2型糖尿病视网膜病变患者血清HbA1c、CysC检测及临床意义  

Changes of serum HbA1c and CysC in patients with type 2 diabetic retinopathy and their clinical significance

作　　者：郭建强[1] 赵俊宏[1] 张分队[1] 叶妮[1] GUO Jianqiang;ZHAO Junhong;ZHANG Fendui(Xi'an No.1 Hospital(First Affiliated Hospital of Northwest University),Xi'an 710002)

机构地区：[1]西安市第一医院(西北大学附属第一医院),西安710002

出　　处：《陕西医学杂志》2020年第5期619-622,共4页Shaanxi Medical Journal

基　　金：陕西省卫生计生科研基金资助项目(2016C004)。

摘　　要：目的:探讨血清糖化血红蛋白(HbA1c)、胱抑素C(CysC)在2型糖尿病视网膜病变(DR)患者中的变化及临床意义。方法:选取92例2型糖尿病患者,根据是否合并视网膜病变分为DR组(40例,合并视网膜病变)和NDR组(52例,不合并视网膜病变),另选取同期性别及年龄匹配的45例健康体检者作为对照组。收集三组一般资料,检测外周静脉血三酰甘油(TG)、总胆固醇(TC)、低密度脂蛋白(LDL-C)、高密度脂蛋白(HDL-C)、空腹血糖(FPG)、HbA1c、高敏C-反应蛋白(hs-CRP)和CysC等生化指标。结果:三组性别、年龄、HDL-C比较无统计学差异(P>0.05);NDR组和DR组BMI、FPG、TC、TG、LDL-C、hs-CRP、HbA1c和CysC水平高于对照组(P<0.05);DR组FPG、hs-CRP、HbA1c、CysC水平高于NDR组(P<0.05);多因素Logistic回归分析显示,糖尿病病程(OR=1.355,95%CI:1.057~1.738)、HbA1c(OR=2.328,95%CI:1.518~3.569)和CysC(OR=4.284,95%CI:1.911~9.607)是2型糖尿病发生视网膜病变的独立危险因素;ROC曲线分析显示,血清HbA1c、CysC预测DR的最佳截断值分别为8.74%、0.88 mg/L,两者联合预测的AUC大于HbA1c及CysC单项预测(均P<0.05),HbA1c与CysC预测的AUC比较无统计学差异(P>0.05)。结论:血清HbA1c及CysC水平升高与糖尿病患者出现视网膜病变密切相关,且对预测DR具有一定价值,两者联合检测对预测DR具有较好的应用价值。Objective:To explore changes of serum glycated hemoglobin(HbA1 c)and cystatin C(CysC)in patients with type 2 diabetic retinopathy(DR)and their clinical significance.Methods:According to presence or absence of retinopathy,a total of 92 patients with type 2 diabetes mellitus(T2 DM)were divided into DR group(retinopathy,40 cases)and NDR group(without retinopathy,52 cases).A total of 45 healthy persons with matched gender and age during the same period were enrolled as control group.The general data in three groups were collected.The biochemical indexes such as triglyceride(TG),total cholesterol(TC),low density lipoprotein cholesterol(LDL-C),high density lipoprotein cholesterol(HDL-C),fasting blood glucose(FPG),HbA1 c,high-sensitivity C-reactive protein(hs-CRP)and CysC in peripheral venous blood were detected.Results:There were no significant differences in gender,age and HDL-C among the three groups.The levels of BMI,FPG,TC,TG,LDL-C,hs-CRP,HbA1 c and CysC in NDR group and DR group were significantly higher than those in control group.The levels of FPG,Hs-CRP,HbA1 c and CysC in DR group were significantly higher than those in NDR group.The results of multivariate Logistic regression analysis suggested that course of diabetes mellitus(OR=1.355,95%CI:1.057~1.738),HbA1 c(OR=2.328,95%CI:1.518~3.569)and CysC(OR=4.284,95%CI:1.911~9.607)were independent risk factors of DR.ROC curve analysis suggested that best cut-off values of serum HbA1 c and CysC for predicting DR were 8.74%and 0.88 mg/L,respectively.AUC of their combined prediction was significantly greater than that of HbA1 c and CysC alone(all P<0.05).There is no significant difference between HbA1 c and CysC in predicting AUC(P>0.05).Conclusion:The increase of serum HbA1 c and CysC levels is closely related to retinopathy in diabetes mellitus patients,which are of certain value in predicting DR.The combined detection of the two is of good application value in predicting DR.

关 键 词：2型糖尿病 视网膜病变 糖化血红蛋白 胱抑素C 病程 相关性 

分 类 号：R774.1[医药卫生—眼科]