血清蛋白标志物与糖尿病视网膜病变预后的相关性  

Correlation between serum protein markers and prognosis of diabetic retinopathy

作　　者：叶青[1] 李超[1] 李斌[1] 张萍[1] 李丹[1] 李晓华[2] YE Qing;LI Chao;LI Bin;ZHANG Ping;LI Dan;LI Xiaohua(Department of Ophthalmology,Suzhou Jiulong Hospital of Shanghai Jiao Tong University,Suzhou 215000,China;Department of Ophthalmology,Henan Provincial Eye Hospital,Henan Provincial People's Hospital,Zhengzhou 450003,China)

机构地区：[1]上海交通大学附属苏州九龙医院眼科,江苏苏州215000 [2]河南省人民医院河南省立眼科医院眼科,郑州450003

出　　处：《中华实用诊断与治疗杂志》2019年第12期1177-1180,共4页Journal of Chinese Practical Diagnosis and Therapy

基　　金：国家自然科学基金(81770952)

摘　　要：目的探讨血清β2-糖蛋白Ⅰ(β2-glycoproteinⅠ,β2-GPⅠ)、和肽素(copeptin)、中期因子(midkine,MK)、YKL-40在糖尿病视网膜病变(diabetic retinopathy,DR)中的意义及其与DR预后的关系。方法143例2型糖尿病(type 2 diabetes mellitus,T2DM)合并DR患者,根据眼底检查结果分为非增殖性DR组(NPDR组)92例和增殖性DR组(PDR组)51例;40例未合并DR的T2DM患者为T2DM组;比较3组患者血清β2-GPⅠ、copeptin、MK、YKL-40水平及视力。随访1a,观察DR患者视力残疾发生情况,并将其分为视力残疾组31例和非视力残疾组112例,比较2组临床资料及血清β2-GPⅠ、copeptin、MK、YKL-40水平,采用多因素logistic回归分析T2DM合并DR患者发生视力残疾的危险因素,采用Pearson相关分析视力与血清β2-GPⅠ、copeptin、MK、YKL-40水平的相关性。结果NPDR组、PDR组血清β2-GPⅠ[(1.16±0.22)、(2.04±0.35)ng/L]、copeptin[(17.83±2.05)、(23.46±3.59)pmol/L]、MK[(3.05±0.31)、(4.42±0.55)pg/L]、YKL-40[(112.40±15.25)、(218.11±26.12)μg/L]水平高于T2DM组[(0.21±0.03)ng/L、(12.50±1.37)pmol/L、(1.67±0.19)pg/L、(78.50±9.12)μg/L](P<0.05),视力(0.48±0.07、0.18±0.03)低于T2DM组(0.72±0.12)(P<0.05);PDR组血清β2-GPⅠ、copeptin、MK、YKL-40水平高于NPDR组(P<0.05),视力低于NPDR组(P<0.05);视力残疾组血清β2-GPⅠ[(2.75±0.36)ng/L]、copeptin[(26.84±3.14)pmol/L]、MK[(4.97±0.61)pg/L]、YKL-40[(260.32±31.84)μg/L]水平及病程[(13.20±3.42)a]、收缩压[(147.65±9.20)mm Hg]、糖化血红蛋白[(12.01±2.52)%]、空腹血糖[(12.80±3.56)mmol/L]、胰岛素抵抗指数(8.24±1.10)高于非视力残疾组[(1.12±0.20)ng/L、(17.90±2.32)pmol/L、(3.14±0.42)pg/L、(119.59±15.40)μg/L、(9.14±3.05)a、(138.60±12.15)mm Hg、(10.22±1.78)%、(9.50±2.21)mmol/L、3.61±0.60](P<0.05);病程长(OR=1.806,95%CI:1.203~2.407,P=0.008)、糖化血红蛋白水平高(OR=2.606,95%CI:1.983~3.230,P<0.001)、血清β2-GPⅠ水平高(OR=2.259,95%CI:1.595~2.923,P<0.001)、copeptin水平高(OR=Objective To investigate the significances of serumβ2-glycoproteinⅠ(β2-GPⅠ),copeptin,midkine(MK)and YKL-40in patients with diabetic retinopathy(DR)and their correlations with the prognosis of DR.Methods Totally 143patients with type 2diabetes mellitus(T2DM)and DR were divided into proliferative DR group(PDR group)and non-proliferative DR group(NPDR group)according to fundus examination results.Another 40T2DM patients without DR were as T2DM group.The serum levels ofβ2-GPⅠ,copeptin,MK and YKL-40as well as visual acuity were compared among three groups.According to the visual disability during one year follow-up,the patients with DR were divided into visual disability group(n=31)and non-visual disability group(n=112)and were compared the serum levels ofβ2-GPⅠ,copeptin,MK and YKL-40.Multivariate logistic regression analysis was used to analyze the risk factors for visual disability in patients with DR.Pearson correlation coefficient method was used to analyze the correlations of visual acuity with the serum levels ofβ2-GPⅠ,copeptin,MK and YKL-40.Results The serum levels ofβ2-GPⅠ((1.16±0.22),(2.04±0.35)ng/L),copeptin((17.83±2.05),(23.46±3.59)pmol/L),MK((3.05±0.31),(4.42±0.55)pg/L)and YKL-40((112.40±15.25),(218.11±26.12)ng/mL)in NPDR and PDR groups were higher than those in T2DM group((0.21±0.03)ng/L,(12.50±1.37)pmol/L,(1.67±0.19)pg/L,(78.50±9.12)μg/mL)(P<0.05),and the visual acuity was lower in NPDR group(0.48±0.07)and PDR group(0.18±0.03)than that in T2DM group(0.72±0.12)(P<0.05).The serum levels ofβ2-GPⅠ,copeptin,MK and YKL-40in PDR group were higher than those in NPDR group,and visual acuity was lower than that in NPDR group(P<0.05).The serum levels ofβ2-GPⅠ((2.75±0.36)ng/L),copeptin((26.84±3.14)pmol/L),MK((4.97±0.61)pg/L),YKL-40((260.32±31.84)μg/mL),course of disease((13.20±3.42)years),systolic blood pressure((147.65±9.20)mm Hg),glycosylated hemoglobin((12.01±2.52)%),fasting plasma glucose((12.80±3.56)mmol/L)and hemeostasis model assessment of insulin resistance(8.

关 键 词：糖尿病视网膜病变 2型糖尿病 β2-糖蛋白Ⅰ 和肽素 中期因子 YKL-40 预后 

分 类 号：R587.2[医药卫生—内分泌] R774.1[医药卫生—内科学]