目的 分析血尿酸、胱抑素C和促代謝因子水平與糖尿病視網(wǎng)膜病變的相關(guān)性。方法 選擇河南省直第三人民醫(yī)院2018年5月-2019年5月收治的106例2型糖尿病患者進(jìn)行研究，根據(jù)視網(wǎng)膜病變程度將患者分為無(wú)糖尿病視網(wǎng)膜病變組（NDR，n=35）、非增生型糖尿病視網(wǎng)膜病變組（NPDR，n=40）、增生型糖尿病視網(wǎng)膜病變組（PDR，n=31），同時(shí)選取同期體檢的健康人群為對(duì)照組（n=33）。檢測(cè)各組血尿酸、胱抑素C、促代謝因子水平，分析血尿酸、胱抑素C、促代謝因子水平與糖尿病視網(wǎng)膜病變的相關(guān)性，采用Logistic回歸模型分析影響糖尿病視網(wǎng)膜病變的因素，采用受試者工作特征曲線(xiàn)（ROC）分析血尿酸、胱抑素C、促代謝因子水平對(duì)糖尿病視網(wǎng)膜病變的診斷價(jià)值。結(jié)果 與對(duì)照組患者比較，糖尿病視網(wǎng)膜病變組患者的血尿酸、胱抑素C、促代謝因子水平均明顯升高（P<0.05），NDR、NPDR、PDR組血尿酸、胱抑素C、促代謝因子水平呈依次升高趨勢(shì)（P<0.05）。Pearson相關(guān)性分析顯示，血尿酸、胱抑素C、促代謝因子與糖尿病視網(wǎng)膜病變發(fā)生呈明顯正相關(guān)（r=0.47，P<0.05；r=0.82，P<0.05；r=0.94，P<0.05）。二元Logistic回歸模型分析顯示，剔除血糖、胰島素抵抗等因素的影響，血尿酸、胱抑素C、促代謝因子是影響糖尿病視網(wǎng)膜病變的獨(dú)立危險(xiǎn)因素（P<0.05）。血尿酸、胱抑素C、促代謝因子診斷糖尿病視網(wǎng)膜病變的曲線(xiàn)下面積（AUC）分別為0.746（95% CI：0.656~0.836）、0.871（95% CI：0.783~0.959）、0.884（95% CI：0.803~0.966），三者聯(lián)合診斷AUC為0.964（95% CI：0.935~0.993）明顯高于各指標(biāo)單獨(dú)檢測(cè)。結(jié)論 糖尿病視網(wǎng)膜病變患者血尿酸、胱抑素C、促代謝因子水平異常升高，可能參與了糖尿病視網(wǎng)膜病變發(fā)生、發(fā)展過(guò)程，聯(lián)合檢測(cè)三者水平對(duì)糖尿病視網(wǎng)膜病變有較好的診斷價(jià)值。

Objective To analyze the correlation between levels of serum uric acid (SUA), cystatin C (Cys-C), and betatrophin and diabetic retinopathy (DR). Methods A total of 106 patients with type 2 diabetes mellitus admitted to Third Provincial Hospital of Henan Province from May 2018 to May 2019 were selected for the study. The patients were divided into no DR group (NDR group, n=35), non-proliferative DR group (NPDR group, n=40), and proliferative DR group (PDR group, n=31) according to the degree of retinopathy, and 33 healthy people for physical examination in the hospital at the same period were selected as control group. The levels of SUA, Cys-C, and betatrophin were detected, and the correlation between levels of SUA, Cys-C, and betatrophin and DR was analyzed. Logistic regression model was used to analyze the factors affecting DR. The receiver operating characteristic curve (ROC) was used to analyze the diagnostic value of blood SUA, Cys-C, and betatrophin on DR. Results Compared with control group, SUA, Cys-C, and betatrophin levels in DR group were significantly increased (P<0.05), and the levels of SUA, Cys-C, and betatrophin in NDR group, NPDR group, and PDR group were increased in turn (P<0.05). Pearson correlation analysis showed that SUA, Cys-C, and betatrophin were positively correlated with DR (r=0.47, 0.82, and 0.94, P<0.05). Binary logistic regression model analysis showed that SUA, Cys-C, and betatrophin were independent risk factors for DR (P<0.05). AUC values of SUA, Cys-C, and betatrophin in the diagnosis of DR were 0.746 (95% CI:0.656-0.836), 0.871 (95% CI:0.783-0.959) and 0.884 (95% CI:0.803-0.966), and the AUC of combined diagnosis of the three was 0.964 (95% CI:0.935-0.993), which was significantly higher than that of individual detection (P<0.05). Conclusion The levels of SUA, Cys-C, and betatrophin in patients with DR are abnormally elevated, which may be involved in the occurrence and development of DR. The combined detection of the three levels has a good diagnostic value on DR.

R977