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血清脂蛋白比值与糖尿病黄斑水肿发生及严重程度的相关性分析

王真艳  陈晓莉  李雪瑶  周绍英  宋永继  陈为民   

  1. 401120重庆市渝北区人民医院眼科
  • 收稿日期:2018-08-06 出版日期:2019-11-25 发布日期:2019-12-06
  • 通讯作者: 王真艳,Email:19097071@qq.com E-mail:19097071@qq.com
  • 基金资助:

    重庆市卫生计生委医学科研项目(2015MSXM156)

Correlation between serum lipoprotein ratio and diabetic macular edema

WANG Zhen-yan, CHEN Xiao-li, LI Xue-yao, ZHOU Shao-ying, SONG Yong-ji, CHEN Wei-min   

  1. Department of Ophthalmology, Yubei District People's Hospital, Chongqing 401120, China
  • Received:2018-08-06 Online:2019-11-25 Published:2019-12-06
  • Contact: WANG Zhen-yan, Email: 19097071@qq.com E-mail:19097071@qq.com

摘要:

目的 探讨血清脂蛋白比值(ApoB/ApoA-1)与糖尿病黄斑水肿(diabetic macular edema,DME)的发生及进展关系。设计 回顾性病例系列。研究对象 2016年3月至2018年3月重庆渝北区医院眼科和内科住院的糖尿病视网膜病变(diabetic retinopathy,DR)患者279例,其中DME患者82例。方法 对279例DR住院患者进行眼底检查和黄斑相干光断层扫描(optic coherence tomography,OCT),发现DME患者82例设为病例组(DME组), 其余197例设为阳性对照组(非DME组),并设立健康对照组80例。82例DME患者再根据黄斑水肿程度,分为轻度(Ⅰ组)、中度(Ⅱ组)和重度组(Ⅲ组)。收集研究对象的身高、体重、糖化血红蛋白,及ApoB和ApoA-1等血脂指标,并计算体质指数、ApoB/ApoA-1比值。比较各组相关指标的差异。主要指标 体质指数,糖化血红蛋白浓度,ApoB/ApoA-1比值和黄斑水肿分级。结果 DME组、非DME组及健康对照组的体质指数、糖化血红蛋白、ApoB/ApoA-1比值的差异均有统计学意义(P均<0.001);轻、中、重度DME患者的ApoB/ApoA-1比值分别为1.01±0.07、1.18±0.04和1.32±0.08(F=142.04,P<0.001)。偏相关性分析排除混杂因素影响后,DME的严重程度与ApoB/ApoA-1比值成正相关(r=0.725 ,P<0.001)。结论 血清脂蛋白比值增高是DME病情发生及进展的高危因素,合理控制血脂可能有利于降低DME的发病风险,ApoB/ApoA-1比值可以作为DME预测及治疗过程中的重要监控指标。

关键词: 血清脂蛋白比, 糖尿病视网膜病变, 黄斑水肿

Abstract:

Objective To study the relationship between serum lipoprotein ratios(ApoB/ApoA-1) and diabetic macular edema (DME). Design Retrospective case series. Participants 279 patients with diabetic retinopathy (DR) hospitalized in Department of Ophthalmology and Internal Medicine from March 2016 to March 2018. Methods Fundus examination and macular optic coherence tomography(OCT) scan were carried out for 279 inpatients, 82 cases of DME were found to be case group (group DME), the remaining 197 cases were control group (non DME group),and 80 healthy controls were also set up. According to the degree of macular edema, 82 patients in the case group were divided into mild group (group I), moderate group (group II) and severe group (Group III). The height, weight, glycosylated hemoglobin and ApoB, ApoA-1 were measured in all patients, and the body mass index (BMI), ApoB/ApoA-1 ratio were calculated, and the data were compared in different groups. Main Outcome Measures BMI glycosylated hemoglobin concentration, ApoB/ApoA-1 ratio and macular edema classification. Results The differences of BMI, HbAIc, ApoB/Apoa-1 ratio among DME group, non DME group and healthy control group were statistically significant(all P<0.001). The ratio of apoB / apoa-1 in patients with mild, moderate and severe macular edema was 1.01±0.07, 1.18±0.04, and 1.32±0.08, respectively (F=142.04, P<0.001). It was found that the severity of DME was positively correlated with the ratio of ApoB/Apoa-1 (r=0.725, P<0.001), after eliminating the influence of confounding factors by partial correlation analysis. Conclusion The increased serum lipoprotein ratio is a high risk factor for DME. Reasonable control of blood lipids and their components may help reduce the risk of DME. ApoB/ApoA-1 ratio can be used as an important monitoring index in the prediction and treatment of DME.

Key words: serum lipoprotein ratio, diabetic retinopathy, macular edema