神经元特异性烯醇化酶与糖尿病视网膜病变的相关性研究

发布时间：2018-04-19 22:26

本文选题：糖尿病微血管病变 + 糖尿病视网膜病变　；参考：《扬州大学》2017年硕士论文

【摘要】：背景/目的:糖尿病微血管病变涉及糖尿病周围神经病变(diabetic peripheral neuropathy,DPN)、糖尿病视网膜病变(diabetic retinopathy,DR)和糖尿病肾病(diabetic nephropathy,DN),其中DR与成人非创伤性致盲密切相关,是糖尿病最常见的并发症之一。DR为不可逆转改变,对其进行早发现、早诊断、早治疗极其重要。目前对于DR诊断主要有彩色眼底照相、眼底荧光素血管造影、光相干断层扫描等,尚无有效的早期诊断DR的生物学指标。国内外已有大量研究显示神经元特异性烯醇化酶(neuron-specific enolase,NSE)作为DPN的独立危险因素,可能成为诊断早期DPN的生物学指标。国外也有研究报道NSE水平与糖尿病患者视网膜病变密切相关,但国内尚无此报道。为此,本研究探讨血清NSE水平与DR的相关性,试图为早期临床诊断提供参考依据。方法:选取2015年9月～2016年6月在扬州大学临床医院内分泌科和眼科住院的1型和2型糖尿病患者137例,其中男性87例,女性50例。所有患者均进行彩色眼底照相检查,根据检查结果分为两组:1、糖尿病视网膜病变组(DR组),共110例,其中男性74例,女性36例,平均年龄(55.18± 13.73)岁;2、无糖尿病视网膜病变糖尿病组(NDR组),共27例,其中男性13例,女性14例,平均年龄(56.70± 10.07)岁。分别收集研究对象的基本信息:性别、年龄、病程、体重指数(BMI)、收缩压(SBP)、舒张压(DBP),采集静脉血标本,测定NSE、糖化血红蛋白(HBA1c)、尿微量白蛋白(UMA)、空腹血糖(FBG)、血尿素氮(BUN)、血肌酐(Scr)、甘油三脂(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)指标。所得数据应用SPSS21.0和Medcalc(v15.6)统计软件处理。结果:DR组(n=110例)与NDR组(n=27例)在性别、年龄、病程、BMI、HBA1c、UMA、FBG、BUN、Scr、TG、TC、HDL-C、LDL-C 无显著差异(P0.05)。NDR 组与DR组比较:血清NSE水平显著升高,舒张压水平下降,均有统计学差异(P0.05)。排除性别、年龄、病程、糖代谢指标等混杂因素影响后,二分类Logistic回归分析显示NSE水平仍与DR密切相关(OR=1.248,95%CI:1.070～1.457,P=0.005)。以血清NSE水平区分糖尿病患者是否有DR的Cutoff值是12.31 μmol/L,其诊断灵敏度为69.09%,特异性为59.26%。结论:DR患者NSE水平显著升高,可能是DR的独立预测因子,且可能是DR潜在生物学标志,血清NSE水平检测可作为DR预测、早期诊断的方法之一。
[Abstract]:Background / objective: diabetic microangiopathy is involved in diabetic peripheral neuropathy (peripheral), diabetic retinopathy (peripheral) and diabetic nephropathy (DN), in which Dr is closely related to adult non-traumatic blindness. Dr is one of the most common complications of diabetes. At present, color fundus photography, fundus fluorescein angiography, optical coherence tomography and so on are the main diagnostic methods for Dr. There is no effective biological index for early diagnosis of Dr. A large number of studies have shown that neuron-specific enolase (NSE) as an independent risk factor for DPN may become a biological index for the diagnosis of early DPN. There are also reports that NSE level is closely related to diabetic retinopathy, but there is no such report in China. Therefore, this study was to investigate the correlation between serum NSE level and Dr in order to provide reference for early clinical diagnosis. Methods: 137 patients with type 1 and type 2 diabetes were selected from September 2015 to June 2016 in Department of Endocrinology and Ophthalmology, Yangzhou University Clinical Hospital, including 87 males and 50 females. All the patients were examined by color fundus photography. According to the results of the examination, they were divided into two groups: one group was divided into two groups: the diabetic retinopathy group (Dr group), the Dr group (n = 110), the male group (n = 74) and the female group (n = 36). The mean age was 55.18 卤13.73 years old. There were 27 cases of NDR in diabetic patients without diabetic retinopathy, including 13 males and 14 females, with an average age of 56.70 卤10.07 years. The basic information of the subjects were collected: sex, age, course of disease, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), and venous blood samples. NSE, HbA1cN, UMAG, FBGG, BUNA, creatinine, TGG, TCU, HDL-CU, LDL-C, LDL-C) were measured in patients with high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), triglyceride triglyceride (TGN), triglyceride triglyceride (TGG), serum urea nitrogen (bun), serum creatinine (Cr), triglyceride triglyceride (TGG). The data were processed by SPSS21.0 and Medcalcv15.6. Results compared with Dr group (n = 110) and NDR group (n = 27), there was no significant difference in serum NSE level and diastolic blood pressure (P 0.05). After discounting the influence of sex, age, course of disease, glucose metabolism and other mixed factors, the NSE level was still closely related to Dr by two classification Logistic regression analysis. The Cutoff value of NSE was 12.31 渭 mol / L, the diagnostic sensitivity was 69.09 and the specificity was 59.26. Conclusion the elevated NSE level in patients with 7% Dr may be an independent predictor of Dr and a potential biological marker of Dr. The detection of serum NSE level may be one of the methods for early diagnosis of Dr.
【学位授予单位】：扬州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R587.2;R774.1

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