血清TyG指数和nesfatin-1及RBP4联合预测糖尿病视网膜病变的价值  

Predictive value of the combination of serum TyG index,nesfatin-1,and retinol-binding protein 4 for diabetic retinopathy

作　　者：尚利晓[1] 魏菁[1] 谢琦莲 李琰 Shang Lixiao;Wei Jing;Xie Qilian;Li Yan(Department of Ophthalmology,the First Affiliated Hospital of Henan University of Science and Technology,Luoyang 471000,Henan Province,China)

机构地区：[1]河南科技大学第一附属医院眼科,中国河南省洛阳市471000

出　　处：《国际眼科杂志》2024年第11期1802-1806,共5页International Eye Science

摘　　要：目的:探究血清甘油三酯-葡萄糖(TyG)指数、摄食抑制因子-1(nesfatin-1)、视黄醇结合蛋白4(RBP4)联合预测糖尿病视网膜病变(DR)的价值,为DR早期预测提供支持。方法:回顾性分析。收集2022-02/2023-12我院接诊的2型糖尿病(T2DM)患者164例的临床资料,按照眼底检查结果分为DR组43例(其中增殖性DR 19例,非增殖性DR 24例),不合并DR的T2DM组121例。入院后记录患者基本资料,检查血清TyG指数、nesfatin-1、RBP4水平。结果:DR组病程长于T2DM组,空腹血糖、糖化血红蛋白、甘油三酯、总胆固醇、低密度脂蛋白及TyG指数、RBP4水平高于T2DM组,高密度脂蛋白、nesfatin-1水平低于T2DM组(均P<0.001)。多因素Logistic回归分析可知,T2DM病程(OR=1.338,95%CI:1.059-1.690)、糖化血红蛋白(OR=5.065,95%CI:1.659-15.470)、低密度脂蛋白(OR=12.715,95%CI:2.385-67.790)、TyG指数(OR=23.057,95%CI:2.936-181.073)、RBP4(OR=1.319,95%CI:1.028-1.692)是T2DM患者发生DR的危险因素,nesfatin-1(OR=0.007,95%CI:0.003-0.016)为保护因素。绘制ROC曲线显示,TyG指数、nesfatin-1、RBP4均对T2DM患者并发DR具有一定预测价值,曲线下面积(areas under curve,AUC)分别为0.804、0.878、0.738,各指标联合预测时AUC为0.946,预测敏感度为83.72%、特异度为92.56%。增殖性DR患者TyG指数、RBP4水平高于非增殖性DR患者,nesfatin-1水平低于非增殖性DR患者(均P<0.05)。Spearman相关性分析显示,TyG指数、RBP4水平与DR病情程度呈正相关,nesfatin-1水平与DR病情程度呈负相关(r_(s)=0.557、0.392、-0.359,均P<0.05)。Pearson相关分析显示,T2DM并发DR患者TyG指数与nesfatin-1水平呈负相关,与RBP4水平呈正相关,nesfatin-1与RBP4水平呈负相关(r=-0.486、0.538、-0.592,均P<0.05)。结论:血清TyG指数、nesfatin-1、RBP4水平与DR发病风险及病情程度有关,可作为DR早期预测的标志物,且联合预测效能更好。AIM:To explore the predictive value of the combination of triglyceride-glucose(TyG)index,nesfatin-1,and retinol-binding protein 4(RBP4)for diabetic retinopathy,and provide evidence for early prediction of DR.METHODS:The clinical data of 164 patients with type 2 diabetes mellitus(T2DM)who admitted to the hospital between February 2022 and December 2023 were retrospectively collected.Based on the fundus examination results,these patients were divided into two groups:the DR group(n=43),including proliferative DR(PDR,n=19)and non-proliferative DR(NPDR,n=24),and the T2DM without DR group(n=121).The TyG index and the level of nesfatin-1 and RBP4 were measured after admission.RESULTS:T2DM patients with DR had a longer disease duration compared with T2DM patients without DR,and the DR group had higher fasting blood glucose,glycosylated hemoglobin,triglyceride,total cholesterol,low-density lipoprotein,TyG index,and RBP4 levels,while lower high-density lipoprotein and nesfatin-1 levels(all P<0.001).Multivariate Logistic regression analysis indicated that the duration of T2DM(OR=1.338,95%CI:1.059-1.690),glycosylated hemoglobin(OR=5.065,95%CI:1.659-15.470),low density lipoprotein(OR=12.715,95%CI:2.385-67.790),TyG index(OR=23.057,95%CI:2.936-181.073)and RBP4(OR=1.319,95%CI:1.028-1.692)were the independent risk factors for DR,while nesfatin-1(OR=0.007,95%CI:0.003-0.016)was an independent protective factor for DR.The ROC curves were drawn,and the results indicated that the TyG index,nesfatin-1,and RBP4 had certain predictive values for DR patients with T2DM,with areas under curve(AUC)of 0.804,0.878 and 0.738,respectively.The combined AUC of the TyG index,nesfatin-1,and RBP4 was 0.946,sensitivity was 83.72%,and specificity was 92.56%.Patients with PDR had a higher TyG index,higher RBP4 level,and lower nesfatin-1 level than patients with NPDR(all P<0.05).Spearman’s correlations indicated a positive association between the TyG index,RBP4 and DR degree,and a negative association between nesfatin-1 and DR degree(r_(s)=0.557,0.392,

关 键 词：甘油三酯-葡萄糖(TyG)指数 摄食抑制因子-1(nesfatin-1) 视黄醇结合蛋白4(RBP4) 糖尿病视网膜病变 

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