不同类型糖尿病视网膜病变患者血清和肽素和几丁质酶1水平的变化及影响因素

Changes in serum copeptin and chitotriosidase levels in patients with different types of diabetic retinopathy and its factors

目的探讨不同类型糖尿病视网膜病变(diabetic retinopathy,DR)患者血清和肽素和几丁质酶1(Chitotriosidase,CHIT1)水平的变化,并分析其影响因素。方法选取2型糖尿病患者197例作为研究对象,将患者分为:无糖尿病视网膜病变(non-diabetic retinopathy,NDR)组、非增生型糖尿病视网膜病变(non-proliferative diabetic retinopathy,NPDR)组、增生型糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)组;另选取同期在我院进行体检的健康体检者60人作为正常对照(normal control,NC)组。收集所有受试者的一般资料,抽取受试者晨起空腹静脉血5 mL,检测总胆固醇、甘油三酯、谷草转氨酶、谷丙转氨酶、血肌酐及空腹血糖(fasting plasma glucose,FPG)、糖化血红蛋白(hemoglobin Alc,HbA1c)、空腹胰岛素(fasting plasma insulin,FINS)水平,用稳态模型评估法计算胰岛素抵抗指数(homeostasis model assessment for insulin resistance,HOMA-IR),计算肾小球滤过率。采用ELISA法测定血清和肽素和CHIT1含量。结果NDR组、NPDR组、PDR组患者血清的和肽素、CHIT1含量均高于NC组,且随着DR病情进展逐渐升高,差异均有统计学意义(均为P<0.05);与NC组相比,NDR组、NPDR组、PDR组患者的FPG、HbA1c、HOMA-IR水平均依次升高,PDR组最高,差异均有统计学意义(均为P<0.05);各组受试者的总胆固醇、甘油三酯、谷草转氨酶、谷丙转氨酶、血肌酐、肾小球滤过率、FINS水平组间比较,差异均无统计学意义(均为P>0.05)。Pearson相关性分析结果显示:血清和肽素含量与年龄、DM病程、SBP、FPG、HbA1c、HOMA-IR、CHIT1含量均呈正相关(r分别为0.11、0.75、0.52、0.83、0.88、0.58、0.96,均为P<0.05);血清CHIT1含量与年龄、DM病程、SBP、DBP、FPG、HbA1c、FINS、HOMA-IR、和肽素含量呈正相关(r分别为0.12、0.77、0.48、0.12、0.84、0.88、0.14、0.61、0.96,均为P<0.05)。多元线性逐步回归分析结果显示:HbA1c、SBP、FPG是血清和肽素含量的独立影响因素,HbA1c、FPG、DM病程、HOMA-IR是血清CHIT1含量的独立影响因素。结论DR患者的和肽素和CHIT1水平显著升高,且与DR的程度相关,二者可能共同参与了DR的发生发展。

Objective To investigate the changes in serum copeptin and chitintriosidase(CHIT1)levels in patients with different types of diabetic retinopathy(DR)and its factors.Methods Totally 197 patients with type 2 diabetes mellitus were enrolled in the study,then the patients were divided into non-diabetic retinopathy(NDR)group,non-proliferative diabetic retinopathy(NPDR)and proliferative diabetic retinopathy(PDR)group;meanwhile another 60 healthy subjects who underwent physical examination in our hospital as the normal control(NC)group.Furthermore,clinical data of all subjects were collected.After 8 h-10 h of overnight fasting,5 mL venous blood samples were collected for measuring the total cholesterol,triglyceride,aspartate aminotransferase,alanine aminotransferase,serum creatinine,fasting plasma glucose(FPG),hemoglobin Alc(HbA1c)and fasting plasma insulin(FINS),the insulin resistance index(HOMA-IR)was calculated by the homeostasis model assessment,and the glomerular filtration rate was calculated.In addition,plasma copeptin and CHIT1 levels were determined by ELISA.Results The blood copeptin and CHIT1 concentrations of patients in NDR group,NPDR group and PDR group were increased gradually as DR progressed,all of which were higher than those in NC group,the difference was statistically significant(all P<0.05).Moreover,compared with the NC group,the FPG,HbA1c,and HOMA-IR levels of the NDR group,NPDR group and PDR group elevated in turn,simultaneously the highest was the PDR group,the difference was statistically significant(all P<0.05).There were no significant differences in the total cholesterol,triglyceride,aspartate aminotransferase,alanine aminotransferase,serum creatinine,glomerular filtration rate,and FINS levels between the groups(all P>0.05).Pearson correlation analysis showed that serum copeptin levels were positively correlated with age,diabetes duration,systolic blood pressure,FPG,HbA1c,HOMA-IR,CHIT1(r=0.11,0.75,0.52,0.83,0.88,0.58,0.96,all P<0.05),and plasma CHIT1 levels were positively correlated with age,diabetes duration,systolic blood pressure,diastolic blood pressure,FPG,HbA1c,FINS,HOMA-IR,copeptin(r=0.12,0.77,0.48,0.12,0.84,0.88,0.14,0.61,0.96,all P<0.05).Further multiple regression analysis displayed that HbA1c,systolic blood pressure,FPG were independent influencing factors for serum copeptin levels.Meanwhile,HbA1c,FPG,diabetes duration and HOMA-IR were independent influencing factors for serum CHIT1 levels.Conclusion It is found that the levels of copeptin and CHIT1 in patients with DR are significantly elevated and are related to the degree of DR,both which may be involved in the development of DR.