血清YKL-40、TNF-α与糖尿病视网膜病变相关性的临床研究

Clinical study on the relationship between serum YKL-40、TNF-αand diabetic retinopathy

目的研究血清中人软骨糖蛋白-39(YKL-40)、肿瘤坏死因子-α(TNF-α)与糖尿病性视网膜病变(DR)的相关性及临床指标间的相关性,探讨YKL-40及TNF-α在DR发生发展中所起的作用,希望用于DR高危人群的筛选、预测及诊断。方法回顾性系列病例研究。本研究旨在比较三种不同类型的糖尿病患者临床指标及YKL-40、TNF-α水平,分别是单纯2型糖尿病无视网膜病变患者(DM组)、非增生性糖尿病性视网膜病变患者(NPDR组)、增生性糖尿病性视网膜病变患者(PDR组)以及选取同期行白内障手术患者为空白对照组(NGT组),其时间选取为2021年3月至2022年6月在我院住院治疗的患者。所有研究对象都应记录并测量其性别、年龄、病程、身高、体重等基本信息,并计算出体质指数(BMI)。测定收缩压(SBP)、舒张压(DBP)。抽取空腹肘静脉血,分离血清。空腹静脉血糖(FBG)、糖化血红蛋白(HbA1c)、甘油三脂(TG)、总胆固醇(TC)、低密度脂蛋白(LDL-C)、高密度脂蛋白(HDL-C)、空腹胰岛素(FINS)等临床指标并计算胰岛素抵抗指数(HOMA-IR)。采用酶联免疫法检测血清中YKL-40及TNF-α的浓度,进一步分析与其他临床指标之间的关系。结果血清YKL-40浓度PDR组为(67.93±8.52)ng/mL,高于NPDR组的(59.29±7.87)ng/mL,DM组的(50.08±10.01)ng/mL及NGT组的(39.07±9.59)ng/mL,差异均有统计学意义(均P<0.001);血清TNF-α浓度PDR组为(68.35±8.66)Pg/mL,高于NPDR组的(60.59±8.58)Pg/mL,DM组的(47.02±11.34)Pg/mL及NGT组的(38.7±8.32)Pg/mL,差异均有统计学意义(均P<0.001)。血清YKL-40与病程、糖化血红蛋白、静脉血糖、胰岛素抵抗指数均呈正相关(均P<0.05);血清TNF-α与病程、糖化血红蛋白、静脉血糖、胰岛素抵抗指数呈正相关(均P<0.05)。血清YKL-40的ROC曲线下的面积(0.894);血清TNF-α的ROC曲线下的面积(0.927);二者联合诊断时的ROC曲线下的面积(0.935)。结论YKL-40及TNF-α水平在NC、DM、NPDR及PDR四组中均逐渐升高,二者可能参与到DR的发病过程;YKL-40及TNF-α的水平升高可能对DR的危险性更高。

Objective To study human cartilage glycoprotein-39(YKL-40)and tumor necrosis factor-α(TNF-α)in serum correlation with diabetes retinopathy(DR)and clinical indicators.To discuss YKL-40 and TNF-αthe role played in the occurrence and development of DR was expected to be used for screening,prediction,and diagnosis of high-risk groups of diabetes retinopathy.Methods A retrospective case series study.The patients with simple type 2 diabetes ignoring retinopathy(DM group),the patients with non proliferative diabetes retinopathy(NPDR group),the patients with proliferative diabetes retinopathy(PDR group),and the patients who underwent cataract surgery at the same time were selected as the blank control group(NGT group),and the time was selected as the patients hospitalized in our hospital from March 2021 to June 2022.All research subject’s basic information,such as gender,age,course of disease,height,weight,systolic blood pressure(SBP),diastolic blood pressure(DBP)and body mass index(BMI)were recorded.The fasting elbow venous blood was drawn to separate the serum.Fasting venous blood glucose(FBG),glycosylated hemoglobin(HbA1c),triglyceride(TG),total cholesterol(TC),low-density lipoprotein(LDL-C),high-density lipoprotein(HDL-C),fasting insulin(FINS)and other clinical indicators,and calculate insulin resistance index(HOMA-IR).The serum YKL-40 and TNF-αwere detected by enzyme-linked immunosorbent assay,and the relationship between them and other clinical indicators was further analyzed.Results The serum YKL-40 concentration in PDR group was(67.93±8.52)ng/mL,which was higher than that in NPDR group(59.29±7.87)ng/mL,DM group(50.08±10.01)ng/mL and NGT group(39.07±9.59)ng/mL,with significant differences(P<0.001).The serum TNF-αconcentration of PDR group was(68.35±8.66)pg/mL,which was higher than that of NPDR group(60.59±8.58)pg/mL,DM group(47.02±11.34)pg/mL and NGT group(38.7±8.32)pg/mL(all P<0.001).Serum YKL-40 was positively correlated with course of disease,glycosylated hemoglobin,ve‐nous blood glucose and insulin resistance index(P<0.05).Serum TNF-αwas positively correlated with the course of dis‐ease,glycosylated hemoglobin,venous blood glucose and insulin resistance index(P<0.05).Area under ROC curve of se‐rum YKL-40,serum TNF-αand the time of combined diagnosis were 0.894,0.927,and 0.935,respectively.Conclusions The levelsof YKL-40 and TNF-αwere gradually increased in the NC,DM,NPDR and PDR groups,which may be involved in the pathogenesis of DR.The increased levels of YKL-40 and TNF-αmay be more dangerous for diabetic patients.