糖尿病视网膜病变相关临床和生物化学指标的监测和预警意义

摘要

Objective To explore the values of different clinical parameters and biochemistry indicators to monitor and predict diabetic retinopathy (DR).Methods The study involved 250 patients with type 2 diabetes mellitua (DM).The patients were divided into DR group (100 patients) with expected sensitivity (Sen) 80％,without DR group (150 patients) with expected specificity (Spe) 60％.DR related clinical and biochemical indicators which including peripheral blood plasma endothelin-1 (ET-1),peripheral vascular endothelial growth factor,plasma magnesium,renal function related indicators,islet function related indicators,blood rheology and blood lipids were detected.Receiver operating characteristic (ROC)was used to analyze accuracy; count the area under a curve (AUC),Sen,Spe and Youden index; develop joint diagnostic testing program.Results The parameters or indicators with clinical value of DR early warning included age,DM duration,plasma ET 1,serum magnesium and urinary albumin (P＜0.05).In the period of mild non-progressive DR,plasma ET-1 had the highest diagnostic validity (AUC=0.742,Spe=72.00％,Sen=72.20％) ; in moderate and severe non-progressive DR period,urinary albumin had the highest diagnosis validity (AUC=0.742,Spe=56.10％,Sen=87.88％) ; in the progressive DR period,the diagnostic validity of plasma ET-1 was highest (AUC =0.857,Spe =84.00 ％,Sen =85.71％).The joint program with the highest Youden index was DM duration combined with plasma ET-1 serial test,and the early warning value was that DM duration exceeded 3.5 years and the tested plasma ET-1 was greater than 160.00 pg/ml.Conclusions Age,DM duration,plasma ET-1,serum magnesium and urinary albumin are the significant parameters or indicators for DR early warning.Joint diagnostic tests can help patients to monitor the progression of DR.%目的 探讨糖尿病视网膜病变(DR)相关临床和生物化学指标在其监测和预警中的意义.方法 研究对象为2型糖尿病(DM)人群.荧光素眼底血管造影(FFA)作为分组金标准:按预期灵敏度(Sen)为80％收集DR病例组100例,预期特异度(Spe)为60％收集无DR对照组150例.检测研究对象DR相关临床及外周血浆内皮素1(ET-1)、血管内皮生长因子、血镁、肾功能相关指标、胰岛功能相关指标、血液流变学指标、血脂等生物化学指标,运用受试者工作特征(ROC)方法进行准确度比较和分析,计算ROC曲线下面积(AUC)、Sen、Spe和约登指数,制定联合诊断试验方案.结果 ROC曲线分析显示,有DR临床预警价值的指标是年龄、DM病程、血浆ET-1、血镁和尿白蛋白(P＜0.05).预管指标诊断准确度分析显示,在轻度非增生型DR时期,血浆ET-1诊断效力最高,AUC=0.742,Spe=72.00％,Sen=72.20％；在中重度非增生型DR时期,尿白蛋白诊断效力最高,AUC=0.742,Spe=56.10％,Sen=87.88％；在增生型DR时期,血浆ET-1诊断效力最高,AUC=0.857,Spe=84.00％,Sen=85.71％.约登指数最高的联合方案是DM病程联合血浆ET-1的序列试验,预警值为DM病程＞3.5年和血浆ET-1＞160.00 pg/ml.结论 DM患者的年龄、病程、血浆ET-1、血镁和尿白蛋白是临床监测和预警DR的有意义指标.综合利用这些指标制定联合诊断试验可以帮助DM患者进行DR病情的监测和风险评估.