2型糖尿病视网膜病变患者血清ZAG、Egr-1、CMKLR1水平与糖脂代谢和胰岛素抵抗的关系及其影响因素

Relationship between serum ZAG,Egr-1,CMKLR1 levels and glucose and lipid metabolism and insulin resistance in patients with type 2 diabetic retinopathy and their influencing factor

目的分析2型糖尿病视网膜病变(DR)患者血清锌a2糖蛋白(ZAG)、早期生长反应基因1(Egr-1)、趋化因子样受体1(CMKLR1)水平与糖脂代谢和胰岛素抵抗(IR)的关系及其影响因素。方法选取2017年6月至2020年3月期间汉中市人民医院眼科收治的2型糖尿病患者227例作为研究对象,其中DR患者93例(DR组),非DR患者134例(n-DR组),另取同期于我院接受体检的健康志愿者70例为对照组。比较三组受检者的基线资料、血清学指标,采用Pearson相关分析血清ZAG、Egr-1、CMKLR1水平与糖脂代谢和IR的关系,多因素Logistic回归分析发生DR的影响因素。结果三组受检者的收缩压(SBP)、空腹血糖(FBG)、糖化血红蛋白(HbA1c)、胰岛素抵抗指数(HOMA-IR)、血清ZAG、Egr-1、CMKLR1水平比较差异均具有统计学意义(P<0.05),其中n-DR组、DR组患者的SBP、FBG、HbA1c、HOMA-IR、血清Egr-1、CMKLR1水平明显高于对照组,DR组患者的SBP明显高于n-DR组,n-DR组、DR组患者的血清ZAG水平明显低于对照组,且DR组血清ZAG水平明显低于n-DR组,差异均具有统计学意义(P<0.05);DR组病程为(7.85±1.97)年,明显长于n-DR组的(3.12±0.86)年,差异具有统计学意义(P<0.05);经Pearson相关分析结果显示,血清ZAG与FBG、HbA1c、HOMA-IR呈负相关(P<0.05);血清Egr-1与FBG、HbA1c、HOMA-IR呈正相关(P<0.05),血清CMKLR1与FBG、HbA1c、HOMA-IR、FINS呈正相关(P<0.05);多因素Logistic回归分析结果显示,病程、HbA1c、ZAG、Egr-1、CMKLR1是DR的独立影响因素(P<0.05)。结论2型糖尿病DR患者血清Egr-1、CMKLR1水平升高,血清ZAG水平降低,其与糖代谢紊乱和IR具有显著相关性,是DR发生发展的独立影响因素。

Objective To analyze the relationship between serum zinc-alpha 2-glycoprotein(ZAG),early growth response gene-1(Egr-1),chemokine receptor-like 1(CMKLR1)levels and glucose and lipid metabolism and in-sulin resistance(IR)in patients with type 2 diabetic retinopathy(DR)and their influencing factors.Methods A total of 227 patients of type 2 diabetes mellitus,who admitted to Department of Ophthalmology,Hanzhong People's Hospital from June 2017 to March 2020,were selected as the research objects,including 93 DR patients(DR group),and 134 non-DR patients(n-DR group).Another 70 healthy volunteers who received physical examination in Hanzhong People's Hospital during the same period were selected as the control group.The baseline database and serological indicators of the three groups of subjects were compared,and Pearson correlation analysis was used to analyze the relationship be-tween serum ZAG,Egr-1,CMKLR1 levels and glucose and lipid metabolism and IR,and the influencing factors of DR were analyzed by multivariate logistic regression analysis.Results There were significant differences in systolic blood pressure(SBP),fasting blood glucose(FBG),hemoglobin A1c(HbA1c),insulin resistance index(HOMA-IR),serum ZAG,Egr-1 and CMKLR1 levels among three groups of subjects(all P<0.05).The SBP,FBG,HbA1c,HOMA-IR,se-rum Egr-1,and CMKLR1 levels of patients in n-DR group and DR group were significantly higher than those of pa-tients in the control group;the SBP of patients in the DR group was significantly higher than that of patients in the n-DR group,the serum ZAG level of patients in the n-DR group and DR group was significantly lower than that of patients in the control group;the serum ZAG level of patients in the DR group was significantly lower than that of patients in the n-DR group;the differences were statistically significant(all P<0.05).The disease course in the DR group was(7.85±1.97)years,which was significantly longer(3.12±0.86)years in the n-DR group,and the difference was statistically sig-nificant(P<0.05).Pearson correlation analysis showed that serum ZAG was negatively correlated with FBG,HbA1c and HOMA-IR(all P<0.05).Serum Egr-1 was positively correlated with FBG,HbA1c,HOMA-IR(all P<0.05),and serum CMKLR1 was positively correlated with FBG,HbA1c,HOMA-IR and FINS(all P<0.05).Multivariate logistic regres-sion analysis results showed that the disease course,HbA1c,ZAG,Egr-1 CMKLR1 were independent influencing fac-tors of DR(all P<0.05).Conclusion The serum Egr-1 and CMKLR1 levels in patients with type 2 diabetes mellitus DR are increased,the serum ZAG level is decreased,which are significantly correlated with glucose and lipid metabo-lism disorder and IR,and they are independent influencing factors for the occurrence and development of DR.