DR患者血清中性粒细胞明胶酶相关脂质运载蛋白含量测定的临床意义

目的　通过检测糖尿病视网膜病变（ｄｉａｂｅｔｉｃｒｅｔｉｎｏｐａｔｈｙ，ＤＲ）患者的中性粒细胞明胶酶相关脂质运载蛋白（ｎｅｕｔｒｏｐｈｉｌｇｅｌａｔｉｎａｓｅａｓｓｏｃｉａｔｅｄｌｉｐｏｃａｌｉｎ，ＮＧＡＬ）及相关危险因素的变化，了解该指标的临床价值。方法　连续性、回顾性收集我院于２０１３年１月１日至２０１４年１月１日收治入院ＤＲ患者的临床资料，另纳入同期入院的糖尿病病程近１０ａ的非ＤＲ患者为对照组，获取平均动脉压、体质量指数、空腹Ｃ肽（ｆａｓｔｉｎｇＣｐｅｐｔｉｄｅ，ＦＣＰ）、空腹血糖、糖化血红蛋白（ｈｅｍｏｇｌｏｂｉｎＡｌｃ，ＨｂＡｌｃ）、血肌酐、甘油三酯、总胆固醇、低密度脂蛋白胆固醇（ｌｏｗｄｅｎｓｉｔｙｌｉｐｏｐｒｏｔｅｉｎ-ｃｈｏｌｅｓｔｅｒｏｌ，ＬＤＬ-Ｃ）、微小ＲＮＡ-２１、细胞角蛋白多肽-１９（ｃｙｔｏｋｅｒａｔｉｎ１９，Ｃｋ-１９）、凝血酶原时间、２４ｈ尿蛋白定量及ＮＧＡＬ含量。所有ＤＲ患者均常规随访１ａ以上以记录是否进展至ＰＤＲ阶段。依据随访结果，将ＤＲ患者分为ＮＰＤＲ组及ＰＤＲ组，对比两组患者组间资料的差异性。结果　经过纳入、排除及剔除标准，共搜集６１例患者的临床资料，其中５５例患者完成随访，至随访末期ＰＤＲ２０例，ＮＰＤＲ３５例。另纳入对照组７２例，三组患者年龄、患高血压病者比例、吸烟者比例、ＬＤＬ-Ｃ、ＨｂＡｌｃ、ＦＣＰ、ＣＫ-１９、ＮＧＡＬ差异均有统计学意义（均为Ｐ＜０．０５）；将ＰＤＲ组患者的ＮＧＡＬ与其他具有差异性的实验室检查指标进行ＰＰＭＣＣ检验以验证其相关性:ＮＧＡＬ与ＨｂＡｌｃ呈正相关（ｒ＝０．５７０，Ｐ＜０．０５）、与ＦＣＰ呈正相关（ｒ＝０．５２９，Ｐ＜０．０５）、与ＣＫ-１９呈正相关（ｒ＝０．５８２，Ｐ＜０．０５）；多因素Ｌｏｇｉｓｔｉｃ回归模型提示:较高水平的ＬＤＬ-Ｃ、ＨｂＡｌｃ、ＦＣＰ、ＮＧＡＬ是初检ＤＲ患者１ａ内进展至ＰＤＲ阶段的独立危险因素（均为Ｐ＜０．０５）；绘制ＮＧＡＬ作为独立危险因素评判ＤＲ患者不良预后的ＲＯＣ曲线，曲线下面积为０．８０７、９５％ＣＩ（０．７６８～０．８５０）。ＮＧＡＬ最佳预测值为７６．８２ｎｇ·ｍＬ－１，其灵敏度为７１．６９％、特异度为８２．６４％。绘制相关ＫＭ生存曲线，亦可证实ＮＧＡＬ高于７６．８２ｎｇ·ｍＬ－１的ＤＲ患者具有更高的不良预后风险（８５．７１％ ｖｓ８．８２％，χ２＝７．９７６，Ｐ＜０．０５）。结论　血清ＮＧＡＬ对于ＤＲ患者的诊断、识别高危风险、评估预后等方面具有重要意义。

The impact of Neutrophil gelatinase associated lipocalin level with diabetic retinopathy patient

Objective To understand the clinical value of some indicator by detecting the changes of neutrophil gelatinase associated lipocalin ( NGAL) and related risk factors in diabetic retinopathy ( DR) patients. Methods The clinical data of DR patients from January I ,2013 to January I ,2014 in our hospital were retrospectively collected.and another diabetic patients without DR were chosen as the control group. Mean arterial pressure ( MAP) , body mass index , fasting C peptide ( FCP) , hemoglobin Alc ( HbAlc ) . serum creatirune , triglyceride, total cholesterol. low density lipoproteincholesterol ( LDL-C ) , microRNA-21 , cytokeratin 19 ( Ck-19 ) , prothrombin time , quantitative test of 24 hours urinary protein ( QT24UP) and NGAL were detected. All DR patients were routinely followed up for I year with whether to record progress to PDR stage. Based on follow-up results , the patients were divided into NPDR group and PDR group. The data between two groups of patients were compared. Results Based on inclusion.exclusion and exclusion criteria, the clinical data of 61 patients were collected ,in which 55 patients completed the follow up ,20 cases in PDR group ,35 cases in NPDR group. Als0 72 cases were included in the control group. There was no statistical difference in age , hypertension , smoking , LDL-C , HbAlc , FCP . CK-19 . NGAL among three groups ( all P > 0. 05 ) . The relationship NGAL with other laboratory parameters in PDR group were tested by PPMCC : NGAL were positively correlated with HbAlc ( r = 0. 570 . P < 0. 05 ) , NGAL was positively correlated with FCP ( r = 0. 529 ,P < 0. 05 ) , NGAL was positively correlated with CK-19 ( r = 0. 582 .P < 0. 05 ) ; Multivariate Logistic regression model suggested that high levels of LDL-C , HbAlc ,FCP and NGAL were the independent risk factors for DR patients progressed into PDR within I year ( all P < 0. 05 ). ROC curve was drawn to show the NGAL as an independent risk factor for evaluation DR patients with poor prognosis .the area under the curve was 0. 807 .95% confidence interval ranged between 0. 768 and 0. 850. The best predictive value of NGAL was 76. 82 ng . mL -l .the sensitivity was 71. 6g% , the specificity was 82. 64% . KM survival curve was drawn. and also confirmed that the patients with NGAL higher than 76. 82 ng . mL -l had a higher risk of poor prognosis ( 85. 71% vs 8. 82% . X2 = 7. 976 ,P < 0. 05 ) . Conclusion The serum NGAL plays an important role in diagnosis of DR .identifying the high risk and assessing prognosis.