血清中期因子联合总胆红素在糖尿病视网膜病变中的诊断价值

Diagnostic value of serum midkine combined with total bilirubin for diabetic retinopathy

目的探讨血清中期因子(MK)、总胆红素(TB)在糖尿病视网膜病变(DR)中的诊断价值。方法将148例T2DM患者按照是否出现DR分为糖尿病无DR组(NDR)50例、非增殖性DR组(NPDR)52例和增殖性DR组(PDR)46例,评价MK和TB在DR中的诊断价值。结果各组年龄、性别、BMI、FPG、HbA_1c、TG、TC、LDL-C、HDL-C、SBP、DBP比较,差异无统计学意义(P>0.05);各组病程、尿白蛋白/肌酐比(UAlb/Cr)、超氧化物歧化酶(SOD)、丙二醛(MDA)、晚期氧化蛋白产物(AOPP)、MK、TB和直接胆红素(DB)比较,差异有统计学意义(P<0.05)。PDR组和NPDR组病程、UAlb/Cr、MDA、AOPP、MK高于NDR组(P<0.05),SOD、TB、DB低于NDR组(P<0.05)。PDR组病程、UAlb/Cr、MDA、AOPP、MK高于NPDR组(P<0.05),SOD、TB、DB低于NPDR组(P<0.05)。Logistic回归分析显示,病程、UAlb/Cr、MDA、AOPP、MK为DR的危险因素(OR值为1.36、1.71、1.27、1.65、2.35,P<0.05),SOD、TB、DB为DR的保护因素(OR值为0.46、0.31、0.46,P<0.05)。TB+MK诊断的敏感性、特异性、阳性预测值、阴性预测值、诊断准确率均高于TB、MK单独诊断效果[曲线下面积(AUC)分别为0.918、0.735、0.762,P<0.05]。结论 DR可能与体内MK升高、TB下降有关,MK联合TB对DR的诊断效能优于MK、TB单一指标。

Objective To investigate the diagnostic value of serum MK（Midkine） and total bilirubin（TB） in diabetic retinopathy（DR）.Methods A total of 148 patients with type 2 diabetes were divided into three groups：diabetes without retinopathy（NDR group,n= 50）,diabetic with non proliferative retinopathy（NPDR group,n = 52） and diabetic with proliferative retinopathy（PDR group,n = 46）according to whether retinal lesions were detected.The diagnostic value of serum MK and TB were investigated.Results Age,gender,body mass index（BMI）,FPG,HbA1 c,TG,TC,LDL-C,HDL-C,SBP.DBP were not statistically different among the three groups（P〉0.05）.Duration,UAlb/Cr,SOD,MDA,AOPP,MK,TB and DB were statistically different among the three groups（P〈0.05）.Duration,ALB/CR,MDA,AOPP,and MK were higher,SOD,TB.DB were lower in PDR and NPDR group than in NDR group（P〈0.05）.Duration,UAlb/Cr,MDA,AOPP,and MK were higher,and SOD,TB,DB were lower in PDR group than in NPDR group（P〈0.05）.Logistic regression analysis showed that duration,ALB/CR,MDA,AOPP,and MK were risk factors（QR= 1.36,1.71,1.27,1.65,2.35,P〈0.05） and SOD,TB,DB were protective factors for DR（QR = 0.46,0.31,0.46,P〈0.05）.Diagnosis sensitivity,specificity,positive predictive value,negative predictive value and accuracy of TB combined with MK were higher than TB,MK alone（AUC= 0.918,0.735,0.762,P〈0.05）.Conclusion DR may be associated with increased MK and decreased TB.Diagnostic efficacy of MK combined with TB is better than MK,TB alone.