2型糖尿病视网膜病变患者血清和肽素、脂质运载蛋白2水平的表达及其临床意义

摘要 目的：探讨2型糖尿病（T2DM）视网膜病变（DR）患者血清和肽素（copeptin）、脂质运载蛋白2（LCN2）的表达及其临床意义。方法：选取2021年1月~2023年1月期间江南大学附属医院接收的2型糖尿病（T2DM）患者141例，将所有患者分为不合并糖尿病视网膜病变（DR）组（NDR组，n=49）、非增生期DR组（NPDR组，n=45）和增生期DR组（PDR组，n=47），另选取同期行健康体检的志愿者50例作为对照组。比较各组临床指标、生化指标及血清copeptin、LCN2水平，采用Pearson相关性分析血清copeptin、LCN2水平与临床指标及生化指标的相关性，采用多因素Logistic回归分析DR的危险因素。结果：对照组、NDR组、NPDR组、PDR组的血清copeptin、LCN2水平呈逐渐升高趋势（P<0.05）。NDR组、NPDR组、PDR组的体重指数（BMI）、收缩压（SBP）、舒张压（DBP）、甘油三酯（TG）、总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）、空腹血糖（FPG）均高于对照组（P<0.05）；对照组、NDR组、NPDR组、PDR组的糖化血红蛋白（HbAlc）、胰岛素抵抗指数（HOMA-IR）呈逐渐升高趋势（P<0.05）；NDR组、NPDR组、PDR组糖尿病病程呈逐渐递增趋势（P<0.05）。Pearson相关性分析显示，copeptin、LCN2水平与HbAlc、HOMA-IR、糖尿病病程呈正相关（P<0.05），与血压、血脂、FPG、BMI无明显相关性（P>0.05）。多因素Logistic回归分析结果显示：糖尿病病程、HbAlc、HOMA-IR、copeptin、LCN2均为DR发生发展的独立危险因素（P<0.05）。结论：高水平copeptin、LCN2可能与DR的发生、发展有关，且与患者糖尿病病程、HbAlc、HOMA-IR关系密切，可用于DR患者的早期诊断及判断其病情的严重程度。

Expression and Clinical Significance of Serum Copeptin and Lipocalin-2 Levels in Patients with Type 2 Diabetic Retinopathy

ABSTRACT Objective: To investigate the expression and clinical significance of serum copeptin and lipocalin-2 (LCN2) in patients with type 2 diabetic retinopathy. Methods: A total of 141 patients with type 2 diabetes mellitus (T2DM) admitted to the Affiliated Hospital of Jiangnan University from January 2021 to January 2023 were selected. All patients were divided into non-diabetic retinopathy (DR) group (NDR group, n=49), non-proliferative DR group (NPDR group, n=45) and proliferative DR group (PDR group, n=47). In addition, 50 volunteers who came for physical examination during the same period were selected as the control group. The clinical indicators, biochemical indicators and serum copeptin and LCN2 levels were compared among the groups. Pearson correlation was used to analyze the correlation between serum copeptin and LCN2 levels and clinical indicators and biochemical indicators. Multivariate Logistic regression was used to analyze the risk factors of DR. Results: The levels of serum copeptin and LCN2 in the control group, NDR group, NPDR group and PDR group showed a gradually increasing trend (P<0.05). The body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), triglyceride (TG), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C) and fasting blood glucose (FPG) in the NDR group, NPDR group and PDR group were higher than those in the control group(P<0.05). The glycosylated hemoglobin (HbAlc) and insulin resistance index (HOMA-IR) in the control group, NDR group, NPDR group and PDR group showed a gradually increasing trend(P<0.05). The course of diabetes in NDR group, NPDR group and PDR group showed a gradually increasing trend(P<0.05). Pearson correlation analysis showed that copeptin and LCN2 levels were positively correlated with HbAlc, HOMA-IR and course of diabete(P<0.05), but not with blood pressure, blood lipid, FPG and BMI(P>0.05). Multivariate Logistic regression analysis showed that the course of diabetes, HbAlc, HOMA-IR, copeptin and LCN2 were independent risk factors for the occurrence and development of DR(P<0.05). Conclusion: High levels of copeptin and LCN2 may be related to the occurrence and development of DR, and are closely related to the course of diabetes, HbAlc and HOMA-IR, which can be used for early diagnosis of DR patients and judging the severity of their condition.