血清CEA、NSE、CA199、CA153、CA125对2型糖尿病视网膜病变的预测价值

Predictive values of serum CEA,NSE,CA199,CA153 and CA125 in type 2 diabetic retinopathy

目的探讨肿瘤标志物如癌胚抗原(CEA)、神经元特异性烯醇化酶(NSE)、糖类抗原199(CA199)、糖类抗原153(CA153)、糖类抗原125(CA125)在2型糖尿病视网膜病变(DR)患者中的预测价值。方法收集徐州市第一人民医院2019年1月—2019年12月住院的2型糖尿病(T2DM)患者306例,分为糖尿病合并视网膜病变组(DR组,n=134)和未合并视网膜病变组(NDR组,n=172)。比较2组血清肿瘤标志物及病程、年龄、空腹血糖(FPG)、糖化血红蛋白(HbA1c)、C肽、尿微量白蛋白/肌酐(ALB/SCr)、甘油三酯(TG)、总胆固醇(TC)等水平。Spearman法分析DR患者血清肿瘤标志物与一般资料的相关性,Logistic多元回归法分析DR的危险因素,绘制ROC曲线。结果DR组患者年龄、病程、CEA、NSE、CA199、CA153、CA125、ALB/SCr、胱抑素C(Cys-C)、尿素氮(BUN)、HbA1c均明显高于NDR组(P<0.05),C肽、肾小球滤过率(GFR)明显低于NDR组(P<0.05)。DR患者CEA、CA199与HbA1c呈正相关,NSE与TC、低密度脂蛋白(LDL-C)呈正相关,CA125与ALB/SCr、高密度脂蛋白(HDL-C)呈正相关(P<0.05)。不同病程(>10年、1~10年、<1年)DR患者CEA、NSE、CA199、CA153、CA125水平的差异有统计学意义(P<0.05),不同年龄(>60岁、40~60岁、<40岁)DR患者CEA、NSE、CA199、CA153水平的差异有统计学意义(P<0.05)。T2DM病程、ALB/SCr、NSE、CA199、CA125为DR的危险因素(P<0.05,OR>1)。DR患者CEA、NSE、CA199、CA153、CA125诊断曲线下面积(AUC)分别为0.669、0.798、0.674、0.687、0.669(P<0.05),其中NSE对应曲线下面积最大,阈值为11.745,敏感度为82.8%,特异度为67.4%。结论血清NSE、CA199、CA125均为DR的危险因素,CEA、NSE、CA199、CA153、CA125对诊断DR有一定的预测价值,尤其NSE诊断DR的价值最高。

Objective To investigate the predictive values of carcinoembryonic antigen(CEA),neuron specific enolase(NSE),carbohydrate antigen 199(CA199),carbohydrate antigen 153(CA153)and carbohydrate antigen 125(CA125)in patients with type 2 diabetic retinopathy(DR).Methods A total of 306 patients with type 2 diabetes mellitus(T2DM)who were admitted in Xuzhou First People's Hospital from January 2019 to December 2019 were enrolled.They were divided into two groups:a diabetic retinopathy(DR)group(n=134)and a non-DR(NDR)group(n=172).Both groups were compared for the levels of serum tumor markers,and disease duration,age,fasting plasma glucose(FPG),glycated hemoglobin Alc(HbAlc),C peptides,urine microalbumin/serum creatinine(ALB/Scr),triglyceride(TG)and total cholesterol(TC).Spearman analysis was employed to analyze the correlation between serum tumor markers and clinical characteristics.The logistic multiple regression was implemented to analyze the risk factors of DR.A receiver operator characteristic(ROC)curve was constructed.Results Patients in the DR group showed remarkable increases in age,disease duration,CEA,NSE,CA199,CA153,CA125,ALB/SCr,Cystatin C(Cys-C),blood urea nitrogen(BUN)and HbA1c,and decreases in C peptides and glomerular filtration rate(GFR),compared with the NDR group(P<0.05).For DR patients,CEA and CA199 were positively correlated with HbA1c,NSE was positively correlated with TC and low-density lipoprotein cholesterol(LDL-C),and CA125 was positively correlated with ALB/SCr and high-density lipoprotein cholesterol(HDL-C)(P<0.05).The levels of CEA,NSE,CA199,CA153,and CA125 were significantly dif-ferent in DR patients with different duration of disease(>10 year,1-10 years,and<1 year)(P<0.05),as well as in DR patients at different ages(>60 year,40-60 years,and<40 year)(P<0.05).The duration of dis-ease,ALB/SCr,NSE,CA199 and CA125 were the risk factors for DR(P<0.05,OR>1).The AUC of CEA,NSE,CA199,CA153 and CA125 in DR patients were 0.669,0.798,0.674,0.687 and 0.669,respectively(P<0.05).The AUC of NSE was higher than other,with a cutoff value of 11.745,a sensitivity of 82.8%and a spe-cificity of 67.4%.Conclusions Serum NSE,CA199 and CA125 are the risk factors of DR.CEA,NSE,CA199,CA153 and CA125 have certain diagnostic value for DR,especially NSE with an optimal value.