血液同型半胱氨酸和糖化血红蛋白水平在糖尿病视网膜病变中的意义

摘要

目的 探讨血清同型半胱氨酸(Hcy)、糖化血红蛋白(HbA1c)在糖尿病视网膜病变患者中的变化及临床意义.方法 病例对照研究.选取从2013年3月至2015年2月在北京积水潭医院就诊的2型糖尿病患者168例作为研究对象,将其分为2组:76例糖尿病有视网膜病变患者(DR组),男32例,女44例,年龄(62.97±12.46)岁;92例糖尿病无视网膜病变患者(NDR组),男46例,女46例,年龄(58.14±13.71)岁.65名同期健康体检者为正常对照组,男34名,女31名,年龄(60.24±10.85)岁.采用循环酶法检测Hcy,离子高效液相色谱法检测HbA1c.多组间比较采用多个独立样本非参数检验;DR组和NDR组患者血液中Hcy和HbA1c的浓度进行ROC曲线分析.结果 健康对照组、NDR组和DR组的Hcy水平分别为7.00(4.55 ～ 10.50) μmol/L、12.45(10.30～15.10)μmol/L、20.10(16.63～25.68)μmol/L;HbA1c的水平分别为5.30(5.00 ～ 5.70)％、6.80 (5.83～8.03)％、7.25(6.50 ～8.60)％,随着糖尿病视网膜病变的产生,Hcy和HbA1c的水平逐渐升高,组间差异均有统计学意义(P＜0.01),且糖尿病视网膜病变组Hcy和HbA1c的水平明显高于无视网膜病变组;血清Hcy诊断DR的受试者工作特征(ROC)曲线下面积为0.8729,取诊断界限值为14.35 μmol/L,敏感度为96.05％,特异度为68.48％;HbA1c的ROC曲线下面积为0.638,取诊断界限值为6.05％,敏感度为98.68％,特异度为31.25％.结论 高Hcy血症及高HbA1c,对于判别糖尿病视网膜病变,两者具有相似的敏感度,Hcy的诊断特异度更高.%Objective To investigate the clinical significance of homocysteine(Hcy) and glycated hemoglobin (HbA1c) in patients with diabetic retinopathy.Methods From March 2013 to February 2015,a total of 168 patients with diabetes from Beijing Jishuitern Hospital were divided into diabetic retinopathy group (76 cases,32 male,44 female,average age 62.97 ± 12.46) and non-diabetic retinopathy group (92 cases,46male,46 female,average age 58.14 ± 13.71),and 65 cases of healthy subjects (46male,46 female,average age 60.24 ± 10.85) were enrolled as normal control group as well.Hcy and HbA1c were detected in all groups.Multiple independent samples nonparametric tests were used to compare the difference between groups.The concentrations of Hcy and HbA1c between DR group and NDR group were analysised by ROC curve analysis.Result The Hcy levels in normal control group,NDR group and DR group were 7.00 (4.55-10.50) μmol/L,12.45 (10.30-15.10) μmol/L,20.10 (16.63-25.68) μmol/L respectively.The HbA1c levels in normal control group,NDR group and DR group were 5.30 (5.00-5.70) ％,6.80 (5.83-8.03) ％,7.25 (6.50-8.60) ％ respectively.There was no significant difference in Hay and HbA1c levels between groups (P ＜ 0.01);Compared with non-diabetic retinopathy group,levels of Hcy,HbA1c in diabetic retinopathy group were obviously higher;The optimal diagnostic cut-off values of Hcy was 14.35 μmol/L,at this cut-off value,the sensitivity was 96.05％,specificity was 68.48％;The optimal diagnostic cut-off values of HbA1c was 6.05％,at this cut-off value,the sensitivity was 98.68％,specificity was31.25％.Conclusion Patients with Diabetic retinopathy might have hyperhomocystinemia,and detection of Hcy may contribute to the early diagnosis of diabetic retinopathy.