2型糖尿病患者视网膜病变与血清胱抑素C及糖化血红蛋白水平的相关性研究

发布时间：2018-05-01 01:38

本文选题：2型糖尿病 + 糖尿病视网膜病变　；参考：《河北医科大学》2017年硕士论文

【摘要】：目的:近30年来我国糖尿病患病率显著增加,糖尿病视网膜病变(Diabetic Retinopathy,DR)是2型糖尿病患者最常见的微血管并发症之一,严重病变会导致患者失明[1]。血清胱抑素C(Cys C)是一种广泛存在于各种组织的体液和有核细胞的低相对分子量、碱性非糖化蛋白质。有研究发现大鼠的玻璃体和隔层视网膜细胞都会表达Cys C。糖化血红蛋白(Hb A1c)是反映患者平均血糖水平高低的敏感指标,是监测糖尿病血糖控制情况的金标准,研究认为糖尿病视网膜病变和糖化血红蛋白水平呈正相关。本研究主要分析了2型糖尿病患者视网膜病变的发生及严重程度与患者血清Cys C及Hb A1c水平的相关性,为2型糖尿病视网膜病变的预防和临床诊治提供客观的评价指标。方法:1选取2015年01月至2016年12月就诊于保定市第一中心医院内分泌科的住院2型糖尿病患者650例进行回顾性病例对照研究。其中男性患者312例,包含DR患者为120例,其中非增殖期视网膜病变(NPDR)患者为75例,增殖期视网膜病变(PDR)患者为45例;女性患者338例,包含DR患者为143例,其中非增殖期视网膜病变(NPDR)患者为80例,增殖期视网膜病变(PDR)患者为63例。2从住院系统收集患者个人基本信息:包括年龄、性别、糖尿病病程、有无糖尿病家族史、身高、体重、吸烟史(定义为至少每日吸烟一支,持续一年以上)、收缩压(SBP)、舒张压(DBP);次日清晨空腹状态下抽静脉血测定空腹血糖(FBG)、糖化血红蛋白(Hb A1c)、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、谷氨酰胺转移酶(GGT)、尿素氮(BUN)、肌酐(SCr)、血尿酸(SUA)、胱抑素C(Cys C);记录患者眼底是否出现微血管瘤、出血点、硬性渗出、新生血管增殖等病变情况,为视网膜病变临床分期提供可靠的依据。分别比较非糖尿病视网膜病变组(NDR组)与糖尿病视网膜病变组(DR组)患者、非增殖期视网膜病变组(NPDR组)与增殖期视网膜病变组(PDR组)患者一般资料及实验室检查;对比不同胱抑素水平及糖化血红蛋白水平2型糖尿病患者发生NDR与DR;NPDR与PDR的患病率;用二元logistic回归分析2型糖尿病患者发生DR的相关危险因素。结果:1 2型糖尿病患者发生DR的患病率为40.46%。胱抑素正常组及胱抑素升高组NDR与DR患病率对比差异有统计学意义(X2=7.770,P=0.0053)。不同糖化血红蛋白水平(糖化血红蛋白7%,7%-8%,8%-9%,9%水平)对比,四组患者中NDR与DR患病率对比差异有统计学意义(X2=66.68,P0.001)。随着Cys C水平升高DR组及NDR组患者例数明显增加;随着Hb A1c水平的升高,DR患病率明显升高。2 Logistic回归分析显示:HDL是2型糖尿病患者发生DR的保护因素[OR值分别为0.134,(95%CI 0.089-0.233,P=0.008)];年龄、糖尿病家族史、吸烟史、SBP、DBP、TG、糖尿病病程、Hb A1c、Cys C均是2型糖尿病患者发生DR的危险因素;OR值分别为1.214,(95%CI1.152-1.320,P=0.021);1.521,(95%CI 1.433-1.624,P=0.012);1.210,(95%CI 1.104-1.264,P=0.044);1.301,(95%CI 1.275-1.421,P=0.034);1.284,(95%CI 1.204-1.328,P=0.036);1.498,(95%CI 1.420-1.562,P=0.010);1.364,(95%CI 1.258-1.425,P=0.034);2.310,(95%CI2.091-2.510,P=0.002);3.211,(95%CI 3.047-3.451,P=0.021)。结论:1 2型糖尿病患者合并视网膜病变的危险因素众多,Hb A1c可以较为真实的反映患者血糖控制情况及DR的严重程度,是2型糖尿病患者发生DR的危险因素。2 Cys C可以作为反映2型糖尿病患者视网膜病变情况的内源性标志物,是DR发生的重要危险因素;早期监测胱抑素C和Hb A1c能够对视网膜病变的发生、发展起到良好的监测作用,为视网膜病变的预防、治疗提供可靠监测指标。3 HDL是2型糖尿病患者发生DR的保护因素;年龄、糖尿病家族史、吸烟史、SBP、DBP、TG、糖尿病病程、Hb A1c、Cys C均是2型糖尿病患者发生DR的危险因素。
[Abstract]:Objective: the prevalence of diabetes in China has increased significantly in the last 30 years. Diabetic retinopathy (Diabetic Retinopathy, DR) is one of the most common microvascular complications in type 2 diabetic patients. Severe lesions will lead to the blindness of [1]. serum cystatin C (Cys C), a low relative fraction of the body fluids and nucleated cells widely distributed in various tissues. It is found that the Cys C. glycated hemoglobin (Hb A1c) is a sensitive indicator of the average blood glucose level of the patients, and is the gold standard for monitoring the control of diabetic blood glucose. This study mainly analyzed the correlation between the incidence and severity of retinopathy of type 2 diabetic patients with the level of serum Cys C and Hb A1c in patients with type 2 diabetic retinopathy, and provided an objective evaluation index for the prevention and clinical diagnosis and treatment of type 2 diabetic retinopathy. Method: 1 from 01 months to December 2016 2015 in the first middle of Baoding City A retrospective case control study was conducted in 650 patients with type 2 diabetes in the Department of endocrinology in the heart hospital, of which 312 cases were male and 120 were DR patients, including 75 cases of non proliferative retinopathy (NPDR), 45 cases of proliferative retinopathy (PDR), 338 cases of female patients, and 143 cases including DR patients, of which the non proliferation period was non proliferative. 80 patients with retinopathy (NPDR) and 63 patients with proliferative retinopathy (PDR) collected the basic information of the patients from the hospital system: age, sex, the course of diabetes, family history of diabetes, height, weight, smoking history (defined as at least one cigarette per day, more than one year), systolic pressure (SBP), diastolic pressure (DBP); diastolic pressure (DBP); (DBP); Fasting blood glucose (FBG), glycated hemoglobin (Hb A1c), total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), glutamine transaminase (ALT), glutamine transaminase (AST), glutamine transferase (GGT), urea nitrogen (BUN), creatinine (SCr), and blood uric acid. A), Cystatin C (Cys C), recording the occurrence of microangioma, bleeding point, hard exudation, neovascular proliferation and other pathological changes in the patients' fundus, providing a reliable basis for the clinical stage of retinopathy. Compared with non diabetic retinopathy group (group NDR) and diabetic retinopathy group (DR group), non proliferative retinopathy group (N General data and laboratory examination in group PDR) and proliferating retinopathy group (group PDR); the incidence of NDR and DR in type 2 diabetic patients with different cystatin levels and glycosylated hemoglobin levels, the prevalence of NPDR and PDR, and the risk factors of DR in type 2 diabetic patients were analyzed by two element logistic regression. Results: type 12 diabetic patients The incidence of the incidence of DR was statistically significant (X2=7.770, P=0.0053) in the normal group of 40.46%. cystatin and the elevated cystatin group (X2=7.770, P=0.0053). The comparison of the levels of glycosylated hemoglobin (glycosylated hemoglobin 7%, 7%-8%, 8%-9%, and 9%) was statistically significant in the prevalence of NDR and DR in the four groups (X2=66.68, P0.001). With the increase of Cys C level, the number of patients in group DR and NDR increased significantly. With the increase of Hb A1c level, the incidence of DR prevalence was significantly higher than that of.2 Logistic regression analysis showed that HDL was the DR protective factor of type 2 diabetes mellitus (0.134). Course, Hb A1c, Cys C are all the risk factors for DR in type 2 diabetic patients; OR values are 1.214, 95%CI1.152-1.320, P=0.021, 1.521, 1.210, 1.301, 1.284, 1.498, 1.364, 1.25. 8-1.425, P=0.034); 2.310, (95%CI2.091-2.510, P=0.002); 3.211, (95%CI 3.047-3.451, P=0.021). Conclusion: there are many risk factors for retinopathy of type 12 diabetic patients. Hb A1c can reflect the patient's blood glucose control and the severity of DR. It is a risk factor for DR in type 2 diabetes patients. The endogenous markers reflecting the retinopathy of type 2 diabetic patients are an important risk factor for the occurrence of DR; early monitoring of cystatin C and Hb A1c can play a good monitoring role in the development of retinopathy, and provide a monitoring index for the prevention of retinopathy, and the monitoring index.3 HDL is the occurrence of DR in type 2 diabetic patients. Protective factors, age, family history of diabetes, smoking history, SBP, DBP, TG, duration of diabetes, Hb A1c, Cys C were all risk factors for DR in type 2 diabetic patients.

【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R587.2;R774.1

【参考文献】