血尿酸、胱抑素C 和促代谢因子水平与糖尿病视网膜病变的相关性分析

Correlation between levels of serum uric acid,cystatin C,and betatrophin and diabetic retinopathy

目的分析血尿酸、胱抑素C和促代谢因子水平与糖尿病视网膜病变的相关性。方法选择河南省直第三人民医院2018年5月—2019年5月收治的106例2型糖尿病患者进行研究,根据视网膜病变程度将患者分为无糖尿病视网膜病变组(NDR,n=35)、非增生型糖尿病视网膜病变组(NPDR,n=40)、增生型糖尿病视网膜病变组(PDR,n=31),同时选取同期体检的健康人群为对照组(n=33)。检测各组血尿酸、胱抑素C、促代谢因子水平,分析血尿酸、胱抑素C、促代谢因子水平与糖尿病视网膜病变的相关性,采用Logistic回归模型分析影响糖尿病视网膜病变的因素,采用受试者工作特征曲线(ROC)分析血尿酸、胱抑素C、促代谢因子水平对糖尿病视网膜病变的诊断价值。结果与对照组患者比较,糖尿病视网膜病变组患者的血尿酸、胱抑素C、促代谢因子水平均明显升高(P<0.05),NDR、NPDR、PDR组血尿酸、胱抑素C、促代谢因子水平呈依次升高趋势(P<0.05)。Pearson相关性分析显示,血尿酸、胱抑素C、促代谢因子与糖尿病视网膜病变发生呈明显正相关(r=0.47,P<0.05;r=0.82,P<0.05;r=0.94,P<0.05)。二元Logistic回归模型分析显示,剔除血糖、胰岛素抵抗等因素的影响,血尿酸、胱抑素C、促代谢因子是影响糖尿病视网膜病变的独立危险因素(P<0.05)。血尿酸、胱抑素C、促代谢因子诊断糖尿病视网膜病变的曲线下面积(AUC)分别为0.746(95%CI:0.656~0.836)、0.871(95%CI:0.783~0.959)、0.884(95%CI:0.803~0.966),三者联合诊断AUC为0.964(95%CI:0.935~0.993)明显高于各指标单独检测。结论糖尿病视网膜病变患者血尿酸、胱抑素C、促代谢因子水平异常升高,可能参与了糖尿病视网膜病变发生、发展过程,联合检测三者水平对糖尿病视网膜病变有较好的诊断价值。

Objective To analyze the correlation between levels of serum uric acid(SUA),cystatin C(Cys-C),and betatrophin and diabetic retinopathy(DR).Methods A total of 106 patients with type 2 diabetes mellitus admitted to Third Provincial Hospital of Henan Province from May 2018 to May 2019 were selected for the study.The patients were divided into no DR group(NDR group,n=35),non-proliferative DR group(NPDR group,n=40),and proliferative DR group(PDR group,n=31)according to the degree of retinopathy,and 33 healthy people for physical examination in the hospital at the same period were selected as control group.The levels of SUA,Cys-C,and betatrophin were detected,and the correlation between levels of SUA,Cys-C,and betatrophin and DR was analyzed.Logistic regression model was used to analyze the factors affecting DR.The receiver operating characteristic curve(ROC)was used to analyze the diagnostic value of blood SUA,Cys-C,and betatrophin on DR.Results Compared with control group,SUA,Cys-C,and betatrophin levels in DR group were significantly increased(P<0.05),and the levels of SUA,Cys-C,and betatrophin in NDR group,NPDR group,and PDR group were increased in turn(P<0.05).Pearson correlation analysis showed that SUA,Cys-C,and betatrophin were positively correlated with DR(r=0.47,0.82,and 0.94,P<0.05).Binary logistic regression model analysis showed that SUA,Cys-C,and betatrophin were independent risk factors for DR(P<0.05).AUC values of SUA,Cys-C,and betatrophin in the diagnosis of DR were 0.746(95%CI:0.656—0.836),0.871(95%CI:0.783—0.959)and 0.884(95%CI:0.803—0.966),and the AUC of combined diagnosis of the three was 0.964(95%CI:0.935—0.993),which was significantly higher than that of individual detection(P<0.05).Conclusion The levels of SUA,Cys-C,and betatrophin in patients with DR are abnormally elevated,which may be involved in the occurrence and development of DR.The combined detection of the three levels has a good diagnostic value on DR.