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目的探讨血清中期因子(MK)、总胆红素(TB)在糖尿病视网膜病变(DR)中的诊断价值。方法将148例T2DM患者按照是否出现DR分为糖尿病无DR组(NDR)50例、非增殖性DR组(NPDR)52例和增殖性DR组(PDR)46例,评价MK和TB在DR中的诊断价值。结果各组年龄、性别、BMI、FPG、HbA_1c、TG、TC、LDL-C、HDL-C、SBP、DBP比较,差异无统计学意义(P>0.05);各组病程、尿白蛋白/肌酐比(UAlb/Cr)、超氧化物歧化酶(SOD)、丙二醛(MDA)、晚期氧化蛋白产物(AOPP)、MK、TB和直接胆红素(DB)比较,差异有统计学意义(P<0.05)。PDR组和NPDR组病程、UAlb/Cr、MDA、AOPP、MK高于NDR组(P<0.05),SOD、TB、DB低于NDR组(P<0.05)。PDR组病程、UAlb/Cr、MDA、AOPP、MK高于NPDR组(P<0.05),SOD、TB、DB低于NPDR组(P<0.05)。Logistic回归分析显示,病程、UAlb/Cr、MDA、AOPP、MK为DR的危险因素(OR值为1.36、1.71、1.27、1.65、2.35,P<0.05),SOD、TB、DB为DR的保护因素(OR值为0.46、0.31、0.46,P<0.05)。TB+MK诊断的敏感性、特异性、阳性预测值、阴性预测值、诊断准确率均高于TB、MK单独诊断效果[曲线下面积(AUC)分别为0.918、0.735、0.762,P<0.05]。结论 DR可能与体内MK升高、TB下降有关,MK联合TB对DR的诊断效能优于MK、TB单一指标。
Objective To investigate the diagnostic value of serum midkine (MK) and total bilirubin (TB) in diabetic retinopathy (DR). Methods According to the presence or absence of DR, 148 patients with T2DM were divided into 50 cases of diabetes without DR group (nDR), 52 cases of nonproliferative DR group (NPDR) and 46 cases of proliferative DR group (PDR) The diagnostic value. Results There was no significant difference in age, sex, BMI, FPG, HbA 1c, TG, TC, LDL-C, HDL-C, SBP and DBP The difference was statistically significant compared with UAlb / Cr, SOD, MDA, AOPP, MK, TB and direct bilirubin (DB) P <0.05). The course of disease, UAb / Cr, MDA, AOPP and MK of PDR group and NPDR group were higher than those of NDR group (P <0.05), while SOD, TB and DB were lower than NDR group (P <0.05). The duration of PDR group was higher than that of NPDR group (P <0.05), SOD, TB and DB were lower than that of NPDR group (P <0.05). Logistic regression analysis showed that the duration of disease, UAb / Cr, MDA, AOPP and MK were the risk factors of DR (OR = 1.36,1.71,1.27,1.65,2.35, P <0.05) (OR 0.46, 0.31, 0.46, P <0.05). The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of TB + MK diagnosis were higher than those of TB and MK alone (the area under the curve (AUC) were 0.918,0.735,0.762, P <0.05] . Conclusions DR may be related to the increase of MK and the decrease of TB in vivo. The diagnostic efficacy of MK combined with TB for DR is better than that of MK and TB.