2型糖尿病并发视网膜病变患者血清皮质醇、肌生成抑制素、SCUBE-1水平变化及临床意义

Changes in serum cortisol,myostatin,and SCUBE-1 levels in type 2 diabetic patients complicated with diabetic retinopathy

目的探讨2型糖尿病(T2DM)并发糖尿病视网膜病变(DR)患者血清皮质醇、肌生成抑制素(Mstn)、信号肽-补体蛋白C1r/C1s、Uegf和Bmp1-表皮生长因子结构域包含蛋白1(SCUBE-1)的水平变化,并分析其与增生型DR的关系。方法将2018年3月至2021年12月北京中医医院怀柔医院眼科收治的T2DM并发DR患者365例纳入研究,根据有无新生血管分为增生型DR组(62例)和非增生型DR组(303例)。将同期北京中医医院怀柔医院内分泌科收治的单纯T2DM患者51例纳入研究作为T2DM组。另外,选取同期于北京中医医院怀柔医院体检健康者51例作为健康对照组。采用酶联免疫吸附试验(ELISA)检测血清皮质醇、Mstn和SCUBE-1水平,同时收集纳入研究者基线资料,采用Pearson相关分析血清皮质醇、Mstn、SCUBE-1与基线资料中各指标的相关性,采用受试者工作特征(ROC)曲线分析血清皮质醇、Mstn、SCUBE-1对增生型DR的诊断价值。结果血清皮质醇、Mstn、SCUBE-1水平的组间比较显示,增生型DR组均高于非增生型DR组,非增生型DR组均高于T2DM组,T2DM组均高于健康对照组(P<0.05)。单因素分析显示,增生型DR组体重指数(BMI)、空腹糖化血红蛋白(HbA1c)、空腹血清葡萄糖(FSG)、空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)、甘油三酯(TG)、血尿素(Urea)、血肌酐(Cr)、尿清蛋白排泄率(UAER)高于非增生型DR组(P<0.05)。Pearson相关分析显示,T2DM并发DR患者血清皮质醇、Mstn、SCUBE-1水平与BMI、糖尿病病程、HbA1c、FSG、FINS、HOMA-IR、TG、Urea、Cr、UAER均呈正相关(P<0.05)。血清皮质醇、Mstn、SCUBE-1、两两联合(皮质醇+Mstn、皮质醇+SCUBE-1、Mstn+SCUBE-1)及3项指标联合检测诊断增生型DR的ROC曲线下面积分别为0.695、0.747、0.742、0.768、0.758、0.771、0.838,3项联合应用的诊断效能较高。结论T2DM并发DR患者血清皮质醇、Mstn、SCUBE-1水平异常升高,与增生型DR有关,3项指标联合检测对增生型DR具有较高的诊断价值。

Objective To investigate the changes of serum cortisol,myostatin(Mstn)and signal peptide-complement protein C1r/C1s,Uegf,and Bmp1-epidermal growth factor domain containing protein 1(SCUBE-1)levels in patients with type 2 diabetes mellitus(T2DM)complicated with diabetic retinopathy(DR),and to analyze their relationship with proliferative DR.Methods A total of 365 patients with T2DM complicated with DR who were admitted to the Department of Ophthalmology of Beijing Hospital of Traditional Chinese Medicine from March 2018 to December 2021 were enrolled in the study.According to the presence or absence of neovascularization,they were divided into proliferative DR group(62 cases)and non-proliferative DR group(303 cases).Fifty-one cases of simple patients with T2DM who were admitted to the Department of Ophthalmology of Beijing Hospital of Traditional Chinese Medicine during the same period were enrolled as the T2DM group.In addition,51 cases of healthy volunteers who had physical examination in Beijing Hospital of Traditional Chinese Medicine during the same period were enrolled as the healthy control group.Enzyme-linked immunosorbent assay(ELISA)was used to detect the levels of serum cortisol,Mstn and SCUBE-1,and the baseline data of the enrolled people were collected.Pearson correlation analysis was used to analyze the correlation between serum cortisol,Mstn,SCUBE-1 and the items in baseline data.The receiver operating characteristic(ROC)curve was used to analyze the diagnostic value of serum cortisol,Mstn and SCUBE-1 in proliferative DR.Results The levels of serum cortisol,Mstn and SCUBE-1 in the proliferative DR group were higher than those in the non-proliferative DR Group,the non-proliferative DR Group was higher than the T2DM group,and the T2DM group was higher than the healthy control group(P<0.05).Univariate analysis showed that body mass index(BMI),glycated hemoglobin lglycosylated hemoglobin(HbA1c),fasting serum glucose(FSG),fasting insulin(FINS),insulin resistance index(HOMA-IR),triglyceride(TG),blood urea(Urea),creatinine(Cr),urinary albumin excretion rate(UAER)in the proliferative DR group were higher than those in the non-proliferative DR group(P<0.05).Pearson analysis showed that the expression levels of serum cortisol,Mstn and SCUBE-1 were positively correlated with BMI,duration of diabetes,HbA1c,FSG,FINS,HOMA-IR,TG,Urea,Cr and UAER(P<0.05).The areas under the curve(AUCs)of serum cortisol,Mstn,SCUBE-1,pair-to-pair combination(cortisol+Mstn,cortisol+SCUBE-1,Mstn+SCUBE-1)and the three indexes combined in the diagnosis of proliferative DR were 0.695,0.747,0.742,0.768,0.758,0.771,0.838 respectively,the diagnostic efficiency of the three combined was higher than the rest.Conclusion The levels of serum cortisol,Mstn and SCUBE-1 in patients with T2DM complicated with DR are abnormally elevated,which is related to proliferative DR.The combined detection of the three indicators has high value for the diagnosis of proliferative DR.