Background Diabetiretinopathy(DR) icommon ophthalmivasculadisease which can lead to blindness,and itpathogenesiicomplex.C-peptide iby-producin insulin synthesis,and loof studieindicate thaC-peptide iclosely related with diabetimicrovasculacomplications.Objective Thistudy wato explore the clinical significance of the detection of C-peptide to assesthe prognosiof non-proliferative DR(NPDR).Methodretrospective case-observational study wadesigned.The clinical datof 205 casewith NPDwere collected in Wuhan Puren Hospital from January 1,2009 to January 1,2010.The patientwere diagnosed by fundufluorescein angiography (FFA) and the stageof theidiseasewere determined based on the Dstaging developed by the Chinese Ophthalmological Society fundustudy group.Twenty-seven-month follow-up waperformed fothe patientto record the parameterof theiblood biochemistry,changein theiphysical conditions,and changein theiblood pressure and DM.The patientwere assigned to the PDgroup and NPDgroup athe end of the follow-up.The independenrisk factofoNPDwaanalyzed using the univariate analysis,and multivariate logistiregression analysiwaused to evaluate the correlation of varioufactorwith pooprognosiof NPDR.Receiveoperating characteristi(ROC) curve wadrawn to assesthe prediction efficiency of C-peptide fothe prognosiof NPDR.ResultThe clinical datof 205 patientwith NPDwere reviewed,and 15 patientfailed to show up fovisitarate of 7.3％.One hundred and ninety patientwith NPDfinished follow-up with mean age of (41.54± 8.15)years.Of the 190 patients,69 patient(36.3％) advanced to PDR,and 121 patient(63.7％) were NPDduring the follow-up.Significandifferencewere seen in age,hypertension history,smoking history,DM course and C-peptide levelbetween the PDgroup and PDgroup (age:=13.78,P＜0.05 ; hypertension history:x2 =21.57,P＜0.05 ;smocking history:x2 =26.96,P＜0.05;DM course:t=6.89,P＜0.05;C-peptide:t=20.50,P＜0.05).pooprognosiwacorrelated with age (OR:1.04,95％ CI:1.01-1.07),hypertension history (OR:1.05,95％ CI:1.02-1.08),smokinghistory (OR:1.07,95％CI:1.04-1.11),DM course (0R:1.18,95％CI:1.13-1.25) oC-peptide conten(0R:1.09,95％ CI:1.06-1.12).The areundethe ROcurve wa0.835 (P＜0.05,95％ CI:0.818-0.843) when the C-peptide waincluded,buwalarge than 0.769 (P ＜ 0.05,95％ CI:0.754-0.780) when Cpeptide waexcluded.ConclusionThe levelof blood C-peptide are lowein the PDpatientthan those in the NPDpatients,and the lowelevel of blood C-peptide in the NPDpopulation increasetheirisk of developing PDR.Testing foblood C-peptide level can benefithe prognosiof NPDR.%背景 糖尿病视网膜病变(DR)是眼科常见的可致盲性血管性疾病,其发病机制复杂.C肽是胰岛素合成过程中的裂解产物,有研究指出其与糖尿病微血管并发症的发生关系密切. 目的 探讨利用血清C肽水平变化指标评估非增生型DR(NPDR)患者预后的临床意义.方法 回顾性分析2009年1月1日至2010年1月1日在武汉市普仁医院眼科经荧光素眼底血管造影(FFA)确诊并按照中华医学会眼科学分会眼底病学组制定的DR分期标准分为NPDR的205例患者资料,患者均进行27个月的门诊随访,随访末期根据患者预后分为未发展为增生期者(NPDR组)和随访末期发展为增生期者(PDR组),通过组间单因素比较法评估患者血液生化指标检测结果的变化、体质量指数(BMI)、血压和糖尿病病程、血清C肽质量浓度与NPDR发展为PDR的独立危险因素,将独立危险因素纳入多因素Logistic回归分析评价各因素与患者不良预后的相关性,绘制受试者工作特征(ROC)曲线,检验血清C肽质量浓度对DR预后的预测效能.结果 共调查205例NPDR患者的临床资料,资料中显示失访者15例,失访率为7.3％.共纳入随访资料完整者190例,平均年龄为(41.54±8.15)岁,随访末期PDR组69例,占36.3％,NPDR组121例,占63.7％,两组间患者年龄、有无高血压病史、有无吸烟史、糖尿病病程、血清C肽质量浓度等差异均有统计学意义(年龄:t=13.78,P＜0.05；高血压病史:x2=21.57,P＜0.05;吸烟史:x2=26.96,P＜0.05；糖尿病病程:t=6.89,P＜0.05;血清C肽质量浓度:t=20.50,P＜0.05).Logistic回归分析结果显示,年龄(OR:1.04,95％ CI:1.01～1.07)、高血压病史(OR:1.05,95％ CI:1.02～1.08)、吸烟史(OR:1.07,95％ CI:1.04 ～1.11)、糖尿病病程(OR:1.18,95％ CI:1.13～1.25)、血清C肽质量浓度(OR:1.09,95％ CI:1.06 ～ 1.12)与患者预后不良均有显著相关性,ROC曲线下面积(AUC)为0.835(P＜0.05,95％ CI:0.818 ～0.843),与未纳入C肽质量浓度因素时AUC的0.769(P＜0.05,95％ CI:0.754 ～0.780)相比明显增加. 结论 PDR患者血清中的C肽水平低于NPDR患者,C肽水平的降低增加了NPDR进展为PDR的风险,C肽水平的检测可增强NPDR患者预后的评估强度.
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