目的：探究血清甘油三酯-葡萄糖(TyG)指数、摄食抑制因子-1(nesfatin-1)、视黄醇结合蛋白4(RBP4)联合预测糖尿病视网膜病变(DR)的价值，为DR早期预测提供支持。
方法：回顾性分析。收集2022-02/2023-12我院接诊的2型糖尿病(T2DM)患者164例的临床资料，按照眼底检查结果分为DR组43例(其中增殖性DR 19例，非增殖性DR 24例)，不合并DR的T2DM组121例。入院后记录患者基本资料，检查血清TyG指数、nesfatin-1、RBP4水平。
结果：DR组病程长于T2DM组，空腹血糖、糖化血红蛋白、甘油三酯、总胆固醇、低密度脂蛋白及TyG指数、RBP4水平高于T2DM组，高密度脂蛋白、nesfatin-1水平低于T2DM组(均P<0.001)。多因素Logistic回归分析可知，T2DM病程(OR=1.338，95%CI：1.059-1.690)、糖化血红蛋白(OR=5.065，95%CI：1.659-15.470)、低密度脂蛋白(OR=12.715，95%CI：2.385-67.790)、TyG指数(OR=23.057，95%CI：2.936-181.073)、RBP4(OR=1.319，95%CI：1.028-1.692)是T2DM患者发生DR的危险因素，nesfatin-1(OR=0.007，95%CI：0.003-0.016)为保护因素。绘制ROC曲线显示，TyG指数、nesfatin-1、RBP4均对T2DM患者并发DR具有一定预测价值，曲线下面积(areas under curve，AUC)分别为0.804、0.878、0.738，各指标联合预测时AUC为0.946，预测敏感度为83.72%、特异度为92.56%。增殖性DR患者TyG指数、RBP4水平高于非增殖性DR患者，nesfatin-1水平低于非增殖性DR患者(均P<0.05)。Spearman相关性分析显示，TyG指数、RBP4水平与DR病情程度呈正相关，nesfatin-1水平与DR病情程度呈负相关(rs=0.557、0.392、-0.359，均P<0.05)。Pearson相关分析显示，T2DM并发DR患者TyG指数与nesfatin-1水平呈负相关，与RBP4水平呈正相关，nesfatin-1与RBP4水平呈负相关(r=-0.486、0.538、-0.592，均P<0.05)。
结论：血清TyG指数、nesfatin-1、RBP4水平与DR发病风险及病情程度有关，可作为DR早期预测的标志物，且联合预测效能更好。
AIM: To explore the predictive value of the combination of triglyceride-glucose(TyG)index, nesfatin-1, and retinol-binding protein 4(RBP4)for diabetic retinopathy, and provide evidence for early prediction of DR.
METHODS: The clinical data of 164 patients with type 2 diabetes mellitus(T2DM)who admitted to the hospital between February 2022 and December 2023 were retrospectively collected. Based on the fundus examination results, these patients were divided into two groups: the DR group(n=43), including proliferative DR(PDR, n=19)and non-proliferative DR(NPDR, n=24), and the T2DM without DR group(n=121). The TyG index and the level of nesfatin-1 and RBP4 were measured after admission.
RESULTS:T2DM patients with DR had a longer disease duration compared with T2DM patients without DR, and the DR group had higher fasting blood glucose, glycosylated hemoglobin, triglyceride, total cholesterol, low-density lipoprotein, TyG index, and RBP4 levels, while lower high-density lipoprotein and nesfatin-1 levels(all P<0.001). Multivariate Logistic regression analysis indicated that the duration of T2DM(OR=1.338, 95%CI: 1.059-1.690), glycosylated hemoglobin(OR=5.065, 95%CI: 1.659-15.470), low density lipoprotein(OR=12.715, 95%CI: 2.385-67.790), TyG index(OR=23.057, 95%CI: 2.936-181.073)and RBP4(OR=1.319, 95%CI: 1.028-1.692)were the independent risk factors for DR, while nesfatin-1(OR=0.007, 95%CI: 0.003-0.016)was an independent protective factor for DR. The ROC curves were drawn, and the results indicated that the TyG index, nesfatin-1, and RBP4 had certain predictive values for DR patients with T2DM, with areas under curve(AUC)of 0.804, 0.878 and 0.738, respectively. The combined AUC of the TyG index, nesfatin-1, and RBP4 was 0.946, sensitivity was 83.72%, and specificity was 92.56%. Patients with PDR had a higher TyG index, higher RBP4 level, and lower nesfatin-1 level than patients with NPDR(all P<0.05). Spearman's correlations indicated a positive association between the TyG index, RBP4 and DR degree, and a negative association between nesfatin-1 and DR degree(rs=0.557, 0.392, -0.359, repectively, all P<0.05). Pearson correlation analysis indicated a negative correlation between the TyG index and the levels of nesfatin-1, a positive correlation between the TyG index and the levels of RBP4, and a negative correlation between the levels of nesfatin-1 and RBP4 in DR patients with T2DM(r=-0.486, 0.538, -0.592, all P<0.05).
CONCLUSION: The serum of TyG index and the levels of nesfatin-1 and RBP4 were early predictive markers for DR and were associated with the risk of the occurrence and severity of the disease. Besides, the combined prediction performance of TyG index, nesfatin-1, and RBP4 was better for DR.
