目的：探讨影响糖尿病视网膜病变(DR)患者血清脂蛋白相关磷脂酶A2(Lp-PLA2)水平的相关因素。

方法：选取2015-09/2017-09我院内分泌科收治的2型糖尿病患者174例为研究对象，根据眼底检查结果分为无糖尿病视网膜病变(NDR)组、非增生性糖尿病视网膜病变(NPDR)组及增生性糖尿病视网膜病变(PDR)组3组，收集并比较三组患者的年龄、性别、体质量指数(BMI)、血压、血糖、血脂、血管内皮生长因子(VEGF)、C反应蛋白(CRP)及Lp-PLA2水平等临床资料。

结果：三组患者的糖尿病病程、空腹血糖(FPG)、餐后2h血糖(2hPG)、糖化血红蛋白(HbA1c)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、VEGF、CRP、Lp-PLA2比较 ，差异均有统计学意义(P<0.05)； NPDR组患者血清TG、TC、HDL-C及CRP水平与NDR组患者比较，差异均无统计学意义(P>0.05)，而PDR组患者各项生化指标与NDR组患者比较，差异均有统计学意义(P<0.05)； PDR组患者VEGF、CRP、Lp-PLA2均较NPDR组患者显著升高，差异均有统计学意义(P<0.05)。Pearson相关分析发现，血清Lp-PLA2与患者年龄、糖尿病病程、2hPG、TG、VEGF、CRP呈正相关； 回归分析发现，血清Lp-PLA2与糖尿病病程、血清VEGF水平呈显著正相关。

结论：DR患者血清Lp-PLA2水平显著升高，其水平与糖尿病病程、血清VEGF水平呈正相关，可作为DR诊断的参考指标。

METHODS: Totally 174 cases of patients with type 2 diabetes mellitus and who treated in Department of Endocrinology from September 2015 to September 2017 were selected as the research objects, and were divided into the non-diabetic retinopathy group(NDR), non-proliferative diabetic retinopathy group(NPDR)and proliferative diabetic retinopathy group(PDR)according to the results of fundus examination. Then, the age, sex, body mass index(BMI), blood pressure, blood glucose, blood lipids, vascular endothelial growth factor(VEGF), C-reactive protein(CRP), and Lp-PLA2 levels and other clinical data of three groups of patients were collected and compared.

RESULTS: There was significant differences in the duration of diabetes, fasting blood glucose(FBP), 2h postprandial blood glucose(2hBP), HbA1c, triacylglycerol(TG), total cholesterol(TC), high density lipoprotein cholesterol(HDL-C), low density lipoprotein cholesterol(LDL-C), VEGF, CRP, Lp-PLA2 between the three groups of patients(P<0.05). There was no significant difference in serum TG, TC, HDL-C and CRP levels between NPDR group and NDR group(P>0.05). While there was significant difference in biochemical indexes of patients between PDR group and NDR group(P<0.05). The VEGF, CRP and Lp-PLA2 in the PDR group were significantly higher than those in the NPDR group, and the difference was statistically significant(P<0.05). Pearson correlation analysis found that the serum Lp-PLA2 was positively correlated with age, course of disease, 2hBG, TG, VEGF and CRP(P<0.05). Multiple linear regression analysis showed that serum Lp-PLA2 was positively correlated with the course of diabetes mellitus and serum level of VEGF(P<0.05).

CONCLUSION: The level of serum Lp-PLA2 in patients with diabetic retinopathy are significantly increased, which the level is positively correlated with the duration of diabetes and serum VEGF level, thus it can be used as diagnostic index for diabetic retinopathy.