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目的:探讨血浆甘丙肽水平与2型糖尿病性视网膜病变的相关性及诊断价值。方法:245例2型糖尿病患者按照眼底检查结果分为2型糖尿病无视网膜病变组(NDR组)95例,2型糖尿病非增殖性视网膜病变组(NPDR组)78例和2型糖尿病增殖性视网膜病变组(PDR组)72例,另选择65例同期体检中心体检的健康人群作为对照组,统计4组受试对象临床资料,常规检查血糖、血脂等临床指标,酶联免疫吸附测定法检测血浆甘丙肽水平。Logistic回归分析影响NPDR和PDR的危险因素,利用受试者工作曲线(ROC)预测甘丙肽对NPDR或PDR的诊断价值。结果:与对照组比较,NDR组、NPDR组、PDR组收缩压(SBP)、舒张压(FBG)、糖化血红蛋白(HbA1c)、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高敏C反应蛋白(Hs-CRP)、胰岛素抵抗指数(HOMA-IR)、血浆甘丙肽明显升高,高密度脂蛋白胆固醇(HDL-C)明显降低,差异有统计学意义(P<0.05)。与NDR组比较,NPDR组、PDR组糖尿病病程、SBP、HOMA-IR、Hs-CRP、血浆甘丙肽明显升高,差异有统计学意义(P<0.05)。与NPDR组比较,PDR组糖尿病病程、Hs-CRP、血浆甘丙肽明显升高,差异有统计学意义(P<0.05)。NPDR和PDR患者血浆甘丙肽与糖尿病病程、FBG、HbA1c、TC、HOMA-IR和Hs-CRP呈正相关(均P<0.05)。Logistic回归分析显示,HbA1c、HOMA-IR、Hs-CRP、甘丙肽水平是影响NPDR的独立危险因素;糖尿病病程、HbA1c、HOMA-IR、Hs-CRP、甘丙肽水平是影响PDR的独立危险因素(均P<0.05)。甘丙肽诊断NPDR的最佳临界值为21.94ng/L,敏感度为72.0%,特异度为91.6%,ROC曲线下面积(AUC)为0.894(95%CI:0.838~0.936,P<0.05)。甘丙肽诊断PDR的最佳临界值为24.92ng/L,敏感度为69.4%,特异度为86.1%,AUC为0.835(95%CI:0.764~0.892,P<0.05)。结论:血浆甘丙肽是影响NPDR和PDR的独立危险因素,通过检测血浆甘丙肽水平能够为诊断NPDR和PDR提供参考。
Objective: To investigate the correlation between plasma galanin level and type 2 diabetic retinopathy and its diagnostic value. Methods: According to the results of fundus examination, 245 patients with type 2 diabetes were divided into 95 cases of type 2 diabetic patients without retinopathy (NDR group), 78 cases of type 2 diabetic nonproliferative retinopathy (NPDR group) and 2 cases of type 2 diabetic proliferative retina (PDR group), 72 cases were selected, and another 65 healthy people at the same time physical examination center were selected as the control group. The clinical data of the 4 groups of subjects were collected, routine examination of blood glucose, blood lipid and other clinical indicators, Galanin levels. Logistic regression analysis was used to analyze the risk factors affecting NPDR and PDR, and the receiver operating curve (ROC) was used to predict the diagnostic value of galanin to NPDR or PDR. Results: Compared with the control group, the SBP, FBG, HbA1c, TC, TG, LDL, LDL-C, Hs-CRP, HOMA-IR, plasma galanin, and HDL-C decreased significantly Significance (P <0.05). Compared with NDR group, the course of diabetes, SBP, HOMA-IR, Hs-CRP, and plasma galanin in NPDR group and PDR group were significantly increased (P <0.05). The duration of diabetes, Hs-CRP and plasma galanin in PDR group were significantly higher than those in NPDR group (P <0.05). Plasma galangin levels in patients with NPDR and PDR were positively correlated with duration of diabetes, FBG, HbA1c, TC, HOMA-IR and Hs-CRP (all P <0.05). Logistic regression analysis showed that the levels of HbA1c, HOMA-IR, Hs-CRP and galanin were independent risk factors for NPDR. The duration of diabetes, HbA1c, HOMA-IR, Hs-CRP and galanin levels were independent risk factors for PDR Factors (all P <0.05). The optimal cutoff value of galanin for NPDR was 21.94ng / L, the sensitivity was 72.0%, the specificity was 91.6%, and the area under the curve of ROC (AUC) was 0.894 (95% CI: 0.838-0.936, P <0.05) . The best cutoff value of galanin for diagnosis of PDR was 24.92ng / L, the sensitivity was 69.4%, the specificity was 86.1%, and the AUC was 0.835 (95% CI: 0.764-0.892, P <0.05). Conclusion: Plasma galanin is an independent risk factor for NPDR and PDR. The detection of plasma galanin can provide a reference for the diagnosis of NPDR and PDR.