2型糖尿病患者血清CTRP9水平与糖尿病视网膜病变的相关性

Correlation between serum CTRP9 level and diabetic retinopathy in patients with type 2 diabetes mellitus

目的探究2型糖尿病患者血清C1q肿瘤坏死因子相关蛋白9(CTRP9)水平与糖尿病视网膜病变(DR)的相关性。方法回顾性选取2019年1月至2021年12月广西玉林市红十字会医院160例2型糖尿病患者作为研究对象,所有患者均行眼底检查,根据有无DR将患者分为DR组(n=70)与非DR组(n=90)。收集患者年龄、性别、体重指数、2型糖尿病病程等一般人口学资料,记录血压、血糖、血脂、肝功能、尿微量蛋白、胰岛素与脂联素水平、C反应蛋白(CRP)、CTRP9等并进行比较,对2型糖尿病患者发生DR的影响因素进行Logistic回归分析,并分析CTRP9水平与各因素的相关性。结果两组患者的舒张压、糖化血红蛋白、空腹血糖、低密度脂蛋白胆固醇(LDL-C)、体重指数、APOA和APOB水平比较,差异均无统计学意义(P>0.05);DR组患者年龄、高血压占比、甘油三酯、总胆固醇、高密度脂蛋白胆固醇(HDL-C)、收缩压、2型糖尿病病程、胰岛素水平、胰岛素抵抗指数、血肌酐、尿酸、CRP水平均明显高于非DR组,脂联素、CTRP9、体重指数水平均明显低于非DR组,差异均有统计学意义(P<0.05)。多因素Logistic回归分析显示,甘油三酯、总胆固醇、HDL-C、胰岛素水平、胰岛素抵抗指数、CRP、脂联素、体重指数、CTRP9是2型糖尿病患者发生DR的独立危险因素(RR=2.754,95%CI=1.268~3.653;RR=2.683,95%CI=1.983~4.326;RR=3.697,95%CI=2.184~10.584;RR=4.362,95%CI=1.732~11.002;RR=2.182,95%CI=1.053~4.428;RR=6.503,95%CI=1.484~14.643;RR=6.538,95%CI=1.632~11.653;RR=8.433,95%CI=2.694~15.885;RR=7.536,95%CI=3.292~15.483,P<0.05)。Spearman相关性分析显示血清CTRP9水平与甘油三酯、总胆固醇、HDL-C、胰岛素水平、胰岛素抵抗、CRP呈负相关(r=-0.605、-0.368、-0.554、-0.227、-0.353、-0.497,P<0.05),与脂联素、体重指数呈正相关(r=0.531、0.378,P<0.05)。结论血清CTRP9水平与2型糖尿病患者发生DR密切相关,与甘油三酯、总胆固醇、HDL-C、胰岛素水平、胰岛素抵抗、CRP呈负相关,与脂联素、体重指数呈正相关,检测血清CTRP9水平可为2型糖尿病合并DR临床诊断治疗及预防提供新的思路。

Objective To explore the correlation between serum C1q tumor necrosis factor-related protein 9(CTRP9)and diabetic retinopathy(DR)in patients with type 2 diabetes mellitus.Methods A total of 160 type 2 diabetes mellitus patients in our hospital from January 2019 to December 2021 were retrospectively selected as the research subjects.All patients underwent fundus examination.The patients were divided into DR group(n=70)and non-DR group(n=90)according to the presence or absence of DR.General demographic data such as gender,body mass index,course of type 2 diabetes mellitus disease,blood pressure,blood sugar,blood lipids,liver function,urinary microprotein,insulin and adiponectin levels,C-reactive protein(CRP),CTRP9,etc.were recorded and compared,and the influencing factors of DR in type 2 diabetes mellitus patients were analyzed.Logistic regression analysis was performed,and the correlation between CTRP9 level and various factors was analyzed.Results There was no significant difference in diastolic blood pressure,hemoglobin A1c,fasting blood glucose,low density lipoprotein cholesterol(LDL-C),body mass index,APOA and APOB between the two groups(P>0.05);the age,proportion of hypertension,triglycerides,total cholesterol,high density lipoprotein cholesterol(HDL-C),systolic blood pressure,type 2 diabetes mellitus course,insulin level,insulin resistance index,blood creatinine,uric acid,and CRP levels in the DR group were higher than those in the non-DR group,the levels of CTRP9 and body mass index were lower than those of the non-DR group,and the differences were statistically significant(P<0.05).Multivariate logistic regression analysis showed that triglyceride,total cholesterol,HDL-C,insulin level,insulin resistance index,CRP,adiponectin,body mass index,and CTRP9 were independent risk factors for DR in patients with type 2 diabetes mellitus(RR=2.754,95%CI=1.268-3.653;RR=2.683,95%CI=1.983-4.326;RR=3.697,95%CI=2.184-10.584;RR=4.362,95%CI=1.732-11.002;RR=2.182,95%CI=1.053-4.428;RR=6.503,95%CI=1.484-14.643;RR=6.538,95%CI=1.632-11.653;RR=8.433,95%CI=2.694-15.885;RR=7.536,95%CI=3.292-15.483,P<0.05).Spearman correlation analysis showed that serum CTRP9 level was negatively correlated with triglycerides,total cholesterol,HDL-C,insulin level,insulin resistance(r=-0.605,-0.368,-0.554,-0.227,-0.353,-0.497),CRP,and was negatively correlated with adiponectin,body mass index was positively correlated(r=0.531,0.378,P<0.05).Conclusion The level of serum CTRP9 is closely related to the occurrence of DR in patients with type 2 diabetes,negatively related to triglycerides,total cholesterol,HDL-C,insulin level,insulin resistance,CRP,and positively related to adiponectin and body mass index.The detection of serum CTRP9 level can provide new ideas for the clinical diagnosis,treatment and prevention of type 2 diabetes mellitus with DR.