血尿酸、胱抑素C和促代谢因子水平与糖尿病视网膜病变的相关性分析

目的 分析血尿酸、胱抑素C和促代谢因子水平与糖尿病视网膜病变的相关性。方法 选择河南省直第三人民医院2018年5月-2019年5月收治的106例2型糖尿病患者进行研究，根据视网膜病变程度将患者分为无糖尿病视网膜病变组（NDR，n=35）、非增生型糖尿病视网膜病变组（NPDR，n=40）、增生型糖尿病视网膜病变组（PDR，n=31），同时选取同期体检的健康人群为对照组（n=33）。检测各组血尿酸、胱抑素C、促代谢因子水平，分析血尿酸、胱抑素C、促代谢因子水平与糖尿病视网膜病变的相关性，采用Logistic回归模型分析影响糖尿病视网膜病变的因素，采用受试者工作特征曲线（ROC）分析血尿酸、胱抑素C、促代谢因子水平对糖尿病视网膜病变的诊断价值。结果 与对照组患者比较，糖尿病视网膜病变组患者的血尿酸、胱抑素C、促代谢因子水平均明显升高（P<0.05），NDR、NPDR、PDR组血尿酸、胱抑素C、促代谢因子水平呈依次升高趋势（P<0.05）。Pearson相关性分析显示，血尿酸、胱抑素C、促代谢因子与糖尿病视网膜病变发生呈明显正相关（r=0.47，P<0.05；r=0.82，P<0.05；r=0.94，P<0.05）。二元Logistic回归模型分析显示，剔除血糖、胰岛素抵抗等因素的影响，血尿酸、胱抑素C、促代谢因子是影响糖尿病视网膜病变的独立危险因素（P<0.05）。血尿酸、胱抑素C、促代谢因子诊断糖尿病视网膜病变的曲线下面积（AUC）分别为0.746（95% CI：0.656~0.836）、0.871（95% CI：0.783~0.959）、0.884（95% CI：0.803~0.966），三者联合诊断AUC为0.964（95% CI：0.935~0.993）明显高于各指标单独检测。结论 糖尿病视网膜病变患者血尿酸、胱抑素C、促代谢因子水平异常升高，可能参与了糖尿病视网膜病变发生、发展过程，联合检测三者水平对糖尿病视网膜病变有较好的诊断价值。

Correlation between levels of serum uric acid, cystatin C, and betatrophin and diabetic retinopathy

Objective To analyze the correlation between levels of serum uric acid (SUA), cystatin C (Cys-C), and betatrophin and diabetic retinopathy (DR). Methods A total of 106 patients with type 2 diabetes mellitus admitted to Third Provincial Hospital of Henan Province from May 2018 to May 2019 were selected for the study. The patients were divided into no DR group (NDR group, n=35), non-proliferative DR group (NPDR group, n=40), and proliferative DR group (PDR group, n=31) according to the degree of retinopathy, and 33 healthy people for physical examination in the hospital at the same period were selected as control group. The levels of SUA, Cys-C, and betatrophin were detected, and the correlation between levels of SUA, Cys-C, and betatrophin and DR was analyzed. Logistic regression model was used to analyze the factors affecting DR. The receiver operating characteristic curve (ROC) was used to analyze the diagnostic value of blood SUA, Cys-C, and betatrophin on DR. Results Compared with control group, SUA, Cys-C, and betatrophin levels in DR group were significantly increased (P<0.05), and the levels of SUA, Cys-C, and betatrophin in NDR group, NPDR group, and PDR group were increased in turn (P<0.05). Pearson correlation analysis showed that SUA, Cys-C, and betatrophin were positively correlated with DR (r=0.47, 0.82, and 0.94, P<0.05). Binary logistic regression model analysis showed that SUA, Cys-C, and betatrophin were independent risk factors for DR (P<0.05). AUC values of SUA, Cys-C, and betatrophin in the diagnosis of DR were 0.746 (95% CI:0.656-0.836), 0.871 (95% CI:0.783-0.959) and 0.884 (95% CI:0.803-0.966), and the AUC of combined diagnosis of the three was 0.964 (95% CI:0.935-0.993), which was significantly higher than that of individual detection (P<0.05). Conclusion The levels of SUA, Cys-C, and betatrophin in patients with DR are abnormally elevated, which may be involved in the occurrence and development of DR. The combined detection of the three levels has a good diagnostic value on DR.