目的：探讨血清尿酸(SUA)、胱抑素C(CysC)水平与糖尿病视网膜病变(DR)的关系。

方法：前瞻性研究。选取2019-05/2021-05本院收治无DR的2型糖尿病(T2DM)患者53例和DR患者83例，DR患者中包括非增殖型糖尿病视网膜病变(NPDR)47例、增殖型糖尿病视网膜病变(PDR)36例。另选取同期体检中心体检健康者48人作为对照组。比较受试者血清学指标，尿酸氧化酶法检测SUA水平，免疫比浊法检测血清CysC含量，Spearman相关性分析血清SUA、CysC与其他血清学指标的相关性，多因素线性逐步回归法分析血清SUA、CysC的影响因素，使用受试者工作特征曲线(ROC)分析血清SUA、CysC对DR预测效能。

结果：T2DM组、NPDR组和PDR组的体质量指数(BMI)、收缩压(SBP)均明显高于对照组(均P<0.05)，PDR组的SBP均明显高于T2DM组和NPDR组(均P<0.05)，NPDR组和PDR组糖尿病病程均明显高于T2DM组(均P<0.05)，PDR组糖尿病病程明显高于NPDR组(P<0.05)。对照组、T2DM组、NPDR组、PDR组纳入对象中空腹血糖(FPG)、糖化血红蛋白(HbA1c)、SUA、CysC水平呈逐渐明显升高趋势(均P<0.001)，PDR组的低密度脂蛋白胆固醇(LDL-C)、甘油三酯(TG)水平明显高于对照组(均P<0.05)，而高密度脂蛋白胆固醇(HDL-C)水平明显低于对照组(P<0.05)。血清SUA水平与FPG、HbA1c、TC、TG水平呈正相关(r_s=0.564、0.631、0.513、0.408，P<0.001)，与HDL-C、LDL-C无相关性(r_s=-0.061、0.035，P>0.05)； 血清 CysC水平与FPG、HbA1c、TC、TG水平呈正相关(r_s=0.524、0.692、0.395、0.435，P<0.001)，与HDL-C、LDL-C无相关性(r_s=-0.012、0.049，P>0.05)，FPG、HbA1c、TC、TG是血清SUA、CysC水平影响因素(P<0.001)。SUA、CysC联合检测时曲线下面积(AUC)(0.892，95%CI：0.840～0.944，敏感性71.1%，特异性94.3%)显著高于其单独检测AUC\〖SUA(0.807，95%CI：0.735～0.879，敏感性69.9%，特异性75.5%)、CysC(0.763，95%CI：0.684～0.841，敏感性69.9%，特异性75.5%)\〗(均P<0.05)。

结论：随着DR病情严重程度加重而血清SUA、CysC水平逐渐升高。血清SUA、CysC联合检测可提高DR诊断预测效能。

METHODS: A prospective study.A total of 53 non-DR patients with type 2 diabetes mellitus(T2DM; T2DM group)and 83 patients with DR admitted to the hospital between May 2019 and May 2021 were enrolled. In DR patients, there were 47 cases with non-proliferative diabetic retinopathy(NPDR)in NPDR group and 36 cases with proliferative diabetic retinopathy(PDR)in PDR group. A total of 48 healthy people in physical examination center during the same period were enrolled as control group. The serological indexes of all subjects were compared. SUA level was detected by urate oxidase method. The level of serum CysC was detected by immunoturbidimetry. The correlation between serum SUA, CysC and the other serological indexes was analyzed by Spearman. The influencing factors of serum SUA and CysC were analyzed by multivariate linear stepwise regression method. The predictive efficiency of serum SUA and CysC for DR was analyzed by receiver operating characteristic(ROC)curves.

RESULTS: The body mass index(BMI)and systolic blood pressure(SBP)in T2DM, NPDR and PDR group were significantly higher than those in control group(all P<0.05). SBP in PDR group was significantly higher than that in T2DM and NPDR group(all P<0.05). The course of diabetes mellitus in NPDR and PDR group was significantly longer than that in T2DM group(all P<0.05), and it was significantly higher in PDR group than in NPDR group(P<0.05). The levels of fasting plasma glucose(FPG), hemoglobin Alc(HbA1c), SUA and CysC in control group, T2DM group, NPDR group and PDR group were gradually increased(all P<0.001). The levels of low-density lipoprotein cholesterol(LDL-C)and triglyceride(TG)in PDR group were significantly higher than those in control group(all P<0.05), while level of high-density lipoprotein cholesterol(HDL-C)was significantly lower than that in control group(P<0.05). The levels of serum SUA were positively correlated with FPG, HbA1c, total cholesterol(TC)and TG levels(r_s=0.564, 0.631, 0.513, 0.408, P<0.001), but they were not correlated with HDL-C or LDL-C(r_s=-0.061, 0.035, P>0.05). The levels of serum CysC were positively correlated with FPG, HbA1c, TC and TG levels(r_s=0.524, 0.692, 0.395, 0.435, P<0.001), but they were not correlated with HDL-C or LDL-C(r_s=-0.012, 0.049, P>0.05). FPG, HbA1c, TC and TG were influencing factors of serum SUA and CysC levels(P<0.001). The area under the curve(AUC)in the combined detection of SUA and CysC(0.892, 95%CI: 0.840-0.944, sensitivity:71.1%, specificity: 94.3%), was significantly greater than that of AUC \〖SUA(0.807, 95%CI: 0.735-0.879, sensitivity: 69.9%, specificity: 75.5%)and CysC(0.763, 95%CI: 0.684-0.841, sensitivity: 69.9%, specificity: 75.5%)\〗 alone(all P<0.05).

CONCLUSION: The levels of serum SUA and CysC gradually increase with the aggravation of DR. The combined detection of serum SUA and CysC can improve the diagnostic and predictive efficiency for DR.