传统脂质比值和载脂蛋白比值与糖尿病视网膜病变的相关性研究

发布时间：2018-06-06 16:37

本文选题：传统脂质比值 + 载脂蛋白比值　；参考：《广州医科大学》2017年硕士论文

【摘要】：研究背景:近三十多年来,随着我国经济高速发展,人口的老龄化及生活方式的改变,糖尿病(Diabetes mellitus,DM)患病率显著增加,其患病人数远超其他国家而居于首位。DM已成为当前威胁人类健康最重要的非传染性疾病之一,其导致的长期的三大营养物质代谢紊乱可进一步造成心、脑、眼、肾、血管等多系统组织器官进行性功能减退和结构改变,甚至脏器衰竭。其中糖尿病视网膜病变(Diabetic retinopathy,DR)是DM患者眼部损害中最常见又最严重的疾病,也是成年人群中低视力和致盲的主要原因,严重影响着成千上万人的生活质量。DR因其起病隐匿、患病率高和致盲率高的特点而成为人们关注的热点。大量流行病学资料显示糖尿病病程、高血糖、高血压和血脂紊乱是促进DR的发生和发展重要危险因素。早期干预危险因素、早期筛查和及时治疗可以有效减少90%由DR导致的视力残疾。大量研究已经证明脂质代谢紊乱是心血管疾病最重要的危险因素,也是DM患者大血管发生动脉粥样硬化病变主要危险因素,与其发生、发展和预后关系密切。临床常用TC、TG、LDL-C和HDL-C等单项指标预测大血管病变发生风险。研究表明脂质代谢紊乱导致的糖尿病大血管病变和微血管病变在发病机制方面存在一定关联,其中,DR是糖尿病患者最重要的微血管病变。大量临床研究表明脂质代谢紊乱也是DR的重要危险因素,但具体何项脂质指标可以预测DR的发生风险目前研究尚未达成一致结论。研究证明传统血脂比值和载脂蛋白比值为血脂综合指标在预测糖尿病大血管病变(心血管)方面比单项血脂检测更有意义。而传统血脂比值、载脂蛋白比值在预测DR方面的价值,鲜有研究,目前尚未有定论。国外有一项关于TG/HDL比值与2型糖尿病患者DR的研究;国内关于TC/HDL比值和TG/HDL比值分别与2型糖尿病患者DR相关性的研究各有一项。此三项研究均表明TG/HDL、TC/HDL是DR发生的敏感指标。同时,近些年来,国内外有一些研究显示载脂蛋白比值也是预测DR发生、发展的敏感指标。而关于脂蛋白比值和载脂蛋白比值分别与2型糖尿病患者DR的关系对比研究尚未见报道。研究目的:探讨传统脂质比值和载脂蛋白比值在预测2型糖尿病患者中糖尿病视网膜病变的临床价值。研究方法:采用横断面回顾性研究方法,以2015年7月至2017年1月期间收治于广州医科大学附属第三医院内分泌科及眼科病房的2型糖尿病患者为研究对象。根据2014年中华医学会眼科学会眼底病学组糖尿病视网膜病变临床诊疗指南中分期标准将研究对象分为无糖尿病视网膜病变(NDR)、非增殖期糖尿病视网膜病变(NPDR)组和增殖期糖尿病视网膜病变(PDR)组。采用单因素方差分析比较三组传统脂质比值和载脂蛋白比值在三组间的差异,对有统计学差异的各项指标利用多分类Logistic回归分析其与DR的关系。并运用ROC曲线定量分析可预测DR发生、发展的脂质指标,从而进一步探讨脂质异常与2型糖尿病视网膜病变的关系。研究结果:1.所收集261例患者中,NDR组有152例,NPDR组有85例,PDR组有24例。2.NDR组、NPDR组、PDR组三组间的TG、n HDL-C、TC/HDL-C、TG/HDL-C、LDL-C/HDL-C、n HDL-C/HDL-C、apo B、apo B/apo A1的差异均具有统计学意义(P0.05),且其值在NDR、NPDR、PDR依次升高。3.NDR组、NPDR组、PDR三组间HDL-C、apo A1的差异均有统计学意义(P0.05),且其值在NDR、NPDR、PDR三组间依次减小。4.NDR组、NPDR组、PDR三组间LDL-C、TC、脂蛋白a、apo E的差异均无统计学意义(P0.05)。5.NDR组、NPDR组、PDR三组间的糖尿病病程、糖化血红蛋白、空腹血糖值、血肌酐、血尿素氮、高血压病史、吸烟史的差异均有统计学意义(P0.05)。6.NDR组、NPDR组、PDR三组间性别、年龄、饮酒史、臀围比、体重指数、血尿酸、CRP、中性粒细胞计数、淋巴细胞计数的差异均无统计学意义(P0.05)。7.多分类logistic回归分析显示糖尿病病程(B=1.083/1.162)、糖化血红蛋白(OR=1.248/1.506)、apo B/apo A1(OR=3.171/6.098)、TG/HDL-C(OR=1.794/2.695)分别与非增值期视网膜病变和增殖期视网膜呈明显正相关。8.TG/HDL-C与apo B/apo A1的受试者工作特征曲线,结果显示TG/HDL-C的AUC=0.596(95%CI为0.522~0.671,P=0.038),apo B/apo A1的AUC=0.636(95%CI为0.566~0.706,P=0.000);apo B/apo A1比值曲线下面积大于TG/HDL-C。且TG/HDL-C比值预测2型糖尿病视网膜病变的适宜切点为2.195,敏感性为45.1%,特异性为73.4%;apo B/apo A1比值预测2型糖尿病视网膜病变的适宜切点为0.865,敏感性为52.4%,特异性为70.5%;但是对两曲线下面积进行Z检验发现两比值的ROC曲线下面积比较差异无统计学意义(Z=0.774,P0.05),表明两种脂质比值在预测2型糖尿病视网膜病变发生、发展效能上差异无统计学意义。研究结论:1、血糖、脂质、糖尿病病程是糖尿病视网膜病变发生、发展的重要危险因素。2、apo B/apo A1、TG/HDL-C比值较单项脂质更能反映2型糖尿病视网膜病变的发生、进展,是评估DR的一个有效指标。3、apo B/apo A1和TG/HDL-C评估2型糖尿病视网膜病变的效能类似,但apo B/apo A1评估2型糖尿病视网膜病变的敏感性更好。
[Abstract]:Background: over the past thirty years, with the rapid development of China's economy, the aging of population and the change of life style, the prevalence rate of diabetes (Diabetes mellitus, DM) has increased significantly. The number of patients who suffer from the number of patients far beyond other countries and the first.DM has become one of the most important non communicable diseases that threaten human health, which has led to a long period of time. The metabolic disorders of the three major nutrients can further cause the heart, brain, eye, kidney, and blood vessels and other systemic tissues and organs to carry out sexual dysfunction and structural changes, and even organ failure. Among them, diabetic retinopathy (Diabetic retinopathy, DR) is the most common and most serious disease in the eye damage of DM patients, and is also the middle and low visual acuity of adult population. The main cause of blindness has seriously affected the quality of life of thousands of people.DR because of its insidious onset, high prevalence and high incidence of blindness. A large number of epidemiological data show that the course of diabetes, hyperglycemia, hypertension and dyslipidemia are important risk factors for the development and development of DR. Early intervention is dangerous. Risk factors, early screening and timely treatment can effectively reduce visual disability caused by 90% of DR. A large number of studies have shown that lipid metabolic disorders are the most important risk factors for cardiovascular disease, and are also the main risk factors for atherosclerotic lesions in large vessels in DM patients. They are closely related to their occurrence, development and prognosis. Clinical use of TC, T Single indicators such as G, LDL-C and HDL-C predict the risk of large vascular lesions. The study shows that the pathogenesis of diabetic macroangiopathy and microvascular disease caused by lipid metabolic disorders is associated with the pathogenesis of diabetes, among which DR is the most important microvascular lesion in diabetic patients. A large number of clinical studies show that lipid metabolic disorders are also important for DR. Risk factors, but what specific lipid indicators can predict the risk of DR is not a consensus conclusion. Studies have shown that the traditional blood lipid ratio and apolipoprotein ratio are more significant in predicting diabetic macrovascular lesions (cardiovascular) than in single blood lipids. Value in predicting the value of DR is rarely studied. There is no final conclusion. There is a study abroad on the TG/HDL ratio and DR in type 2 diabetic patients; there is a study on the correlation between the ratio of TC/HDL and the TG/HDL ratio with DR in type 2 diabetic patients respectively. These three studies all indicate that TG/HDL, TC/HDL is a sensitive indicator of DR. In recent years, some studies have shown that the ratio of apolipoprotein is also a sensitive index for predicting the occurrence and development of DR. The comparison of the relationship between the ratio of lipoprotein and apolipoprotein with DR in type 2 diabetic patients has not been reported. The clinical value of diabetic retinopathy. Study methods: a cross-sectional retrospective study was used to study type 2 diabetes patients in the Department of Endocrinology and ophthalmology ward of the Third Affiliated Hospital of Guangzhou Medical University from July 2015 to January 2017. According to the ophthalmology of the Ophthalmology Society of the Chinese Medical Association in 2014 The standard of clinical diagnosis and treatment of diabetic retinopathy was divided into non diabetic retinopathy (NDR), non proliferative diabetic retinopathy (NPDR) group and proliferative diabetic retinopathy (PDR) group. The three groups of traditional lipid ratio and apolipoprotein ratio were compared in the three groups by single factor analysis of variance. Differences were made by multiple classification Logistic regression analysis on the relationship with DR. The ROC curve quantitative analysis could be used to predict the incidence of DR and the development of lipid indicators, and the relationship between lipid abnormality and type 2 diabetic retinopathy was further explored. Fruit: among the 261 patients in the 1. group, there were 152 cases in NDR group, NPD There are 85 cases in group R, and in group PDR, there are 24 cases in group.2.NDR, NPDR group, and PDR group of TG, n HDL-C, TC/HDL-C, TG/HDL-C, LDL-C/HDL-C, and their values are all statistically significant. NDR, NPDR, PDR three groups reduced.4.NDR group, NPDR group, PDR three groups of LDL-C, TC, lipoprotein a, apo E were not statistically significant (P0.05) group, three groups of diabetes course, glycosylated hemoglobin, fasting blood glucose, blood creatinine, blood urea nitrogen, hypertension history, smoking history differences were statistically significant The differences in sex, age, drinking history, hip circumference, body mass index, blood uric acid, CRP, neutrophils count, and lymphocyte count were not statistically significant between groups.6.NDR, NPDR and PDR three (P0.05).7. multiple classification logistic regression analysis showed the course of diabetes (B= 1.083/1.162), glycosylated hemoglobin (OR=1.248/1.506), apo B/apo 8), TG/HDL-C (OR=1.794/2.695) showed significant positive correlation with.8.TG/HDL-C and apo B/apo A1 in non value-added retinopathy and proliferating retina, and the results showed that AUC=0.596 of TG/HDL-C (95%CI was 0.522~0.671, P=0.038). The appropriate cutting points were 2.195, the sensitivity was 45.1%, the specificity was 73.4%, and the appropriate point of apo B/apo A1 ratio was 0.865, the sensitivity was 52.4%, and the specificity was 70.5%, but the area under the two curve was two compared with the ratio of apo B/apo A1, but the Z test of the two curve found two ratio. There was no statistically significant difference in the area under the ROC curve of the value (Z=0.774, P0.05). It showed that the two kinds of lipid ratios had no significant difference in predicting the incidence of retinopathy of type 2 diabetic retinopathy. Conclusion: 1, blood sugar, lipid, and diabetes course are the occurrence of retinopathy of diabetic retinopathy, the important risk factor of development,.2, apo B/apo A1, The TG/HDL-C ratio is more likely to reflect the occurrence of type 2 diabetic retinopathy than single lipid. Progress is an effective indicator of DR,.3. Apo B/apo A1 and TG/HDL-C evaluate the efficacy of type 2 diabetic retinopathy, but apo B/apo A1 evaluation of type 2 diabetic retinopathy is more sensitive.
【学位授予单位】：广州医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R587.2;R774.1

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