2型糖尿病视网膜病变患者同型半胱氨酸和血尿酸水平及其预测价值  

Homocysteine and serum uric acid levels in type 2 diabetic retinopathy and their predictive value for disease

作　　者：魏静 张金成[1] 史亚男 张慧芹[1] 吴岩[1] Wei Jing;Zhang Jincheng;Shi Yanan;Zhang Huiqin;Wu Yan(Department of Endocrinology,Cangzhou Central Hospital of Hebei Province,Cangzhou 061000,China)

机构地区：[1]河北省沧州市中心医院内分泌一科,沧州061000

出　　处：《中华眼底病杂志》2023年第2期125-131,共7页Chinese Journal of Ocular Fundus Diseases

基　　金：沧州市重点研发计划项目 (204106110)。

摘　　要：目的观察同型半胱氨酸(Hcy)、血尿酸(SUA)水平与2型糖尿病(T2DM)患者视网膜病变的相关性,初步探讨其预测价值。方法回顾性研究。2020年1月至2021年3月于沧州市中心医院内分泌科住院治疗的T2DM患者324例纳入研究。检测患者空腹血糖(FBG)、糖化血红蛋白(HbA1C)、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)、血肌酐(Scr)、血尿素氮(BUN)、Hcy、SUA以及外周血内皮祖细胞(EPC)、循环祖细胞(CPC)、内皮细胞(CEC)计数,计算胰岛素抵抗指数(HOMA-IR)。根据有无糖尿病视网膜病变(DR)将患者分为无DR(NDR)组、DR组,分别为100、214例。对比观察两组患者临床资料和实验室生物化学指标。采用logistic回归分析法分析T2DM患者发生DR的独立危险因素;平滑曲线拟合分析法分析Hcy、SUA与DR的曲线关系,并利用受试者工作特征曲线(ROC曲线)计算Hcy、SUA及两者联合预测T2DM患者发生DR的ROC面积(AUC),评估Hcy、SUA对T2DM患者发生DR的预测价值。结果DR组患者糖尿病病程(t=5.380)、收缩压(SBP)(t=2.935)、高血压(χ^(2)=10.248)、糖尿病肾病(χ^(2)=9.515)、糖尿病周围神经病变(χ^(2)=24.501)、FBG(t=3.945)、HbA1C(t=3.336)、TG(t=2.898)、LDL-C(t=3.986)、Scr(t=2.139)、SUA(t=7.138)、HOMA-IR(t=3.237)、BUN(t=3.609)、Hcy(t=2.363)以及CEC计数(t=19.396)显著高于NDR组,差异有统计学意义(P<0.05);EPC(t=9.563)、CPC(t=7.684)计数显著低于NDR组,差异有统计学意义(P<0.05)。Logistic回归分析结果显示,糖尿病病程、SBP、高血压、FBG、HbA1C、LDL-C、SUA、Hcy、EPC、CPC、CEC均是T2DM患者发生DR的独立危险因素(P<0.05)。平滑曲线拟合分析结果显示,Hcy、SUA与DR的发生呈线性正相关。调整混杂因素后,当Hcy≥15μmol/L时,Hcy每增加1μmol/L,DR发生风险增加14%[比值比(OR)=0.92,95%可信区间(CI)0.88~0.98,P<0.05];当Hcy<15μmol/L时,差异无统计学意义(OR=0.96,95%CI 0.92~1.08,P>0.05)。当SUA≥304�Objective To observe the correlation between homocysteine(Hcy)and serum uric acid(SUA)and retinopathy in type 2 diabetes mellitus(T2DM),preliminary study on its predictive value.Methods A retrospective study.From January 2020 to March 2021,a total of 324 T2DM patients hospitalized in Department of Endocrinology,Cangzhou Central Hospital of Hebei Province were included.Fasting blood glucose(FBG),glycated hemoglobin(HbA1C),triglycerides(TG),low density lipoprotein cholesterol(LDL-C),high density lipoprotein cholesterol(HDL-C),serum creatinine(Scr),blood urea nitrogen(BUN),Hcy,SUA,peripheral blood endothelial progenitor cells(EPC),circulating endothelial cells(CEC)were counted and homeostasis model assessment for insulin resistance(HOMA-IR)was calculated.According to the absence or presence of diabetic retinopathy(DR),the patients were divided into non DR(NDR)group and DR group with 100 and 214 cases,respectively.Clinical data and laboratory biochemical indexes of the two groups were compared and observed.The logistic regression was used to analyze the independent risk factors for DR in T2DM patients.Smooth curve fitting was used to analyze the curve relationship between Hcy,SUA and DR,and ROC area(AUC)of Hcy,SUA;their combined prediction of DR in T2DM patients was calculated by receiver operating characteristic curve(ROC curve),and the predictive value of Hcy and SUA for DR in T2DM patients was evaluated.Results Diabetic course(t=5.380),systolic blood pressure(t=2.935),hypertension(χ^(2)=10.248),diabetic nephropathy(χ^(2)=9.515),diabetic peripheral neuropathy(χ^(2)=24.501),FBG(t=3.945),HbA1C(t=3.336)and TG in DR Group(t=2.898),LDL-C(t=3.986),Scr(t=2.139),SUA(t=7.138),HOMA-IR(t=3.237),BUN(t=3.609),Hcy(t=2.363)and CEC(t=19.396)were significantly higher than those in NDR group.The difference was statistically significant(P<0.05).EPC(t=9.563)and CPC(t=7.684)levels were significantly lower than those of NDR group,and the difference was statistically significant(P<0.05).Logistic regression analysis showed that diabete

关 键 词：同型半胱氨酸 血尿酸 2型糖尿病 糖尿病视网膜病变 预测价值 

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