血清胱抑素C与2型糖尿病视网膜病变的相关性研究

发布时间：2018-04-29 03:17

本文选题：糖尿病视网膜病变 + 胱抑素C　；参考：《西安医学院》2017年硕士论文

【摘要】：研究目的:糖尿病视网膜病变(DR)是最为常见的糖尿病慢性微血管病变之一,早期无明显自觉症状,病变发展到黄斑后开始出现不同程度的视力减退,最终导致不可逆性失明,是成年人中首位致盲性眼病。相较胱抑素C与糖尿病肾病的相关性研究,胱抑素C与2型糖尿病视网膜病变相关性的研究很少。本研究通过病例对照研究2型糖尿病患者中,以视网膜病变作为主要观察指标,探讨血清中胱抑素C含量是否能作为2型糖尿病视网膜病变的危险因素。研究方法:选取2014年9月-2016年1月西安医学院第二附属医院内分泌科室住院并请眼科进行会诊的84名2型糖尿病患者及28名无2型糖尿病无视网膜病变体检结果无明显异常的正常人。仔细询问患者病史及其相关资料,收集患者入院期间血生化检查结果,所有入组病例行眼底照相检查,必要时行眼底血管荧光造影检查,2型糖尿病患者按是否存在视网膜病变分为NDR组(2型糖尿病不伴有视网膜病变患者)DR组(2型糖尿病患者伴视网膜病变患者),按视网膜病变程度将DR组分为NPDR组(2型糖尿病伴非增殖性视网膜病变)PDR组(2型糖尿病伴增殖性视网膜病变)两组,28名体检结果无异常的正常人作为对照组。采用SPSS 18.0软件对所得数据进行统计分析,计量资料用((?)±S)表示,非正太分布的计量资料用中位数(四分位间距)表示,符合正太分布数据多样本间比较用方差分析,不符合正态分布的数据多样本之间用非参数检验,Spearman相关分析研究数据之间的关系,对胱抑素及各变量进行logistic多元逐步回归分析,以P0.05为差异有统计学意义。研究结果:1.对照组、NDR组、NPDR组级PDR组的一般资料及抽血检查结果比较显示:各组的糖化血红蛋白、总胆固醇、甘油三酯、尿素氮、肌酐、胱抑素C、病程的差异均有统计学意义(p0.05)。2.根据四分位法按胱抑素水平高低分组后,高血清胱抑素C水平组糖尿病视网膜病变的患病率明显高于其他三组,差异有统计学意义(p0.05)。3.Spearman相关分析显示:血清胱抑素C水平与糖化血红蛋白、尿素氮及肌酐呈正相关(r=0.223;r=0.335;r=0.502)(p0.05),血清胱抑素水平与总胆固醇、甘油三酯、病程、年龄无相关性。4.Logistic回归分析显示:病程、血清胱抑素及糖化血红蛋白为2型糖尿病视网膜病变的独立危险因素。研究结论:1.高血清胱抑素C水平组糖尿病视网膜病变的患病率明显高于其他三组。2.血清胱抑素C是糖尿病视网膜病变的独立危险因素。
[Abstract]:Objective: diabetic retinopathy (DRR) is one of the most common diabetic chronic microangiopathy. Is the first adult blinding eye disease. The correlation between cystatin C and diabetic nephropathy is less than that between cystatin C and type 2 diabetic retinopathy. The aim of this study was to investigate whether the level of cystatin C in serum was a risk factor for type 2 diabetic retinopathy by using retinopathy as the main observation index in a case-control study. Methods: from September 2014 to January 2016, 84 patients with type 2 diabetes mellitus and 28 patients without type 2 diabetes mellitus without retinopathy who were hospitalized in the Department of Endocrinology, second affiliated Hospital of Xi'an Medical College and asked for ophthalmic consultation were selected. A normal person without obvious abnormalities. Carefully ask the patient's medical history and related data, collect the results of the blood biochemical examination during admission, and all the incoming cases undergo fundus photography. Fundus fluorescein angiography was performed when necessary. According to the presence of retinopathy, patients with type 2 diabetes were divided into two groups: NDR group, type 2 diabetes mellitus without retinopathy group, Dr group, type 2 diabetic patients with retinopathy. According to the degree of retinopathy, Dr group was divided into two groups: type 2 diabetes mellitus with non-proliferative retinopathy (NPDR group) and type 2 diabetes mellitus with proliferative retinopathy (NPDR group). SPSS 18.0 software was used to analyze the data, and the measurement data was expressed by the mean of the median (quartile spacing). The variance analysis was used to compare the data in accordance with the data of the distribution of the positive and too many samples, and the non-positive distribution was expressed as the median (quartile spacing). Non-parametric test was used to study the relationship between multiple samples of non-normal distribution data. The logistic stepwise regression analysis of cystatin and its variables was carried out, and the difference was statistically significant (P0.05). The result of the study was: 1. The general data and blood samples of PDR group in control group were compared. The results showed that there were significant differences in glycosylated hemoglobin, total cholesterol, triglyceride, urea nitrogen, creatinine, cystatin C and course of disease in each group. The prevalence of diabetic retinopathy in the high serum cystatin C group was significantly higher than that in the other three groups. Spearman correlation analysis showed that there was a positive correlation between serum cystatin C level and glycosylated hemoglobin, urea nitrogen and creatinine, serum cystatin level and total cholesterol, triglyceride, course of disease. Logistic regression analysis showed that the course of disease, serum cystatin and glycosylated hemoglobin were independent risk factors for type 2 diabetic retinopathy. Conclusion: 1. The prevalence of diabetic retinopathy in high serum cystatin C group was significantly higher than that in other three groups. Serum cystatin C is an independent risk factor for diabetic retinopathy.
【学位授予单位】：西安医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R587.2;R774.1

【参考文献】