糖尿病视网膜病变患者血清SIRT4、CTRP5、Galectin-3与糖脂代谢和预后的关系研究

Study on relationship between serum SIRT4,CTRP5 and Galectin-3 levels with glycolipid metabolism and prognosis in patients with diabetic retinopathy

目的 探讨糖尿病视网膜病变(DR)患者血清沉默信息调节因子4(SIRT4)、补体C1q肿瘤坏死因子相关蛋白5(CTRP5)、半乳糖凝集素-3(Galectin-3)与糖脂代谢和预后的关系。方法 选取2021年1月至2022年1月该院收治的115例DR患者作为DR组,其中非增生型DR患者61例(非增生型DR组)、增生型DR患者54例(增生型DR组),另选取同期在该院进行健康体检的受试者50例作为对照组。对DR组和对照组SIRT4、CTRP5、Galectin-3、血糖[空腹血糖(FPG)]、血脂[总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)]指标进行检测并比较。同时分析DR患者血清SIRT4、CTRP5、Galectin-3与血糖、血脂指标的相关性。对治疗后的DR患者进行6个月的随访观察,根据患者的视力残疾状况将患者分为预后良好组和预后不良组,比较两组血清SIRT4、CTRP5、Galectin-3水平。采用多因素Logistic回归分析DR患者预后不良的危险因素;采用受试者工作特征(ROC)曲线分析SIRT4、CTRP5、Galectin-3单项或3项联合检测对DR患者预后不良的预测价值。结果 血清SIRT4、CTRP5、Galectin-3、FPG、TC、TG、LDL-C水平均表现为增生型DR组>非增生型DR组>对照组,而HDL-C水平表现为增生型DR组<非增生型DR组<对照组,任意两组间比较,差异均有统计学意义(P<0.05)。Pearson相关分析显示DR患者的SIRT4、CTRP5、Galectin-3水平与FPG、TG、TC、LDL-C水平呈正相关(P<0.05),与HDL-C水平呈负相关(P<0.05)。预后不良组血清SIRT4、CTRP5、Galectin-3水平高于预后良好组(P<0.05)。预后不良组DR病程长于预后良好组(P<0.05),增生型DR比例高于预后良好组(P<0.05)。多因素Logistic回归分析结果显示,SIRT4≥24 ng/mL、CTRP5≥8 ng/mL、Galectin-3≥1 400 ng/mL、DR病程≥6个月、DR分期为增生型是DR患者预后不良的独立危险因素(OR>1,P<0.05)。ROC曲线分析结果显示,血清SIRT4、CTRP5、Galectin-3单项检测最佳截断值分别为24 ng/mL、8 ng/mL、1 400 pg/mL时,各指标预测DR患者预后不良的AUC分别为0.796、0.743、0.718。以多因素Logistic回归分析的结果建立模型Ln(P/1-P)=0.573×X_(SIRT4)+0.809×X_(CTRP5)+0.424×X_(Galectin-3),作为3项指标联合检测的模型,结果该模型预测DR患者预后不良的AUC为0.833(95%CI:0.706~0.961),具有较高预测价值。结论 DR患者血清SIRT4、CTRP5、Galectin-3水平升高,并与患者的糖脂代谢有一定的相关性,且SIRT4≥24 ng/mL、CTRP5≥8 ng/mL、Galectin-3≥1 400 ng/mL、DR病程≥6个月、DR分期为增生型是DR患者预后不良的危险因素,SIRT4、CTRP5、Galectin-3联合检测较单项检测对DR患者预后不良的预测价值更高。

Objective To investigate the relationship between serum silent information regulator 4(SIRT4),complement C1q tumor necrosis factor-related protein 5(CTRP5) and galectin-3 with glucose and glycolipid metabolism and prognosis in the patients with diabetic retinopathy(DR).Methods A total of 115 patients with DR admitted and treated in this hospital from January 2021 to January 2022 were selected as the DR group,including 61 cases of non-proliferative type DR(non-proliferative DR group) and 54 cases of proliferative type DR(proliferative DR group).The other 50 healthy subjects undergoing physical examination in this hospital during the same period were selected as the control group.The levels of SIRT4,CTRP5,Galectin-3,blood glucose [fasting blood glucose(FPG)] and blood lipids [total cholesterol(TC),triglycerides(TG),low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C)] indicators were measured in the DR group and control group and the comparison was performed.The correlation between the levels of SIRT4,CTRP5 and Galectin-3 with blood glucose and lipid indicators was analyzed.After treatment,a six-month follow-up observation was conducted on the patients with DR.According to the visual disability status of the patients,they were divided into the good prognosis group and poor prognosis group.The levels of SIRT4,CTRP5 and Galectin-3 were compared between the two groups.The multivariate Logistic regression was adopted to analyze the risk factors of poor prognosis in the patients with DR.The receiver operating characteristic(ROC) curve was used to analyze the predictive value of SIRT4,CTRP5 and Galectin-3 single or 3-item combination in predicting the poor prognosis in the patients with DR.Results The levels of serum SIRT4,CTRP5,Galectin-3,FPG,TC,TG and LDL-C all were manifested as the proliferative DR group > non-proliferative DR group> control group,while the HDL-C level was manifested as the proliferative DR group < non-proliferative DR group < control group,moreover the difference between any two groups was statistically significant(P<0.05).Pearson correlation analysis showed that SIRT4,CTRP5 and Galectin-3 in the patients with DR were positively correlated with FPG,TG,TC and LDL-C(P<0.05),and negatively correlated with HDL-C(P<0.05).The serum SIRT4,CTRP5 and Galectin-3 levels in the poor prognosis group were higher than those in the good prognosis group(P<0.05).The duration of DR in the poor prognosis group was longer than that in the good prognosis group(P<0.05),and the proportion of proliferative DR was higher than that in the good prognosis group(P<0.05).The results of multivariate logistic regression analysis showed that SIRT4 ≥24 ng/mL,CTRP5 ≥8 ng/mL,Galectin-3 ≥1 400 ng/mL,DR course ≥6 months,and DR stage as proliferative type were the independent risk factors for the poor prognosis in the patients with DR(OR>1,P<0.05).The ROC curve results showed that when the optimal cutoff values for serum SIRT4,CTRP5,and Galectin-3 single item detection were 24 ng/mL,8 ng/mL and 1 400 pg/mL respectively,the areas under the curve(AUC) of various indicators for predicting the poor outcome in the patients with DR were 0.796,0.743 and 0.718,respectively.The model established by the results of multiple Logistic regression analysis was Ln(P/1-P)=0.573 ×X_(SIRT4)+0.809 ×X_(CTRP5)+0.424×X_(Galectin-3),AUC of this model for predicting the adverse outcome in the patients with DR was 0.833(95%CI:0.706-0.961),indicating high predictive value.Conclusion The serum SIRT4,CTRP5 and Galectin-3 levels in the patients with DR are increased,which has a certain correlation with glucolipid metabolism level,moreover the SIRT4 ≥24 ng/mL,CTRP5 ≥8 ng/mL,Galectin-3 ≥1 400 ng/mL,DR course≥6 months and DR stage as the proliferative type are the independent risk factors for the poor prognosis in patients with DR.The combined detection of SIRT4,CTRP5 and Galectin-3 has a higher predictive value in the poor prognosis in DR patients compared to single item detection.