不同程度T2DM合并DR患者糖脂代谢指标、血清25(OH)D和VEGF水平的变化及临床意义

Changes and clinical significance of glucose and lipid metabolism indicators,serum 25(OH)D,and VEGF levels in patients with different degrees of type 2 diabetes mellitus complicating retinopathy

目的探讨不同程度2型糖尿病(T2DM)合并视网膜病变(DR)患者糖脂代谢指标、血清者血清25羟维生素D[25(OH)D]、血管内皮生长因子(VEGF)水平的变化及临床意义。方法选择2019年6月至2021年月6月西安航天总医院内分泌科收治的210例T2DM患者作为研究对象,根据患者病变情况分组,其中单纯T2DM者为T2DM组(n=70)、增殖型DR者为PDR组(n=80)、单纯型DR者为BDR组(n=60),同期选择75例体检健康者为对照组。比较各组受试者空腹血糖(FPG)、糖化血红蛋白(HbAlc)、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白(LDL-C)、高密度脂蛋白(HDL-C)及25(OH)D、VEGF水平,采用Pearson法分析血清25(OH)D、VEGF与糖脂代谢指标间的相关性。结果对照组健康者的FPG、HbAlc、TC、TG、LDL-C、HDL-C水平分别为(5.09±0.75)mmol/L、(4.57±0.71)%、(4.81±0.69)mmol/L、(1.29±0.23)mmol/L、(2.71±0.38)mmol/L、(1.09±0.22)mmol/L,明显低于T2DM组的(8.78±1.34)mmol/L、(8.71±1.29)%、(5.41±0.98)mmol/L、(1.91±0.38)mmol/L、(3.87±0.73)mmol/L、(1.48±0.31)mmol/L、BDR组的(10.28±2.74)mmol/L、(10.72±1.97)%、(6.52±1.25)mmol/L、(2.71±0.52)mmol/L、(3.98±0.51)mmol/L、(2.01±0.19)mmol/L和PDR组的(13.29±3.12)mmol/L、(13.09±2.87)%、(7.82±0.98)mmol/L、(3.69±0.62)mmol/L、(4.91±0.72)mmol/L、(2.98±0.36)mmol/L,而T2DM组患者的上述指标水平明显低于BDR组和PDR组,BDR组上述指标明显低于PDR组,差异均有统计学意义(P<0.05);对照组健康者的25(OH)D水平为(20.98±4.29)ng/mL,明显高于T2DM组的(13.44±2.15)ng/mL、BDR组的(8.29±1.92)ng/mL和PDR组的(4.89±0.77)ng/mL,而T2DM组又明显高于BDR组和PDR组,BDR组明显高于PDR组,差异均有统计学意义(P<0.05);对照组健康者的VEGF水平为(5.98±1.21)g/L,明显低于T2DM组的(8.21±2.10)g/L、BDR组的(14.34±3.82)g/L和PDR组的(19.39±4.28)g/L,而T2DM组又明显低于BDR组和PDR组,BDR组明显低于PDR组,差异均有统计学意义(P<0.05);经Pearson相关性分析结果显示:T2DM合并DR患者的血清25(OH)D水平与FPG、HbAlc、TC、TG、LDL-C、HDL-C水平呈负相关(P<0.05),而VEGF水平与FPG、HbAlc、TC、TG、LDL-C、HDL-C水平呈正相关(P<0.05)。结论糖脂代谢指标、血清25(OH)D、VEGF共同参与了T2DM合并DR的发生及发展,且与病情严重程度紧密相关。

Objective To explore the significance of changes in the levels of glucose and lipid metabolism in-dexes,serum 25-hydroxyvitamin D[25(OH)D],and vascular endothelial growth factor(VEGF)in patients with differ-ent degrees of type 2 diabetes mellitus(T2DM)complicated with retinopathy(DR).Methods A total of 210 patients with T2DM admitted to the Department of Endocrinology,Xi'an Aerospace General Hospital from June 2019 to June 2021 were selected as the study subjects.They were grouped according to the pathological changes of the patients:T2DM group(n=70,pure T2DM patients),PDR group(n=80,proliferative DR patients),and BDR group(n=60,simple DR patients).During the same period,75 healthy individuals were selected as the control group.The levels of fasting blood glucose(FPG),glycosylated hemoglobin(HbAlc),total cholesterol(TC),triacylglycerol(TG),low density lipo-protein(LDL-C),high density lipoprotein(HDL-C),and 25(OH)D,VEGF in each group were compared.The correla-tion between serum 25(OH)D,VEGF,and glucose and lipid metabolism indicators was analyzed using Pearson's meth-od.Results The levels of FPG,HbAlc,TC,TG,LDL-C,and HDL-C in the control group were(5.09±0.75)mmol/L,(4.57±0.71)%,(4.81±0.69)mmol/L,(1.29±0.23)mmol/L,(2.71±0.38)mmol/L,and(1.09±0.22)mmol/L,which were significantly lower than(8.78±1.34)mmol/L,(8.71±1.29)%,(5.41±0.98)mmol/L,(1.91±0.38)mmol/L,(3.87±0.73)mmol/L,(1.48±0.31)mmol/L in the T2DM group,(10.28±2.74)mmol/L,(10.72±1.97)%,(6.52±1.25)mmol/L,(2.71±0.52)mmol/L,(3.98±0.51)mmol/L,(2.01±0.19)mmol/L in BDR group,and(13.29±3.12)mmol/L,(13.09±2.87)%,(7.82±0.98)mmol/L,(3.69±0.62)mmol/L,(4.91±0.72)mmol/L,(2.98±0.36)mmol/L in PDR group;the levels of the above indicators were significantly lower in T2DM group than those in BDR and PDR groups,and also in BDR group than PDR group;the differences were statistically significant(P<0.05).The level of 25(OH)D in the control group was(20.98±4.29)ng/mL,which was significantly higher than(13.44±2.15)ng/mL in the T2DM group,(8.29±1.92)ng/mL in BDR group,and(4.89±0.77)ng/mL in PDR group;the level was significantly higher in the T2DM group than the BDR and PDR groups,and also in the BDR group than the PDR group;the differences were statistically significant(P<0.05).The level of VEGF in the control group was(5.98±1.21)g/L,which was significantly lower than(8.21±2.10)g/L in the T2DM group,(14.34±3.82)g/L in the BDR group,and(19.39±4.28)g/L in the PDR group;the level was significantly lower in the T2DM group than the BDR and PDR groups,and also in the BDR group than the PDR group;the differenc-es were statistically significant(P<0.05).Pearson correlation analysis showed that serum 25(OH)D levels in T2DM pa-tients with DR were negatively correlated with FPG,HbAlc,TC,TG,LDL-C,and HDL-C levels(P<0.05),while VEGF levels were positively correlated with FPG,HbAlc,TC,TG,LDL-C,and HDL-C levels(P<0.05).Conclusion Glycolipid metabolism indexes,serum 25(OH)D,and VEGF are involved in the occurrence and development of T2DM complicated with DR,and are closely related to the severity of the disease.