CTRP3和svacm-1在糖尿病视网膜病变患者血清中的表达水平和临床意义

Expression levels of CTRP3 and sVCAM-1 in the serum of patients with diabetic retinopathy and their clinical significance

【目的】探讨血清补体C1q肿瘤坏死因子相关蛋白3(complement-C1q/TNF-ralated 3,CTRP3)、可溶性血管细胞黏附因子-1(soluble vascular cell adhesion molecule 1,sVCAM-1)在糖尿病视网膜病变(diabetic retinopathy,DR)患者血清中表达水平及临床意义。【方法】选取2016年4月至2017年4月我院收治的96例DR患者为研究对象,其中增殖型糖尿病视网膜病变者42例,单纯型糖尿病视网膜病变者54例,同期选取45例单纯糖尿病患者为对照,40例体检健康者为正常对照组(NC),比较4组一般资料、血糖、血脂指标,采用酶联免疫吸附试验检测血清CTRP3、sVCAM-1水平,分析血清CTRP3、sVCAM-1水平与糖尿病视网膜病变患者一般资料、血糖、血脂指标之间的相关性。【结果】4组患者体质指数、病程、收缩压、空腹血糖、餐后2 h血糖(2 hours postprandial plasma glucose,2hPG)、糖化血红蛋白(glycosylated hemoglobin,HbA1c)、总胆固醇、三酰甘油(triglyceride,TG)、低密度脂蛋白胆固醇(low density lipoprotein cholesterol,LDL-C)、胰岛素抵抗指数(homeostasis model assessment for insulin resistance index,HOMA-IR)比较,差异有统计学意义(P<0.05);DR组血清CTRP3水平明显低于NC组,且随着DR病情加重,血清CTRP3水平呈逐级降低趋势,两两比较差异有统计学意义(P<0.05);DR组血清sVCAM-1水平明显高于NC组,且随着DR病情加重,血清sVCAM-1水平呈逐级升高趋势(P<0.05);Pearson相关性分析结果显示,DR患者血清CTRP3水平与HbA1c、TG、LDL-C、HOMA-IR呈明显负相关(r=-0.436、-0.531、-0.540、-0.528,P<0.05),DR患者血清sVCAM-1水平与TG、病程呈明显正相关(r=0.487、0.562,P<0.05)。多因素Logistic回归分析结果显示,病程、收缩压、2hPG、HbA1c及CTRP3、sVCAM-1是DR发生的独立危险因素。【结论】DR患者血清CTRP3水平明显降低,sVCAM-1水平明显升高,与患者血压、血糖、血脂等指标异常密切相关,可能在DR疾病发生及发展过程发挥重要作用,对临床诊断及治疗DR具有一定指导意义。

【Objective】To explore the expression levels of serum complement C1 q tumor necrosis factor related protein 3（CTRP3）,soluble vascular cell adhesion factor-1（sVCAM-1） in the serum of patients with diabetic retinopathy（DR） and their clinical significance.【Methods】A total of 96 cases with DR treated in our hospital were selected as the study objects from April 2016 to April2017, including 42 cases with proliferative diabetic retinopathy（PDR） and 54 cases with simple diabetic retinopathy（SDR）. In the same period, 45 cases with simple diabetes mellitus（NDM） were selected as control and 40 cases with physical examination as normal control group（NC）. General data, blood glucose, blood lipids were compared among the four groups The serum levels of CTRP3 and sVCAM-1 were detected by Enzyme linked immunosorbent assay（ELISA）, and the correlation was analyzed between serum levels of CTRP3 and sVCAM-1 as well as general data, blood glucose and blood lipids in patients with diabetic retinopathy. 【Results】There was statistically significant difference in body mass index（BMI）, disease duration, systolic blood pressure, fasting blood glucose（FPG）, 2 h postprandial blood glucose（2 hPG）, glycosylated hemoglobin（HbA1 c）, total cholesterol（TC）, triglyceride（TG）, low density lipoprotein cholesterol（LDL-C） and homeostasis model assessment for insulin resistance index（HOMA-IR）（P〈0.05）. Serum CTRP3 level in the DR group was significantly lower than that in the NC group, and with the aggravation of DR, serum CTRP3 level decreased gradually（P0.05）. Serum sVCAM-1 level in the DR group was significantly higher than that in the NC group, and serum sVCAM-1 level increased gradually with the aggravation of DR（P0.05）. Pearson correlation analysis showed that serum CTRP3 of DR was negatively correlated with HbA1 c, TG, LDL-C and HOMA-IR（r=-0.436,-0.531,-0.540,-0.528, P0.05）, and serum sVCAM-1 level of DR was positively correlated with TG and disease duration（r=0.487, 0.562, P0.05）. Multivariate logistic regression analysis showed that course of disease, SBP, 2 hPG, HbA1 c, CTRP3 and sVCAM-1 were independent risk factors for the occurrence of DR.【Conclusion】The serum level of CTRP3 in patients with DR decreases significantly, while the level of sVCAM-1 is significantly elevated, which is closely related to the abnormalities of blood pressure, blood glucose and blood lipids. It may play an important role in the occurrence and development of DR, and has certain guidance for clinical diagnosis and treatment of DR.