血细胞相关炎症指标与糖尿病视网膜病变的关系:北辰眼病研究

The relationship between blood cell-related inflammatory markers and diabetic retinopathy:a study from Beichen Eye Study

目的观察血细胞相关炎症指标与糖尿病视网膜病变(DR)的相关性。方法横断面研究。2020年6月至2022年2月天津医科大学眼科医院进行的北辰眼病研究Ⅰ期数据纳入研究。研究内容包括:问卷调查、常规全身和眼部检查及实验室血细胞相关指标血小板平均体积(MPV)、血小板分布宽度(PDW)、中性粒细胞、淋巴细胞检查,计算中性粒细胞/淋巴细胞比值(NLR)和血小板/淋巴细胞比值(PLR)。DR诊断及分型参照DR国际临床分级标准进行。单眼或双眼DR均定义为DR患者。根据是否患有糖尿病及DR,将受检者分为非糖尿病组、糖尿病无DR组、DR组。定量资料多组间比较采用Kruskal-Wallis H检验;两组间比较采用Wilcoxon秩和检验。组间分类变量比较采用χ^(2)检验。逐步调整变量,构建未经调整的单变量模型以及调整不同参数后的模型Ⅰ、Ⅱ、Ⅲ。不同模型下MPV、PDW、NLR、PLR与DR的相关性行logistic回归分析。受试者工作特征(ROC)曲线分析NLR不同模型对DR的诊断效能。结果共招募受检者3328名。其中,男性1121名(33.68%,1121/3328),女性2207名(66.32%,2207/3328);年龄61.84(6.05)岁。非糖尿病组、糖尿病无DR组、DR组分别为2679、476、173名。三组受检者MPV、PLR比较,差异无统计学意义(H=5.98、1.94,P=0.051、0.379);但与非糖尿病组、糖尿病无DR组比较,DR组PDW、NLR呈上升趋势。完全调整相关因素的模型Ⅲ中,非糖尿病组与DR组[比值比(OR)=1.440,95%可信区间(CI)1.087~1.920,P=0.041]、糖尿病无DR组与DR组(OR=1.990,95%CI 1.440~2.749,P<0.001),NLR均是DR发生的独立危险因素。ROC曲线分析结果显示,NLR的模型Ⅲ诊断效能最高,曲线下面积为0.751(95%CI 0.706~0.796,P<0.001),最佳截断值为0.390,灵敏度、特异性分别为74.3%、64.8%。结论与非糖尿病、糖尿病无DR受检者比较,DR组患者NLR显著增高;NLR是DR发生的独立危险因素。

Objective To observe the correlation between blood cell-related inflammatory markers and diabetic retinopathy(DR).Methods A cross-sectional study.From June 2020 to February 2022,the phaseⅠdata of Beichen Eye Study in Tianjin Medical University Eye Hospital were included in the study.The research contents included questionnaires,routine systemic and ocular examinations,and laboratory blood cell-related indicators including mean platelet volume(MPV),platelet distribution width(PDW),neutrophils,and lymphocytes were performed.Neutrophil/lymphocyte ratio(NLR)and platelet/lymphocyte ratio(PLR)were calculated.The diagnosis and classification of DR referred to the international clinical classification standard of DR.Monocular or binocular DR was defined as DR patients.Participants were categorized into different groups based on whether they had diabetes and whether they had DR.The groups included the no-diabetes group,the diabetes without DR group,and the DR group.The Kruskal-Wallis H test was used for the comparison of quantitative data among multiple groups.Wilcoxon test was used for comparison between the two groups.Theχ^(2) test was used to compare the categorical variables between groups.The variables was adjusted step by step,an unadjusted univariate model was built and the different parameters of the modelⅠ,Ⅱ,Ⅲwere adjusted.The correlation between MPV,PDW,NLR,PLR,and DR in different models was analyzed by logistic regression.The receiver operating characteristic(ROC)curve was used to analyze the diagnostic efficacy of different NLR models for DR.Results A total of 3328 subjects were recruited.Among them,1121(33.68%,1121/3328)were males and 2207(66.32%,2207/3328)were females.The median age of the included participants was 61.84(6.05)years.The no-diabetes group,the diabetes without DR group,and the DR group were 2679,476,and 173,respectively.There was no significant difference in MPV and PLR among the three groups(H=5.98,1.94;P=0.051,0.379).However,compared with no-diabetes group and the diabetes without DR group,PDW and NLR in the DR group showed an upward trend.In modelⅢwith completely adjusted related factors,NLR was an independent risk factor for DR in no-diabetes group and DR group[odds ratio(OR)=1.440,95%confidence interval(CI)1.087-1.920,P=0.041],diabetes without DR group and DR group[OR=1.990,95%CI 1.440-2.749,P<0.001].The results of ROC curve analysis showed that the diagnostic efficiency of NLR modelⅢwas the highest,the area under the curve was 0.751(95%CI 0.706-0.796,P<0.001),the optimal cutoff value was 0.390,and the sensitivity and specificity were 74.3%and 64.8%,respectively.Conclusions The NLR of the DR group is significantly higher than that of the no-diabetes group and diabetes without DR group.NLR is an independent risk factor for DR.