h PG,TG,TC,LDL-C,Hcy,and was negative correlated with HDL-C（P 〈 0. 01）. Risk factors for multiple stepwise regression analysis showed that duration,HbA1c,Hcy and RBP4 were major risk factors affecting DR. Conclusion Measuring the Hcy and RBP4 levels can early detect the DR,which provide a certain way for screening and treating.