血清脂联素及尿酸水平与2型糖尿病视网膜病变的相关性研究

Correlation between the level of serum adiponectin and uric acid and retinopathy in type 2 diabetes mellitus

目的观察2型糖尿病(type 2 diabetes mellitus,T2DM)患者血清脂联素及尿酸水平变化,初步探讨其与糖尿病视网膜病变(diabetic retinopathy,DR)的相关性。方法回顾性分析2017年6月至2019年6月在青岛市中心医院内分泌科住院治疗的120例T2DM患者的临床资料,根据眼底结果分为无DR组(40例)、增生型DR组(45例)、非增生型DR组(35例),同期选取健康体检者30例作为对照组。比较4组受试者实验室生化指标、血清脂联素及尿酸水平。多因素Logistic回归分析影响DR的危险因素。结果4组受试者总胆固醇(cholesterol total,TC)比较差异无统计学意义(P>0.05),空腹血糖(fasting blood-glucose,FPG)、甘油三酯(glycerin trilaurate,TG)、低密度脂蛋白胆固醇(low density lipoprotein cholesterol,LDL-C)、高密度脂蛋白胆固醇(high density lipoprotein cholesterol,HDL-C)、糖化血红蛋白(glycosylated hemoglobin,HbA1c)比较差异有统计学意义(F=1.638、0.582、2.715、5.382、5.174,P=0.007、0.016、0.028、0.003、0.001);无DR组、非增生型DR组及增生型DR组TG、HbA1c、FPG均显著高于对照组(无DR组vs对照组:t=2.246、12.440、14.539,P=0.028、0.000、0.000;非增生型DR组vs对照组:t=3.127、14.775、14.767,P均=0.000;增生型DR组vs对照组:t=3.349、16.197、12.755,P=0.001、0.000、0.000),且随病情加重而上升。非增生型DR组及增生型DR组HDL-C显著低于对照组(非增生型DR组vs对照组:t=2.113,P=0.040;增生型DR组vs对照组:t=2.778,P=0.007),且随病情加重而下降。4组血清脂联素及尿酸水平比较差异具有统计学意义(F=4.728、26.491,P=0.004、0.001),无DR组、非增生型DR组及增生型DR组血清脂联素水平均显著低于对照组(无DR组vs对照组:t=2.227,P=0.031;非增生型DR组vs对照组:t=5.198,P=0.000;增生型DR组vs对照组:t=6.827,P=0.000),且随病情加重而下降。无DR组、非增生型DR组及增生型DR组血清尿酸水平均显著高于对照组(无DR组vs对照组:t=5.681,P=0.000;非增生型DR组vs对照组:t=13.688,P=0.000;增生型DR组vs对照组:t=23.620,P=0.000),且随病情加重而上升。多因素Logistic回归分析结果显示,糖尿病病程、HbA1c、脂联素及尿酸是影响DR的独立危险因素。结论DR患者血清脂联素水平降低,尿酸水平升高,且与DR进展相关,脂联素和尿酸是影响DR的危险因素。

Objective To observe the changes of serum adiponectin and uric acid levels in patients with type 2 diabetes mellitus(T2DM),and to investigate its correlation with diabetic retinopathy(DR).Methods Data of 120 hospitalized T2DM patients in our hospital from Jun.2017 to Jun.2019 were retrospectively analyzed.According to the fundus findings,they were divided into no DR group(40 cases),hyperplastic DR group(45 cases)and non-proliferative DR group(35 cases).30 healthy cases in the same period were selected as the control group.The level of aboratory biochemical indexes,serum adiponectin and uric acid were compared between the 4 groups.Risk factors affecting DR were analyzed by Logistic multivariate regression.Results There was no significant difference in TC among the four groups(P>0.05).There were significant differences in TG,LDL-C,HDL-C,HbA1c,and FPG among the four groups(F=1.638,0.582,2.715,5.382,5.174,P=0.007,0.016,0.028,0.003,0.001).TG,HbA1c,and FPG of DR group,non-proliferative DR group and proliferative DR group were significantly higher than those of the control group(no DR group vs the control group:t=2.246,12.440,14.539,P=0.028,0.000,0.000;Non-hyperplastic DR group vs the control group:t=3.127,14.775,14.767,P=0.000;Hyperplastic DR group vs the control group:t=3.349,16.197,12.755,P=0.001,0.000,0.000),and the level of these indexes were rising with the aggravation of the disease.HDL-C of DR group,non-proliferative DR group and proliferative DR group were significantly lower than that of the control group(non-hyperplastic DR group vs the control group:t=2.113,P=0.040;DR group vs the control group:t=2.778,P=0.007),and decreased with the aggravation of the disease.There were significant differences in the level of serum adiponectin and uric acid among the four groups(F=4.728,26.491,P=0.004,0.001).The level of serum adiponectin was significantly lower in no DR group,non-proliferative DR group and proliferative DR group than that in the control group(no DR group vs the control group:t=2.227,P=0.031;Non-hyperplastic DR group vs the control group:t=5.198,P=0.000;Hyperplastic DR group vs the control group:t=6.827,P=0.000),and decreased with the aggravation of the disease.The level of serum uric acid in the DR group,non-proliferative DR group and proliferative DR group were significantly higher than those in the control group(No DR group vs the control group:t=5.681,P=0.000;Non-hyperplastic DR group vs the control group:t=13.688,P=0.000;Hyperplastic DR group vs the control group:t=23.620,P=0.000),and increased with the aggravation of the disease.Multivariate Logistic regression analysis showed that the course of diabetes,HbA1c,adiponectin and uric acid were independent risk factors affecting DR.Conclusions The level of serum adiponectin decreases in DR patients,and the level of serum uric acid increases in DR patients,which relates to DR progress.Adiponectin and uric acid are risk factors affecting DR.