2型糖尿病视网膜病变患者血清APN、SUA及MLR水平的变化及诊断价值研究  

A Study of Changes and Diagnostic Value of Serum APN,SUA and MLR in Patients with Type 2 Diabetic Retinopathy

作　　者：刘爱华 白晶[1] 王娜[1] 刘向祎[1] LIU Aihua;BAI Jing;WANG Na;LIU Xiangyi(Department of Laboratory Medicine,Beijing Tongren Hospital Affiliated to Capital Medical University,Beijing100730,China;Department of Laboratory Medicine,Xiyuan Hospital,China Academy of Chinese Medical Science,Beijing 100091,China)

机构地区：[1]首都医科大学附属北京同仁医院检验科,北京100730 [2]中国中医科学院西苑医院检验科,北京100091

出　　处：《标记免疫分析与临床》2024年第3期414-420,共7页Labeled Immunoassays and Clinical Medicine

基　　金：基于AI+大数据的临床检验质量风险预测与实时监控模型关键技术研究(编号:22YGA910003)。

摘　　要：目的通过比较血清脂联素(APN)、血尿酸(SUA)及单核细胞与淋巴细胞比值(MLR)在2型糖尿病视网膜病变(DR)患者中的水平变化,探讨其辅助DR早期诊断的价值。方法选取2022年1月至2022年8月在首都医科大学附属北京同仁医院(以下简称为“我院”)收治的2型糖尿病(T2DM)患者150例,依据临床诊断分为3组:糖尿病无视网膜病变组(T2DM组)55例,非增生性糖尿病视网膜病变组(NPDR组)39例、增生性糖尿病视网膜病变组(PDR组)56例;另选取我院同期健康体检者51例作对照组。测定所有研究对象的血清APN水平,并收集所有对象的血糖、血脂、肝功、肾功等生化指标及血常规中单核细胞计数和淋巴细胞计数,计算三酰甘油-葡萄糖(TyG)指数、MLR。比较各项指标在4组之间水平变化,寻找差异性指标,运用ROC曲线分析各指标单独及联合辅助诊断DR的价值。结果(1)4组间比较,血清APN、SUA、MLR比较差异具有统计学意义(P<0.001、P=0.004、P=0.001),T2DM组、NPDR组、PDR组APN水平均低于对照组;T2DM组、NPDR组及PDR组SUA、MLR均高于对照组,且随病情加重而上升。(2)2组间比较中,PDR组APN、SUA、MLR水平均显著高于T2DM组,差异均有统计学意义(P<0.05),而NPDR组APN、SUA、MLR水平与T2DM组和PDR组的组间比较差异无统计学意义(P>0.05)。(3)Logistic回归分析中,结果显示APN、MLR、SUA为2型糖尿病患者发生视网膜病变的危险因素(OR>1,P<0.05)。(4)ROC曲线分析显示APN、SUA、MLR、APN+SUA+MLR的灵敏度分别为56.8%、61.1%、68.4%、77.9%,特异性分别为74.5%、63.6%、58.2%、74.5%,曲线下面积(AUC)分别为0.691、0.615、0.639、0.816,阴性预测值分别为50.0%、48.6%、51.6%、66.1%,阳性预测值分别为79.4%、74.4%、73.9%、84.1%,对判断糖尿病是否合并视网膜病变具有一定诊断价值。结论DR的发生发展与APN、SUA、MLR水平相关,3项指标单独检测对DR的辅助诊断价值有限,3者联合检测更有助于DObjective To evaluate and compare level changes of serum adiponectin(APN),serum uric acid(SUA)and monocyte to lymphocyte ratio(MLR)in patients with type 2 diabetic retinopathy(DR),and to explore their values to assist the early diagnosis of DR.Methods From January,2022 to August,2022,150 patients with type 2 diabetes mellitus(T2DM)were enrolled in this study.According to clinical diagnosis,these patients were divided into three groups:diabetes mellitus(T2DM)group(55 cases),non-proliferative diabetic retinopathy(NPDR)group(39 cases),and proliferative diabetic retinopathy(PDR)group(56 cases).In addition,51 healthy subjects were selected as the control group.Serum levels of APN,blood glucose,blood lipid,liver function,kidney function,monocyte count and lymphocyte count were measured in all study subjects.We then evaluated and compared level changes of each index among the four groups,in order to identify the differential index,and to analyze the value of each index alone and combined with the diagnosis of DR by ROC.Results(1)There were significant differences in serum APN,SUA and MLR among the four groups(P<0.001,P=0.004,P=0.001).The levels of APN in the T2DM group,NPDR group and PDR group were lower than those in the control group;SUA and MLR in T2DM group,NPDR group and PDR group were higher than those in the control group,and increased with the severity of the disease.(2)Levels of APN,SUA and MLR in PDR group were significantly higher than those in T2DM group(P<0.05),while levels of APN,SUA and MLR in NPDR group were not significantly different from those in T2DM group and PDR group(P>0.05).(3)Logistic regression analysis showed that APN,MLR and SUA were the risk factors of retinopathy in type 2 diabetes mellitus(OR>1,P<0.05).(4)The sensitivities of APN,SUA,MLR,APN+SUA+MLR were 56.8%,61.1%,68.4%,77.9%,and the specificities were 74.5%,63.6%,58.2%,74.5%,while AUCs were 0.691,0.615,0.639,0.816,and negative predictive value were 50.0%,48.6%,51.6%,66.1%,positive predictive value were 79.4%,74.4%,73.9%,84.1%,respective

关 键 词：脂联素 糖尿病视网膜病变 单核细胞与淋巴细胞比值 尿酸 三酰甘油-葡萄糖指数 

分 类 号：R587.2[医药卫生—内分泌] R744.1[医药卫生—内科学]